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Clin Med III Exam I > Disorders of Esophagus and Stomach > Flashcards

Disorders of Esophagus and Stomach Flashcards

1
Q

Which esophageal spinchter is voluntary?

A

UES b/c it is striated muscle

LES is smooth muscle–>involuntary

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2
Q

Four regions of the stomach

A

cardia, fundus, body, antrum

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3
Q

PUD is an imbalance between what

A

aggressive factors and defense mechanisms (H pylori, NSAIDs, ETOH)

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4
Q

Signs of a gastric ulcer

A

pain shortly after or during eating

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5
Q

Signs of a duodenal ulcer

A

pain hours after eating

pain wakes patient up at night

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6
Q

Presentation of PUD

A
  • epigastric pain (gnawing/burning)
  • dyspepsia
  • chest pain/heart burn
  • hematemesis, coffee ground emesis, melena, hematochezia
  • sx’s of anemia
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7
Q

Difference of an ulcer vs erosion

A

ulcers go into muscularis, erosions are more superficial

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8
Q

Whats the number 1 thing you should think of with PUD

A

H pylori

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9
Q

Risk factors for PUD

A
  • alcohol
  • H pylori
  • NSAIDs
  • caffeine
  • smoking/tobacco
  • physiological stress
  • genetics
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10
Q

What would a sudden onset of pain suggest in PUD

A

perforation or peritonitis

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11
Q

Exam findings in PUD

A
  • abd tenderness
  • GUAIAC +
  • gastric outlet obstruction w/ chronic duodenal ulcer
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12
Q

What is the work up for PUD

A
  • H pylori testing (urea breath test)
  • endoscopy
  • fasting gastrin level
  • CXR
  • upper GI contrast study
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13
Q

Gold standard for PUD diagnosis

A

endoscopy

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14
Q

What will an endoscopy show if pt has PUD

A

discrete mucosal lesion w/ punched out smooth ulcer base

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15
Q

When would you do a CXR in patietns with PUD

A

if they look sick, looking for perforation or pneumomediastinum

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16
Q

Treatment for PUD in a stable patient

A
  • endoscopy- epi injection, hemoclips, thermal coagulation
  • PPI

if H pylori tx w/ tripple therapy

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17
Q

What is the triple therapy for H pylori

A

PPI and Clarithro and amox or flagyl

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18
Q

Treatment for PUD in an unstable patient

A
  • ABCs
  • IVF resucitation
  • PPI infusion
  • NGT
  • GI consult
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19
Q

When would you consult surgery for a patient with PUD

A

of perforation present or failed EGD for hemostasis

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20
Q

What is a dysmotility disorder

A

dysfunction of coordianted peristalsis/motility pattern of the esophagus

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21
Q

Achalasia

A

obstruction and proximal dilation of esophagus w/ food bolus stasis due to loss of ganglion cells from esophagus wall causing LES to fail to completely relax

(failure to relax)

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22
Q

Diffuse esophageal spasm

A

functional imbalance between excitaroy and inhibitory pathyway–>disrupted peristalsis (entire esophagus contracts)

