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Clin Med 3 > Disorders of the Esophagus and Stomach > Flashcards

Disorders of the Esophagus and Stomach Flashcards

1
Q

how many sphincters does the esophagus have?

A

2 - Upper and lower

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2
Q

what is the upper esophageal sphincter function?

A

striated muscle more voluntary

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3
Q

what is the LES function?

A

smooth muscle w/baseline tone so minimal reflux

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4
Q

what is the pathophysiology of peptic ulcer disease (PUD)?

A

excoriated segment of GI mucosa (stomach or beginning of duodenum)

imbalance b/w aggressive factors and defense mechanisms

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5
Q

what is there an imbalance of in PUD?

A

imbalance b/w aggressive factors and defense mechanisms

-H.pyloria, NSAIDs, ETOH, bile salts, etc.

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6
Q

sx’s of gastric ulcer vs duodenal ulcer

A

gastric ulcer: pain shortly after or during eating

duodenal ulcer: pain hours after eating, pain wakes pt @ night

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7
Q

what is the most common cause of PUD?

A

H. pylori

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8
Q

what is the second most common cause of PUD?

A

NSAIDs

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9
Q

sx’s of PUD

A

epigastric pain* - gnawing/burning esp after meals and worse at night

Hematemesis, coffee ground emesis, melena, hematochezia (sx’s when ulcer is bleeding)

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10
Q

PUD is the most common cause of what?

A

upper GI bleed

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11
Q

PUD risk factors

A

-alcohol, H. pylori, NSAIDs, hypersecretory state of gastrin

anything that can cause imbalance

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12
Q

PUD exam

A

ABD tenderness
-epigastric tenderness typically mild-moderate

GUAIAC +

Chronic duodenal ulcer

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13
Q

sudden onset of pain in PUD may indicate?

A

perforation

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14
Q

PUD work-up

A
  • **H. Pylori testing
  • Urea breath test

***Endoscopy - MODALITY OF CHOICE TO DX PEPTIC ULCER!!!

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15
Q

what is the dx modality of choice for PUD?

A

endoscopy

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16
Q

what is the treatment for PUD if H. pylori positive?

A

Triple therapy tx (2 abx and a PPI for 2 weeks)
-PPI + Calrithromycin + Amoxicillin

OR Quadruple therapy (PPI + Bismuth subsalicylate + Tetracycline + Metro)

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17
Q

what are dysmotility disorders?

A

dysfunction of coordinated peristalsis/motility pattern of the esophagus

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18
Q

examples of dysmotility disorders?

A

Achalasia, Diffuse esophageal spasm (DES), Nutcracker esophagus, HTN LES, Scleroderma esophagus

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19
Q

what is achalasia?

A

dysmotility disorder of the esophagus

Relative obstruction and proximal dilation of esophagus with food bolus stasis

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20
Q

what is lost in achalasia? what does the loss cause?

A

ganglion cells are lost from esophagus wall

loss causes LES to fail and completely relax (increased LES tone - stays contracted)

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21
Q

what is diffuse esophageal spasm (DES)?

A

dysmotility disorder of the esophagus

Functional imbalance between excitatory and inhibitory pathway

esophagus randomly contracts

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22
Q

what is HTN LES?

A

dysmotility disorder of the esophagus

Resting LES >45mmHg
-Pressure at LES is always high

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23
Q

what is scleroderma esophagus?

A

dysmotility disorder of the esophagus

Smooth muscle replaced by scar tissue -> lose peristalsis and LES tone

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24
Q

what is the most common presentation of dysmotility disorders?

A

Chest pain

  • sudden onset and intermittent
  • difficulty swallowing with chest pain

also have dysphagia (solid -> liquid)

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25
Q

what is the dx tool of choice for dysmotility disorders? others?

A

Barium Esophagram

can also do Manometry (measures pressure at the LES)

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26
Q

what is the tx of dysmotility disorders?

A

start with their diet (eat smaller meals, etc.)

nitrates and CCB

TCAs (Imipramine or Amitriptyline)

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27
Q

what tx can you do for dysmotility if meds don’t work?

A

Botox in LES

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28
Q

what is an esophageal stricture?

A

narrowing of lumen of the esophagus

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29
Q

what are the 2 main causes for esophageal strictures?

A

inflammation and cancer

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30
Q

what is the most common cause for distal esophageal stricture?

A

GERD

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31
Q

what are common causes of proximal/mid esophageal stricture?

A

malignancy, pill esophagitis, mediastinal radiation, caustic ingestion

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32
Q

what are the 2 most common sx’s of esophageal strictures?

