Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

GI Exam 2 > Disorders of the Esophagus > Flashcards

Disorders of the Esophagus Flashcards

1
Q

4 Layers of the Esophagus

A

● Stratified Squamous Epithelial Cells
● Inner Circular Muscle
● Myenteric Nerve Plexus- Can Provide local
reflexive control
● Outer longitudinal Muscle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Upper Esophageal Sphincter anatomy

A

thickened area of striated muscle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Lower Esophageal Sphincter anatomy

A

Tonically contracted smooth muscle via vagal cholinergic mechanism. During
swallowing, vagal inhibitory fibers allow sphincter to relax

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Swallowing phases

A
  • Pharyngeal Phase
    Touch receptors in the oropharynx
    Epiglottis covers the larynx
  • Esophageal Phase
    Bolus passes past the Upper Esophageal Sphincter
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

_____: a subjective sensation of difficulty or abnormality of swallowing

A

Dysphagia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

_____: pain with swallowing.

A

Odynophagia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

_____: a non-painful sensation of a lump, tightness, foreign body or retained food bolus in the pharyngeal or cervical area

A

Globus sensation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

_____: painful, difficult, or disturbed digestion, accompanied by symptoms such as nausea, heartburn, bloating, and stomach discomfort

A

Dyspepsia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Esophagitis is ____

A

Inflammation of the esophagus due
to an irritant or reaction of some kind

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Most common etiologies of esophagitis

A

○ Reflux esophagitis (most common)
○ Pill-induced esophagitis - Antibiotics, NSAID
○ Infectious esophagitis
○ Eosinophilic esophagitis
○ Radiation/Chemo esophagitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Inflammation of the esophageal mucosa can (if severe) ultimately lead to _____

A

erosions with hemorrhage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Infectious esophagitis is most common in _____

A

immunocompromised patients (HIV/AIDS, leukemia, Immunosuppressive medications)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Most common infectious etiology of esophagitis is ______.

A

Candida albicans

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Medication-induced esophagitis occurs secondary to _____

A

NSAIDs, antibiotics, potassium chloride, vitamin C, Quinidine, Alendronate, etc.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

_____ is a little-understood condition that is believed to be related to an allergic, immune reaction (usually to food)

A

Eosinophilic esophagitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Eosinophilic esophagitis leads to _____ visible on EGD and Barium Swallow

A

concentric mucosal rings due to the esophageal lining becoming densely populated with eosinophils

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

T/F Radiation Therapy directed over the chest or neck region may lead
to inflammation of the esophagus that is usually self-limited

A

T

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

_____ occurs with GERD

A

Reflux esophagitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Characteristic Signs and Symptoms of esophagitis

A

■ Retrosternal chest pain (heartburn) is common
■ Odynophagia or Epigastric abdominal pain/bloating
■ Dysphagia
■ Water brash (acidic regurgitation, “bitter taste in mouth”)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Patients with infectious esophagitis may also experience the following S&S:

A

■ Acute onset of dysphagia (difficulty) and/or odynophagia (pain)
■ Fever
■ Hematemesis (occasionally) or blood tinged sputum
■ Acute Anorexia and weight loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Diagnosis of Esohpagitis

A

● Barium Swallow studies are ordered first.
● EGD is also usually ordered.
○ The two are complementary of each other.
GI-ESOPH-1
● Barium Swallow Esophagram can reveal
characteristic shapes and findings, including
strictures and concentric rings if Eosinophilic.
● EGD allows for biopsy or sampling of pathology.
● Labs: Test to see if they are Immunocompromised

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What test is ordered first for esophagitis?

A

Barium Swallow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Esophagitis management includes:

A

○ To treat Reflux Esophagitis, treat the GERD (PPIs, H2 Blockers, etc.)
○ Treatment of Infectious Esophagitis is specific to the pathogen (Candidal- Clotrimazole Troche (immunocompetent) or PO/IV antifungals such as Fluconazole (immunocompromised or severe sx))
○ Eosinophilic Esophagitis - diet changes, PPIs, and glucocorticoids.
○ Med-induced Esophagitis- d/c offending med and PPI therapy.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Mallory-Weiss Syndrome

A

● Mallory-Weiss tears are Longitudinal lacerations in the mucosa near
the gastroesophageal junction or cardia of the stomach.
● It is characterized by upper GI bleeding.
○ Hematemesis (85%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

When do Mallory-Weiss lacerations occur?

