Disorders of Esophagus, Stomach, and Duodenum Flashcards
What is inflammation or injury to esophageal mucosa
esophagitis
what is the typical presentation of esophagitis
retrosternal chest pain
heart burn
dysphagia
odynophagia
what is the most common cause of esophagitis
GERD
other: radiation, infection, local injury
what is the most common cause of infectious esophagitis
candida
HSV is most common viral
how can esophagitis be diagnosed/worked up
endoscopy/biopsy to differentiate subtypes
What is the treatment of esophagitis
acid suppression, lifestyle modifications, liquid/soft/puree diet
topical lidocaine and opioids for pain
AVOID NSAIDS
what is the treatment for erosive/reflux esophatitis
H2 blocker or PPI
What are complications of esophagitis
Bleeding
stricture
Barrettt’s esophagus
perforation
laryngitis
aspiration pneumonitis
What can cause inflammation of gastric mucosa
infection (H. pylori)
drugs (nsaids, alcohol)
Stress
autoimmune phenomena
how is gastritis diagnosed
endoscopy
what is the clinical presentation of non-erosive gastritis
most asx but may c/o dyspepsia or other vague symptoms
what testing is used for non-erosive gastritis if symptomatic
Testing for H/pylori appropriate
What is H.pylori
common gastric pathogen causing gastritis, PUD, gastric adeno-carcinoma and gastric lymphoma
how is H.pylori diagnosed
urea breath test (m/c and gold standard)
stool antigen test
endoscopic biopsy
what is the treatment of H.pylori
Quaduple therapy: PPPI, Bismuth subsalicylate, metronidazole, tetracycline
what are common causes of erosive gastritis
NSAIDs
Alcohol
Stress
what is the clinical presentation of erosive gastritis
often asx but may c/o dyspepsia, N/v
first sign often hematemesis or melena: usu 2-5 days of inciting event
what is the treatment of erosive gastritis
manage bleeding (endoscopic hemostasis, total gastrectomy; acid suppression
mild: remove offending agent, redust gastric acidity
what is incompetence of LES that allows for reflux of gastric contents into esophagus, causing burning pain
GERD
What are the typical symptoms of GERD
heartburn; usu 30-60 minutes after meals and upon reclining; often report relief from antacids or baking soda
What are factors for reflux
weight gain
fatty foods
caffeinated or carbonated beverages
alcohol
tobacco smoking
drugs/meds
What are risk factors for GERD
hiatal hernia, pregnancy (weakens LES)
obesity, pregnancy, asthma (increase pressure on stomach)
diabetes, PUD, Connective tissue d/o (conditions that affect transit)
What is the initial treatment of choice for GERD
lifestyle modification
elevating head of bed, weight loss
What are the drug treatment options for GERD
Anacids
H2-receptor antagonists
PPIs
what are complications of GERD
esophagitis
esophageal structure
Barrett esophagus
esophageal CA
What is the only complication of GERD with malignant potential
Barretts esophagus
what is the biggest risk factor for GERD and BE
obesity, especially central rather than BMI
what is the presentation of BE
symptoms of GERD
- chronic GERD symptoms
what does diagnosis of BE require
gross endoscopic ID of columnar metaplasia; described as “salmon-pink tongues” of mucosal tissue
pathological confirmation of intestinal metaplasia with goblet cells on biopsy
what is the treatment of BE
its a burn - put out the fire aka suppress acid/reflux
if BE is left untreated what are they at risk of developing
adenocarcinoma
what is another name for gastrinoma
zollinger-ellison syndrome; Z-E syndrome
where are gastrinomas located
pancreas or duodenal wall
what is the result of gastrinomas
gastric acid hypersecretion and aggressive, refractory peptic ulceration
how are gastrinomas diagnosed
measuring serum gastrin lovels
what is the treatment of gastrinoma
PPI and surgical removal
what are symptoms of esophageal motility disorders
symptoms depend on cause but typically:
difficulty swallowing (dysphagia)
chest pain/pressure
heartburn
what is the evaluation for esophageal motility disorders
depends on symptoms:
upper endoscopy
barium swallow
esophageal manometry
acid-and reflux-related tests
what are neurogenic esophageal motility disorders
all affect swallowing but not classified as mitility disorders
generalized d/o of neuromusuclar function
m.gravis
amyotrophic lateral sclerosis
stroke
parkinsons
DM2
What is Diffuse Esophageal spasm (DES)
spectrum of motility disorders characterized by non-propulsive contractions, hyperdynamic contractions, or elevated LES pressure