manometry w/ >20% simultaneous contractions

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23
Q

Nutcracker esophagus

A

distal esophagus mmhg @ peristalsis >220 at LES

high pressure

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24
Q

HTN LES

A

chronic high pressure at LES

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25
Scleroderma esophagus
- smooth muscle atrophy and fibrosis | - smooth muscle is replaced by scar tissue and lose peristalsis and LES tone
26
Presentation of dysmotility syndromes
DEPENDS ON THE CAUSE - dysphagia - chest pain
27
Work up for dysmotility disorders
BARIUM ESOPHAGRAM - manometry (measure the pressure) - endoscopy - CXR
28
Tx for dysmotility disorders
- start with dietary changes - nitrates and CCB - TCA (pain modifier) - botox in LES - endoscopy therapy (pneumatic dilation)
29
If all other methods fail how do you treat dysmotility disorder
surgery- Heller myotomy | -decreases the pressure at LES by cutting the muscle
30
What is an esophageal stricture
narrowing of lumen of the esophagus
31
Causes of distal strictures
- GERD - adenocarcinoma - collagen vascular disease - extrinsic compression - prolonged NGT
32
Causes of proximal/mid strictures
- caustic ingestions - malignancy - mediastinal radiation - various types of esophagitis - dermal disease (pemphigoid)
33
Sx of stricture
- dysphagia (most common) - odynophagia - heartburn - food impaction - chest pain - chronic cough
34
What is the biggest contributer to strictures
GERD
35
Work up for strictures
- basic labs - endoscopy (rule out malignancy) - barium esophagram: shows size of structure - CT: stage malignancy - manometry: suspected dysmotility
36
Treatment of strictures. What is the treatment of choice
- PPI - adjust diet - esophageal dilation via EGD - intralesional steroid injection if all else fails dilation is treatment of choice
37
What is a mallory-weiss tear
upper GI bleed d/t longitudinal mucosal lacerations
38
What causes a mallory weiss tear
persistent wretching/vomiting
39
Where is the location of mallory weiss tears
distal esophagus
40
Risk factors for mallory weiss tears
anticoags, excessive ETOH
41
Treatment for mallory weiss tears
typically nothing, self limiting -supportive
42
Sx's of esophagitis
- heartburn - DYSPHAGIA - odynophagia - sour taste in mouth - nausea - bloating - abd pain/ chest pain - cough/wheeze/hoarseness
43
Number one cause of esophagitis
reflux
44
Tx of esophagitis
- pain - PPI - sucralfate
45
How would you treat infectious esophagitis? Candidia, HSV, CMV
-candida: fluconazole, clotrimazole, amphotercin B HSV: acyclovir CMV: gangiclocvir and fosacarnet
46
5 causes of esophagitis
- reflux - infection - radiation - medication - systemic disease
47
How do you treat eosinophillic esophagitis
- determine allergen - leukotriene inhibitors - steroids
48
What are some complications of esophagitis
- esophageal stricures - malnutrition - perforation and/or GI bleeding - Barretts esophagus
49
Where does erosive gastritis typically occur
at greater curvature of stomach
50
What typically causes erosive gastritis
NSAIDs
51
Most common cause of non erosive gastritis
H pylori
52
What would an EGD show in a patient with gastritis
thick, edema, erosions, erythematous gastric folds
53
Sx's of gastritis
- burning/gnawing epigastric pain - N/V - melena/hematemesis/ hematochezia/coffee ground emesis
54
Tx of gastritis
- triple therapy w/ H pylori infection - D/C offending agents - antacid - sucralfate - H2 blocker - PPI
55
What can cause GERD
- impairment or failure of LES - delayed gastric emptying - decreased esophageal motility
56
What is the most common cause of GERD
hiatal hernia
57
Sx's of GERD
- heartburn - dysphagia - regurgitation - sour taste in mouth - night time cough - chest pain - asthma/hoarseness - aspiration pneumonia
58
Tx of GERD
- lifestyle modifications - antacid - H2 blocker - PPI - corrective surgery (last resort)
59
When would a patient get anti reflux surgery for GERD
- poorly controlled on PPI - barretts esophagitis - young age - poor therapy compliance - extra esophageal sx - medical therapy too expensive
60
What is the corrective surgery for GERD
Nissen Fundoplication
61
Complications of GERD
- strictures | - Barrett esophagus
62
Where are small cell carcinomas of the esophagus found? What are the main causes?
upper half of the esophagus caused by smoking and ETOH
63
Where are adenocarcinomas of the esophagus located? What causes it?
lower half of the esophagus caused by GERD/Barrett esophagus
64
What is Barrett esophagus
chronic reflux and esophageal exposure causes metaplasic conversion of distal squamous epithelium to columnar epithelium
65
Presentation of esophageal CA
- dysphagia - weight loss/cachexia - regurgitate food - epigastric pain - chronic cough - hoarseness/dysphonia
66
What would an endoscopy of early esophageal cancer show
superficial plaque, nodule, ulceration
67
What would an endoscopy show in advance esophageal cancer
stricture, ulcerated mass, circumferential mass, large ulceration
68
How is used to stage esophageal cancer
- endoscopic ultrasound (T and N staging) | - CT/PET scan/bone scan (M staging)
69
When would you do a bronchospy in a pt with esophageal CA
if CA found in middle upper 1/3 of esophagus or above the carina
70
What is the definitive tx for esophageal CA
esophagectomy
71
What is the therapy for non surgical candidates
- chemo/radiation - laser therapy - stents
72
What are the contraindications of an esophagectomy
- N2 or greater - mets to solid organs - invasion of local structures - severe comorbidity
73
What are the complications of an esophagectomy
- anastamotic leaks | - stricture
74
What is correlated with gastric cancer
- what you are eating | - H pylori
75
What type of cancer is gastric cancer (typically)
adenocarcinoma
76
Risks for gastric cancer
- family hx - h pylori - smoming - pernicious anemia - previous gastric surgery - obesity - diet
77
Sx's of gastric cancer
- insidious presentation of vague symptoms - weightloss/anorexia - gastric outlet obstruction - small bowel obstruction - palpable enlarged stomach
78
What are the signs of hematongenous spread of gastric cancer
- sister mary joseph node - virchow node - hepatomegaly - pleural effusion
79
Tx of gastric cancer
pre op chemo + surgery
80
Why types of surgery do you do for gastric CA
- total gastrectomy - esophagastrectomy - subtotal gastrectomy

Clin Med III Exam I (9 decks)

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