A

Occur when there is a sudden increase in the intragastric pressure.
○ Frequently, this occurs with significant
retching, vomiting, or even coughing.
○ Can accompany the retching after binge
drinking ETOH.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

____ account for 8-15% of Upper GI bleeds

A

Mallory-Weiss Tears

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Diagnosis of Mallory-Weiss Tears

A

○ Upper Endoscopy ASAP
○ Barium Swallow study should be avoided

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

How can we treat Mallory-Weiss tears?

A

○ If necessary, emergency stabilization should occur.
■ Fluid resuscitation if tachycardic and hypotensive
■ STAT EGD for evaluation and cautery or balloon tamponade
○ Reverse anticoagulant if being taken
○ Twice-daily proton pump inhibitors (IV
then oral)
○ NPO for first couple days, then introduce
soft foods slowly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

When is Mallory-Weiss Tears emergent?

A

If they are tachycardic and hypotensive, difficulty breathing, dizzy, LOC, etc.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Esophageal Varices

A

Dilated submucosal esophageal veins,
generally located at the distal esophagus
Left gastric→Portal System

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Develops secondary to portal HTN and
seen in 50% of cirrhosis patients

A

Esophageal Varices

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Up to 1/3 of patients with esohpageal varices may develop an _____

A

upper GI bleed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Characteristic Signs and Symptoms of esphageal varices

A

■ Usually painless, massive upper GI
bleeding
■ Nausea, with bright red blood or “coffee
ground” hematemesis likely
■ May present with hematochezia or
Melena
■ Dependent on the size of bleed, may
develop weakness, postural
hypotension, tachycardia, and shock.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

T/F Varices are usually asymptomatic until they bleed

A

T

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Esophageal Varices Diagnosis

A

Upper Endoscopy (EGD) is the standard for
visualizing the pathology and assessing the
risk of hemorrhage
○ Barium esophagrams may reveal varices.

36
Q

If “red wale mark” is present then_____

A

Esophageal varices are considered “high risk for bleeding.”

37
Q

What other imaging is helpful for visualizing esophageal varices?

A

CT and MRI are also very useful in assessing the
severity and size of the varices, visualizing the
“extraluminal” varices EGD cannot see

38
Q

What is prophylactic care for esophageal varices, specifically in patients with cirrhosis?

A

Patients with cirrhosis should undergo a screening EGD
○ If patient has varices present, treat prophylactically
■ Small to medium - Non Selective B-Blocker (such as nadolol)
■ If large, Esophageal variceal ligation

39
Q

Emergency management for variceal bleeding

A

○ Emergency stabilization of the patient may be
necessary, including fluid and blood transfusion
○ Immediate control of bleeding is necessary (at same time as fluids)
○ Endoscopic evaluation with banding or sclerotherapy to stop the bleeding
○ If these treatments are failing, balloon tamponade may be required.

40
Q

Mortality of variceal bleeds

A

■ 30% mortality with 1st bleed; 50% within 6 weeks.

41
Q

If the endoscopic treatments are not
working to stop the variceal)bleed, there is a
procedure of last resort, and what does this do for the patient?

A

■ Transjugular Intrahepatic Portosystemic
Shunt (TIPS)
○ Partially shunts blood away from liver,
decreasing portal HTN.

42
Q

Esophageal Dysmotility Disorders include:

A

○ Neurogenic Dysphagia
○ Achalasia
○ Diffuse Esophageal Spasm
○ Scleroderma Dysphagia
○ Zenker’s Diverticulum
○ Esophageal Stricture/Stenosis

43
Q

Neurogenic Dysphagia

A

● Any neurological or muscular condition that affects the oral or pharyngeal
motor function, leading to dysphagia.

