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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
what is the dx tool of choice for dysmotility disorders? others?
Barium Esophagram can also do Manometry (measures pressure at the LES)
26
what is the tx of dysmotility disorders?
start with their diet (eat smaller meals, etc.) nitrates and CCB TCAs (Imipramine or Amitriptyline)
27
what tx can you do for dysmotility if meds don't work?
Botox in LES
28
what is an esophageal stricture?
narrowing of lumen of the esophagus
29
what are the 2 main causes for esophageal strictures?
inflammation and cancer
30
what is the most common cause for distal esophageal stricture?
GERD
31
what are common causes of proximal/mid esophageal stricture?
malignancy, pill esophagitis, mediastinal radiation, caustic ingestion
32
what are the 2 most common sx's of esophageal strictures?
dysphagia (difficulty swallowing) and food impaction (food gets stuck on stricture)
33
common epidemiology of pts with esophageal strictures?
GERD
34
what is the first line dx modality for esophageal strictures?
endoscopy
35
what is a good dx modality for esophageal strictures if stricture is very tight?
barium esophagram
36
what dx modality for esophageal strictures do you do if have malignant stricture?
CT - more for staging
37
what is the definitive tx of choice for esophageal strictures?
EGD - esophageal dilation
38
tx for esophageal strictures
meds - PPIs (b/c associated with GERD) Diet ***EGD - esophageal dilation
39
what is a mallory-weiss tear?
Upper GI bleed due to longitudinal mucosal lacerations in GEJ or gastric cardia (distal esophagus) from persistent vomiting
40
what type of lacerations are in mallory-weiss tear?
longitudinal mucosal lacerations
41
most common hx of pt with mallory-weiss tear?
excessive ETOH binge
42
mallory-weiss tear sx's
hematemesis -> Bright red blood occurs after ETOH binge and vomiting
43
what is the dx modality of choice for mallory-weiss tears that is also therapeutic?
EGD
44
does mallory-weiss tear require treatment?
no!!!
45
if do outpatient tx for mallory-weiss tear, what is the tx?
PPI +/- sucralfate (mucosal suppressant) antiemetic (don't want them vomiting)
46
what is Boerhaave syndrome?
TRANSMURAL RUPTURE OF THE DISTAL ESOPHAGUS ALSO FROM VOMITING
47
risk factors for Boerhaave syndrome?
overeating and ETOH
48
most common sx of Boerhaave syndrome?
SEVERE chest pain that can radiate to back/shoulder NO HEMATEMESIS
49
definitive dx for Boerhaave syndrome? can also do?
esophagram (see extravasation of gastrografin into pleural cavity) CXR (see pleural effusion, mediastinal widening), CT CT = imaging of choice
50
tx for Boerhaave syndrome?
IVF, abx surgical consult w/Thoracotomy w/direct repair of rupture and drainage of pleural cavity
51
what is esophagitis?
general term for any inflammation, irritation, swelling of the esophagus
52
most common etiology of esophagitis?
reflux esophagitis (Gastric contents passively regurgitate into esophagus and irritate mucosa)
53
what do pts with infectious esophagitis commonly have?
bad odynophagia if fungal (candida)
54
medication induced esophagitis?
injury with abx, NSAIDS, DOXY, tetracyclines
55
common sx's of esophagitis
dysphagia, bitter/sour taste in mouth, odynophagia
56
common risk factors for esophagitis?
GERD, meds that treat dysmotility (NSAIDS, pill esophagitis), obesity and pregnancy
57
dx modality of choice for esophagitis?
EGD -diagnostic visually and with pathology bx/brushings therapeutic if bleeding
58
esophagitis tx
stabilize pain - narcotics, H2 blockade, liquid antacid therapy or sucralfate PPI for 2-4 weeks (to decrease acid production)
59
education for esophagitis - what should these pts decrease?
meal size, weight, ETOH, NSAIDs, ASA, fatty food, citrus food, spicy food
60
education for esophagitis - what should these pts stop?
smoking
61
education for esophagitis - what should this pts start doing?
- 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
what is gastritis?
inflammatory changes to gastric mucosa
63
what causes erosive gastritis?
Reactive gastritis d/t exposure and gravity usually @ greater curvature of stomach most often w/NSAIDs
64
what causes non-erosive gastritis?