what are symptoms of DES
chest pain, dysphagia
how is DES diagnosed
barium swallow or manometry
what are the treatemnts for DES
Nitrates
CCBs (verapamil)
botulinum toxin
surgical or endoscopic myotomy
anti-reflux therapy
what is achalasia
neurogenic esophageal motility disorder characterized by impaired esophageal peristalsis and lack of LES relaxation during swallowing
what are the symptoms of achalasia
slowly progressive dysphagia, usu. to both liquids and solids
regurgitation of undigested foods
how is achalasia worked up
manometry
barium swallow
endoscopy
what is the treatment of achalasia
dilation
botulinum toxin injection
surgical myotomy
endoscopic myotomy
what causes achalasia
loss of ganglion cells in myenteric plexus of esophagus, resulting in denervation of esophageal muscle
What is esophageal diverticula
outpouching of mucosa though muscular layer of the esophagus
how is esophageal diverticula diagnosed
barium swallow
what is Zenker’s (pharyngeal)diverticula
posterior out-pouching of mucosa and submucosa thru cricopharyngeal muscle
what is mid-esophageal (traction) diverticula
caused by traction from mediastinal inflammatory lesions or by esophageal motility disorders
what is epi-phrenic diverticula
just above the diaphragm
usu. with motility disorder (achalasia, DES)
what is the clinical presentation of Zenker diverticulum
regugitation of food when bending or lying down
asperation pneumonitis as result of nocturnal regurgitation
what is the treatment of esophageal diverticula
specific tx usually not required
resection occasionally needed for large/symptomatic diverticula
what is esophageal obstruction
usually develops slowly and incomplete
Intrinsic vs extrinsic obstruction
what are intrinsic obstructions
esophageal tumors
esophageal rings
esophageal webs
structures caused by GERD or rare, caustic ingestion
what are Extrinsic obstruction
enlarged left atrium
aortic aneurysm
substernal thyroid gland
cervical bony exostosis
thoracic tumor
What is a lower esophageal ring
aka Schatzki ring; B ring
ring like narrowing of distal esophagus resulting in dysphagia
What is the treatment of lower esophageal rings
wide-lumen rings: instruct to chew food thoroughly
narrow-lumen: dilation by endoscopy
surgical resection rarely required
what are other names for esophageal webs
plummer-vinson syndrome
patterson-kelly syndrome
sideropenic dysphagia
what is an esophageal web
thin mucosal membrane grows across the lumen, may cause dysphagia; rare without anemia
what is the best method of diagnosis for esophageal webs
barium swallow
what is the treatment of esophageal webs
correct anemia; can be easily ruptured during endoscopy
what is Mallory-Weiss syndrome
non-penetrating mucosal laceration of distal esophagus and proximal stomach caused by vomiting, retching or hiccupping
how is Mallory-Weiss syndrome diagnosed
clinical with hx hematemesis after 1+ episodes of non-bloody vomitting
endoscopic diagnostic and therapeutic
what are esophageal varices
dilated veins in distal esophagus or proximal stomach caused by elevated pressure in portal venous system
usu from cirrhosis
how are esophageal varicies diagnosed
endoscopy
what is the treatment of esophageal varices
airway management, fluid resuscitation, transfusion
endoscopic banding and IV octreotide
trans-jugular intrahepatic protosystemic shunting procedure
what is the presentation of esophageal varices
usually present with sudden, painless, upper GI bleeding, often massive: signs of shcok may be present
what is the prognosis of esophageal varices
40% variceal bleeding stops spontaneously
mortality depends on severity of liver disease more than volume of bleeding
NOT good diagnosis
what is TIPS procedure
emergency intervention of choice for esophageal varices
guidewire passed from vena cava through liver and passage dilated via balloon catheter
stent size is crucial
what is erosion of GI mucosa that usuaulyl affects stomach or first few cm of duodenum
PUD
what causes PUD
H.pylori or NSAID use
what are the symptoms of PUD
burning epigastric pain often RELIEVED by food
how is PUD diagnosed
endoscopiy
H.pylori testing
what is the treatment of PUD
acid suppression, eradication of H.pylori (if present), NSAID avoidance
if burning epigastric pain wakens the patient at night, what is this highly suggestive of
duodenal ulcer highly suspicious
what are complications of PUD
Hemorrhage
performation
recurrence