44
Q

Common causes of neurogenic dysphagia:

A

○ Stroke (CVA)
○ Traumatic brain injury
○ Amyotrophic Lateral Sclerosis (ALS)
○ Cervical Spine surgery (ACDF)

45
Q

Patients with this disorder commonly presents with difficulty swallowing both liquids and solids

A

Neurogenic Dysphagia

46
Q

Treatment of Neurogenic dysphagia disorder is focused on ______

A

underlying cause, but prognosis may not be great

47
Q

Achalasia

A

Esophageal neuromuscular disorder, likely
due to a progressive degeneration of ganglion
cells in the myenteric plexus, although
etiology is usually unknown

48
Q

Results in loss of peristalsis and loss of
relaxation of the lower esophageal sphincter.

A

Achalasia

49
Q

Achalasia S&S:

A

○ Slowly progressing dysphagia (solids->liquids)
with episodic regurgitation and occasional
pain.
○ Weight loss can occur secondary to significant
difficulty with eating.
○ Average age of diagnosis is between 30 and
60 years of age.
○ Heartburn that is unresponsive to PPIs

50
Q

Diagnosis of Achalasia

A

○ Barium Swallow study can reveal structural
and motor abnormalities: Classic to Achalasia is the “Parrot-Beak” or “Bird-Beak” appearance
○ EGD should be gently attempted to rule out
other pathology, such as cancer.
○ Esophageal Manometry (Required for
diagnosis) will reveal loss of peristalsis
waves within stenosis, as well as incomplete
LES relaxation with swallowing

51
Q

Achalasia Treatment

A

Medical management may include
■ Pneumatic Endoscopic balloon dilation
■ Surgical Myotomy or Peroral endoscopic
myotomy (POEM) - the LES is weakened
by cutting its muscle fibers
■ Botulism injections into the lower
esophageal sphincter

52
Q

T/F If lAchalasia is left untreated, the dilated portion of the esophagus will continue to enlarge

A

T

53
Q

T/F recurrence of achalasia is uncommon

A

F

54
Q

Diffuse Esophageal Spasm

A

An abnormality in the coordination and
strength of peristaltic contractions.
○ High-amplitude muscle spasms

55
Q

Characteristic Signs and Symptoms of Diffuse Esophageal Spasm

A

○ Dysphagia or intermittent chest pain that
may or may not be associated with eating
or drinking.
○ Symptoms may be triggered by stress,
large food boluses, or extreme temperature foods

56
Q

Diagnosis of Diffuse esophageal spasm

A

○ Barium Esophagram reveals the classic “corkscrew”
appearance of uncoordinated simultaneous
contractions (AKA “Rosary Beads”).
○ Esophageal Manometry will also be abnormal.

57
Q

Management of Diffuse esophageal spasm

A

○ Goal- Reduce symptoms and reassure patient.
○ Calcium Channel Blockers or Sublingual Nitroglycerin
may stop esophageal spasms for some patients.
○ Endoscopic dilation or surgery reserved for severe.

58
Q

Scleroderma Dysphagia

A

● Scleroderma (AKA Systemic Sclerosis) is an autoimmune disease characterized by progressive hardening of the skin.
● Atrophy and fibrosis of the esophagus smooth muscle leads to eventual lack of esophageal peristalsis. Present in over 50% of patients with scleroderma
○ The Lower Esophageal Sphincter loses its tone and GERD develops with
reflux esophagitis

59
Q

Diagnosis of Scleroderma Dysphagia

A

Usually based on clinic signs/symptoms
○ Upper Endoscopy - Screen for Barrett’s Esophagus
○ Esophageal Manometry reveals low LES pressure and seemingly
paralyzed esophagus with time.
○ Barium Esophagram may reveal loss of peristalsis waves and loss
of full Lower Esophageal Sphincter tone

60
Q

In what disorder will you see a “bird beak” appearance on Barium swallow?

A

Achalasia

61
Q

Management of scleroderma dysphagia

A

○ This is difficult to treat.
○ The focus is on treating the GERD (PPIs, etc)
and working to prevent reflux complications,
like esophagitis and Barrett’s

62
Q

Esophageal Strictures

A

● Luminal narrowing of the esophagus that is most commonly secondary to inflammation or scarring of the lower esophagus (Esophagitis) caused by GERD

63
Q

Approximately 70-80% of all strictures are related _____

A

to GERD

64
Q

What is this?