H. pylori (chronic inflammation, chronic atrophic gastritis)
65
most common etiologies of gastritis
NSAIDs, ETOH (esp liquid - vodka, gin, whiskey), H. pylori
66
gastritis work-up
H. pylori urea breath test EGD
67
what will you see on EGD for gastritis?
thick, edema, erosions, erythematous gastric folds
68
most common sx's for gastritis?
epigastric pain, burning, gnawing
69
tx for gastritis?
if H. pylori + then treat w/triple therapy or quadruple therapy D/C offending agents (NSAIDs, ETOH) Antacid, sucralfate, H2 blocker, PPI
70
what is GERD?
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
what is the most common etiology of GERD?
LES transient relaxation most commonly d/t HIATAL HERNIA
72
GERD sx's
very bad heartburn, dysphagia, regurgitation, hoarseness/dysphonia/laryngitis, night time cough
73
gold standard dx of GERD?
24hr esophageal pH monitoring (but not often done) | -quantifies mount of reflux w/sx's
74
most GERD dx is what?
clinical
75
GERD dx with EGD?
not doing this with all pts with classic sx's of GERD | -done if persistent sx's or complications of GERD
76
GERD tx
lifestyle modifications PPIs - best for GERD
77
what tx is the best for GERD?
PPIs
78
complication of GERD?
Barrett's esophagus | -get metaplastic conversion of distal squamous epithelium to columnar epithelium from chronic acid exposure
79
esophageal carcinoma cells types seen in Eastern Europe/asia? where in esophagus and due to what?
small cell carcinoma upper half of esophagus d/t smoking & ETOH
80
esophageal carcinoma cells types seen in US? where in esophagus and due to what?
adenocarcinoma lower half esophagus d/t GERD/Barrett's metaplasia
81
esophageal carcinoma risk factors
ETOH, GERD
82
most common sx's of esophageal carcinoma?
dysphagia (progress from solids to liquids VERY QUICKLY) weight loss >50% Virschow node (means very advanced) - left sided supraclavicular node
83
2 most common sx's of esophageal carcinoma?
dysphagia and weight loss >50%
84
what is the difference with dysphagia in esophageal cancer vs dysmotility disorders?
in esophageal cancer: -dysphagia progress VERY QUICKLY from solids to liquids in dysmotility: -takes months to progress from solids to liquids
85
esophageal cancer dx
Endoscopy with bx = definitive
86
when is endoscopic U/S done for esophageal cancer?
once have diagnosis for staging
87
when is CT done for esophageal cancer?
when looking for mets
88
esophageal cancer medical treatment - is there an ideal tx? medical tx reserved for who?
no ideal tx is agreed upon reserved for non-surgical candidates and palliative in nature
89
esophageal cancer medical tx meds
chemotherapy and XRT combined | -5-FU, cisplatin, paclitaxel, anthracyclines
90
esophageal ca surgical tx
esophagectomy
91
does the type of esophageal cancer surgery influence survival?
no!! staging at the time of surgery does
92
what needs to be stopped for pt to have lower risk of esophageal cancer?
GERD inflammation (can lead to Barrett's)
93
once pt has high grade dysplasia in esophagus, what do you need to talk to them about?
getting an esophagectomy
94
gastric cancer decreased in U.S. due to what?
refrigeration of foods and screening for H. pylori
95
most common etiologies for gastric cancer?
H. pylori (strongest risk factor) Pernicious anemia Diet with high salt foods and no fridge
96
sx's of gastric cancer?
insidious presentation | -indigestion, dysphagia, weight loss
97
if pt has gastric cancer that has spread to liver, what are some signs?
sister Mary Joseph node (periumbilical node), virschow node
98
gastric cancer work-up/definitive dx
EGD w/bx = definitive dx
99
gastric cancer standard of care tx
Neoadjuvant chemoradiotherapy preoperative epirubicin/cisplatin/5-FU or docetaxel/cisplatin/5-FU
100
gastric cancer surgery options
total gastrectomy, esophagogastrectomy (tumor @ GEJ and cardia), subtotal gastrectomy (tumors of distal stomach)

Clin Med 3 (21 decks)

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