A

dysphagia (difficulty swallowing) and food impaction (food gets stuck on stricture)

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33
Q

common epidemiology of pts with esophageal strictures?

A

GERD

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34
Q

what is the first line dx modality for esophageal strictures?

A

endoscopy

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35
Q

what is a good dx modality for esophageal strictures if stricture is very tight?

A

barium esophagram

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36
Q

what dx modality for esophageal strictures do you do if have malignant stricture?

A

CT - more for staging

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37
Q

what is the definitive tx of choice for esophageal strictures?

A

EGD - esophageal dilation

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38
Q

tx for esophageal strictures

A

meds - PPIs (b/c associated with GERD)

Diet

***EGD - esophageal dilation

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39
Q

what is a mallory-weiss tear?

A

Upper GI bleed due to longitudinal mucosal lacerations in GEJ or gastric cardia (distal esophagus) from persistent vomiting

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40
Q

what type of lacerations are in mallory-weiss tear?

A

longitudinal mucosal lacerations

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41
Q

most common hx of pt with mallory-weiss tear?

A

excessive ETOH binge

42
Q

mallory-weiss tear sx’s

A

hematemesis -> Bright red blood

occurs after ETOH binge and vomiting

43
Q

what is the dx modality of choice for mallory-weiss tears that is also therapeutic?

A

EGD

44
Q

does mallory-weiss tear require treatment?

A

no!!!

45
Q

if do outpatient tx for mallory-weiss tear, what is the tx?

A

PPI +/- sucralfate (mucosal suppressant)

antiemetic (don’t want them vomiting)

46
Q

what is Boerhaave syndrome?

A

TRANSMURAL RUPTURE OF THE DISTAL ESOPHAGUS ALSO FROM VOMITING

47
Q

risk factors for Boerhaave syndrome?

A

overeating and ETOH

48
Q

most common sx of Boerhaave syndrome?

A

SEVERE chest pain that can radiate to back/shoulder

NO HEMATEMESIS

49
Q

definitive dx for Boerhaave syndrome? can also do?

A

esophagram (see extravasation of gastrografin into pleural cavity)

CXR (see pleural effusion, mediastinal widening), CT

CT = imaging of choice

50
Q

tx for Boerhaave syndrome?

A

IVF, abx

surgical consult w/Thoracotomy w/direct repair of rupture and drainage of pleural cavity

51
Q

what is esophagitis?

A

general term for any inflammation, irritation, swelling of the esophagus

52
Q

most common etiology of esophagitis?

A

reflux esophagitis (Gastric contents passively regurgitate into esophagus and irritate mucosa)

53
Q

what do pts with infectious esophagitis commonly have?

A

bad odynophagia if fungal (candida)

54
Q

medication induced esophagitis?

A

injury with abx, NSAIDS, DOXY, tetracyclines

55
Q

common sx’s of esophagitis

A

dysphagia, bitter/sour taste in mouth, odynophagia

56
Q

common risk factors for esophagitis?

A

GERD, meds that treat dysmotility (NSAIDS, pill esophagitis), obesity and pregnancy

57
Q

dx modality of choice for esophagitis?

A

EGD
-diagnostic visually and with pathology bx/brushings

therapeutic if bleeding

58
Q

esophagitis tx

A

stabilize

pain - narcotics, H2 blockade, liquid antacid therapy or sucralfate

PPI for 2-4 weeks (to decrease acid production)

59
Q

education for esophagitis - what should these pts decrease?

A

meal size, weight, ETOH, NSAIDs, ASA, fatty food, citrus food, spicy food

60
Q

education for esophagitis - what should these pts stop?

A

smoking

61
Q

education for esophagitis - what should this pts start doing?

A
  • Raise head of bed 6-8 inches on blocks
  • Stay upright for @ least 3 hrs after meals
  • Taking pills w/o LOTs of H2O, in upright position and w/ ‘mattress’ of food
62
Q

what is gastritis?

A

inflammatory changes to gastric mucosa

63
Q

what causes erosive gastritis?

A

Reactive gastritis d/t exposure and gravity usually @ greater curvature of stomach most often w/NSAIDs

64
Q

what causes non-erosive gastritis?

A

H. pylori (chronic inflammation, chronic atrophic gastritis)

65
Q

most common etiologies of gastritis

A

NSAIDs, ETOH (esp liquid - vodka, gin, whiskey), H. pylori

66
Q

gastritis work-up

A

H. pylori urea breath test

EGD

67
Q

what will you see on EGD for gastritis?

A

thick, edema, erosions, erythematous gastric folds

68
Q

most common sx’s for gastritis?

A

epigastric pain, burning, gnawing

69
Q

tx for gastritis?

A

if H. pylori + then treat w/triple therapy or quadruple therapy

D/C offending agents (NSAIDs, ETOH)

Antacid, sucralfate, H2 blocker, PPI

70
Q

what is GERD?

A

Reflux of gastric contents (acid, bile, pancreatic secretions) into esophagus causing sx’s associated w/mucosal injury d/t impaired clearance of esophageal refluxate

71
Q

what is the most common etiology of GERD?

A

LES transient relaxation most commonly d/t HIATAL HERNIA

72
Q

GERD sx’s

A

very bad heartburn, dysphagia, regurgitation, hoarseness/dysphonia/laryngitis, night time cough

73
Q

gold standard dx of GERD?

A

24hr esophageal pH monitoring (but not often done)

-quantifies mount of reflux w/sx’s

74
Q

most GERD dx is what?

A

clinical

75
Q

GERD dx with EGD?

A

not doing this with all pts with classic sx’s of GERD

-done if persistent sx’s or complications of GERD

76
Q

GERD tx

A

lifestyle modifications

PPIs - best for GERD

77
Q

what tx is the best for GERD?

A

PPIs

78
Q

complication of GERD?

A

Barrett’s esophagus

-get metaplastic conversion of distal squamous epithelium to columnar epithelium from chronic acid exposure

79
Q

esophageal carcinoma cells types seen in Eastern Europe/asia? where in esophagus and due to what?

A

small cell carcinoma

upper half of esophagus

d/t smoking & ETOH

80
Q

esophageal carcinoma cells types seen in US? where in esophagus and due to what?

A

adenocarcinoma

lower half esophagus

d/t GERD/Barrett’s metaplasia

81
Q

esophageal carcinoma risk factors

A

ETOH, GERD

82
Q

most common sx’s of esophageal carcinoma?

A

dysphagia (progress from solids to liquids VERY QUICKLY)

weight loss >50%

Virschow node (means very advanced) - left sided supraclavicular node

83
Q

2 most common sx’s of esophageal carcinoma?

A

dysphagia and weight loss >50%

84
Q

what is the difference with dysphagia in esophageal cancer vs dysmotility disorders?

A

in esophageal cancer:
-dysphagia progress VERY QUICKLY from solids to liquids

in dysmotility:
-takes months to progress from solids to liquids

85
Q

esophageal cancer dx

A

Endoscopy with bx = definitive

86
Q

when is endoscopic U/S done for esophageal cancer?

A

once have diagnosis for staging

87
Q

when is CT done for esophageal cancer?

A

when looking for mets

88
Q

esophageal cancer medical treatment - is there an ideal tx? medical tx reserved for who?

A

no ideal tx is agreed upon

reserved for non-surgical candidates and palliative in nature

89
Q

esophageal cancer medical tx meds

A

chemotherapy and XRT combined

-5-FU, cisplatin, paclitaxel, anthracyclines

90
Q

esophageal ca surgical tx

A

esophagectomy

91
Q

does the type of esophageal cancer surgery influence survival?

A

no!! staging at the time of surgery does

92
Q

what needs to be stopped for pt to have lower risk of esophageal cancer?

A

GERD inflammation (can lead to Barrett’s)

93
Q

once pt has high grade dysplasia in esophagus, what do you need to talk to them about?

A

getting an esophagectomy

94
Q

gastric cancer decreased in U.S. due to what?

A

refrigeration of foods and screening for H. pylori

95
Q

most common etiologies for gastric cancer?

A

H. pylori (strongest risk factor)

Pernicious anemia

Diet with high salt foods and no fridge

96
Q

sx’s of gastric cancer?

A

insidious presentation

-indigestion, dysphagia, weight loss

97
Q

if pt has gastric cancer that has spread to liver, what are some signs?

A

sister Mary Joseph node (periumbilical node), virschow node

98
Q

gastric cancer work-up/definitive dx

A

EGD w/bx = definitive dx

99
Q

gastric cancer standard of care tx

A

Neoadjuvant chemoradiotherapy preoperative

epirubicin/cisplatin/5-FU or docetaxel/cisplatin/5-FU

100
Q

gastric cancer surgery options

A

total gastrectomy, esophagogastrectomy (tumor @ GEJ and cardia), subtotal gastrectomy (tumors of distal stomach)

Clin Med 3 (21 decks)

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