A

Esophageal strictures - Schatzki’s ring

65
Q

Slowly progressive dysphagia to solid foods is the most common presenting complaint with _____

A

Esophageal strictures

66
Q

If the stricture is secondary to an Esophageal Malignancy, the patient
can experience ____

A

rapid onset and development of dysphagia with
profound weight loss

67
Q

Diagnosis of Esophageal strictures

A

○ Barium Swallow Esophagram is the initial test of choice.
○ Endoscopic evaluation (with endoscopic ultrasound and biopsy) is then utilized for
further evaluation of Barium Swallow findings.
○ CT scan of the chest can be used to visualize masses.

68
Q

_____ has been shown to be beneficial and
safe in benign strictures and Schtazki rings

A

Endovascular balloon dilation

69
Q

Zenker’s Diverticulum

A

A rare anatomic abnormality occurring primarily in elderly male patients
● The exact mechanism of development is unknown, but it is believed to develop
secondary to a defect in the posterior hypopharynx.

70
Q

What is this called?

A

Diffuse Esophageal Spasm

71
Q

What is this called?

A

Achalasia, “bird beak”

72
Q

What is this?

A

Esophageal strictures

73
Q

Characteristic Signs and Symptoms of Zenker’s Diverticulum

A

■ Regurgitation of undigested food hours after eating
■ Dysphagia
■ Aspiration of organic material
■ Unexplained weight loss
■ Halitosis

74
Q

Most life-threatening complication of Zenker’s

A

Aspiration of organic material

75
Q

Diagnosis of Zenker’s Diverticulum

A

○ Barium Swallow esophagram is
still considered the diagnostic study of choice, especially for initial evaluation.
○ Upper Endoscopy (EGD) is often used for further evaluation and pre-operative planning

76
Q

Management of Zenker’s Diverticulum

A

○ Unless the lesion is large and
causing symptoms, treatment may
not be recommended
○ Open or Endoscopic surgery can be
performed on larger, symptomatic
diverticula

77
Q

Esophageal Neoplasm include two disctinct types:

A

○ Squamous Cell Carcinoma
○ Adenocarcinoma

78
Q

Squamous Cell Carcinoma of the esophagus features:

A

■ Generally occurring in the
proximal (upper) 2/3.
■ Associated with alcohol and
tobacco usage. Synergistic

79
Q

Features of Adenocarcinoma of the esophagus

A

■ Occurring in the distal 1/3.
■ Strongly associated with
chronic GERD (Barrett’s)

80
Q

Barrett esophagus (BE)

A

Stratified squamous epithelium that
normally lines the esophagus is
replaced by a columnar epithelium

81
Q

Characteristic Signs and Symptoms of Esophageal neoplasms

A

Progressive dysphagia for solids (and eventually liquids), as well as profound weight loss - The two most characteristic clinical features
○ Other symptoms include:
■ Hoarseness of voice
■ Epigastric or retrosternal pain
■ Odynophagia
■ Hematemesis
■ Cough

82
Q

Diagnosis of esophageal neoplasms

A

○ Barium Swallow Esophagram may be the good initial test
○ Upper Endoscopy (EGD) allows for detailed intraluminal visualization with ability to biopsy the tumor
○ Endoscopic Ultrasound allows for staging
and can measure depth and lymph node
involvement

83
Q

a. Bird Beak pattern can
be seen, but in places other than the LES with ____

A

Esophageal neoplasms

84
Q

Management of esophageal neoplasm

A

○ Treatment generally involves surgery of some sort, as long as the
patient is a surgical candidate.
○ Radiation and chemotherapy are generally used to some extent as
well, although the effects are less than desirable.

85
Q

Prognosis for esophageal neoplasms?

A

■ Depends on stage, but is generally pretty poor.
■ The overall 5-year survival rate is approximately 19%.
■ Most patients have metastatic disease upon diagnosis.
■ The 5-year survival of those with Stage 4 disease is < 5%.

86
Q

When speaking of dysphagia, the following are red flags concerning for significant pathology

A

○ Rapid onset of dysphagia and/or odynophagia
○ Unexpected weight loss with dysphagia
○ Significant worsening of previously controlled GERD

These red flags warrant urgent EGD evaluation and/or Barium Swallow.

GI Exam 2 (6 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions