Disorders of the Esophagus & Stomach (Adults Pt 1)

Question 1

Esophagus

Answer 1

No digestion or absorption occurs in the esophagus

Question 2

What does the esophagus do?

Answer 2

Simple muscular tube that transports food from the pharynx to the stomach by coordinated muscle contraction.

Question 3

What could wrong with the esophagus?

Answer 3

Obstruction, dysfunction (of the muscle or the nerves that innervate them, outpouchings (diverticula) that prevent the food from going where it’s supposed to go, GERD (prevents stomach contents from re-entering the esophagus)

Question 4

Obstruction in the Esophagus can occur from what?

Answer 4

Inside: foreign object, tumor, “wings/webs” such as scar tissue
Outside: lung cancer, enlarged lymph nodes

Question 5

Dysphagia can be caused by a _______ or ______ obstruction of the esophagus.

Answer 5

Mechanical; functional

Question 6

Functional Obstruction is

Answer 6

An impairment of esophageal motility.

Question 7

Upper esophageal obstruction discomfort occurring ____ seconds after swallowing, and lower esophageal ____ after swallowing.

Answer 7

Upper: 2-4 sec
Lower: 10-15 sec

Question 8

Any muscle could fail in the esophagus one or two ways:

Answer 8

fail to contract (PSNS: Fight or flight) and or fail to relax (SNS: rest and digest)

Question 9

If the PSNS is compromised, then the esophagus has ______ peristalsis and is unable to relax

Answer 9

Decreased

Question 10

if the esophagus fails to contract esophageal ______ could occur in the ______ & other connective tissues such as _______.

Answer 10

Dilates; scleroderma; Chagas’ disease

Question 11

If the esophagus fails to relax _____ could occur diffused throughout the entire esophagus. It can present as ______ ______ that mimics angina.

Answer 11

SPASMS; chest pain

Question 12

Achalasia is a form of _____ ______ caused by the loss of esophageal innervation or relaxation of the lower esophageal sphincter.

Answer 12

Functional dysphagia

Question 13

Achalasia Pathophysiology

Answer 13

“Failure to relax”, destroys PSNS neurons and remains constricted.

Question 14

Late phase of Achalasia is a condition where food gets stuck and causes esophageal _____, proximal to that occlusion. Can’t relax!

Answer 14

Dilation

Question 15

Bird Beak on Barium Swallow is known as?

Answer 15

Food travels down the esophagus and gets stuck before the stomach causing esophageal dilation proximal to the unrelaxed location.

Question 16

Pulsion Diverticula

Answer 16

Outpouching of the esophagus causes esophageal diverticula

Question 17

Esophageal diverticula can be

Answer 17

Congenital

Question 18

Zenkers diverticulum outpouching causes what?

Answer 18

Outpouching of the lumen causes food and drink to get stuck down there before being digested.

Question 19

IF regular food appears digested, it cant be a result of Zenkers diverticulum . T or F

Answer 19

True

Question 20

What is the most common esophageal disorder?

Answer 20

GERD

Question 21

What is the pathophysiology behind GERD?

Answer 21

chyme regurgitation from the stomach into the esophagus, causing esophagitis causing from repeated exposed to acids and enzymes (pepsin) in the regurgitated gastric contents.

Question 22

Define Hiatal Hernia

Answer 22

Protrusion of the upper part of the stomach through the hiatus (esophageal opening in the diaphragm) at the gastroesophageal junction.

Question 23

Clinical Manifestations of GERD

Answer 23

Heartburn from acid regurgitation, chronic cough, laryngitis, asthma attacks, sinusitis, and upper abdominal pain with one hour of eating

Question 24

Define Esophagitis

Answer 24

Inflammation fo the esophagus

Question 25

Esophagitis can be caused by:

Answer 25

Meds, chemotherapy, radiation, chronic disease, infection (candida, herpes, mycobacterium)

Question 26

Clinical Manifestations of Hiatal Hernia

Answer 26

Asymptomatic, heartburn, regurgitation, dysphagia, & epigastric pain

Question 27

Hiatal Hernia

Answer 27

Protrusion (herniation) of the upper part of the stomach through the diaphragm & into the thorax.

Question 28

3 types of hiatal hernia

Answer 28

Sliding, paraesophageal, mixed

Question 29

Type 1 Hiatal Hernia: _____

Answer 29

SLIDING: Most common; Proximal stomach portion moves moves into the thoracic cavity through an opening in the diaphragm for the esophagus & vagus nerves

Question 30

Type 2 Hiatal hernia: ________ aka “rolling”

Answer 30

Paraesophageal hernia: Herniation of the greater curvature of the stomach is through a secondary opening in the diaphragm

Question 31

Type 3 Hiatal Hernia: ______

Answer 31

Mixed; Type I & II

Question 32

Esophageal Cancer Pathophysiology

Answer 32

Facilitated by chronic inflammation & dysplasia caused by gastroesophageal reflux (Barrett’s esophagus) & long term exposure to irritants (alcohol and tobacco)

Question 33

What are the two types of esophageal cancer?

Answer 33

Adenocarcinoma & squamous cell carcinoma

Question 34

Clinical manifestations for esophageal cancer

Answer 34

Back pain, chest pain, dysphagia, resp symptoms, trachea compressed

Question 35

Esophageal varices

Answer 35

Dilation of esophageal veins, usually caused by liver disease/portal hypertension.

Question 36

Pathophysiology of Esophageal Varices

Answer 36

1. Lower esophagus is drained into the superficial veins lining the esophageal mucosa 2. Esophageal mucosa drains into the LEFT gastric vein, then drains into the portal vein 3. Gradient greater than 10, builds collateral circulation in the lower esophagus, abdominal wall, stomach, and rectum. 4. blood vessels become distended, becoming more thin walled and appear as varicosities.

Question 37

Pyloric obstruction is the

Answer 37

Narrowing or blockage of the pylorus which is the opening btw the stomach and the duodenum

Question 38

What can lead to Pyloric obstruction?

Answer 38

Congenital, inflammation and scarring secondary to a gastric ulcer, or tumor growth.

Question 39

Intestinal obstruction prevents the normal movement of _______ thorough the intestinal tract.

Answer 39

Chyme; usually mechanical (torsion, herniation, or tumor is usually the cause.

Question 40

Paralytic Ileus causes

Answer 40

Functional obstruction

Question 41

What are the most severe consequences of intestinal obstruction:

Answer 41

Fluid/electrolyte loss, HYPOvolemia, shock, intestinal necrosis, and perforation of the intestinal wall.

Question 42

Most common stomach disorder?

Answer 42

Peptic ulcers

Question 43

What is a peptic ulcer?

Answer 43

Circumscribed area of mucosal inflammation and ulceration caused by excessive secretion of gastric acid, disruption of protective mucosal barrier, or BOTH!

Question 44

Name the 3 type of peptic ulcers?

Answer 44

Lower esophagus, stomach, or duodenal ulcers

Question 45

Clinical manifestations of peptic ulcers

Answer 45

Pain begins 30 mins to 2 hours after eating when the stomach is empty

Question 46

Gastric/peptic ulcers are frequently caused by

Answer 46

H.pylori

Question 47

Is gastritis an acute or or chronic inflammation of the gastric mucosa?

Answer 47

It is both!

Question 48

What is the PRIMARY defect in gastric ulcer development?

Answer 48

Increased mucosal permeability to hydrogen ions

Question 49

Gastric ulcer manifestation

Answer 49

Pain occurs immediately after eating; chronic; anorexia, vomiting, weight loss

Question 50

Zollinger - Ellison Syndrome

Answer 50

Pancreatic tumor called a gastrinoma secretes gastrn / chronic secretion of gastric acid

Question 51

Define “Stress related mucosal” disease

Answer 51

It’s a peptic ulcer related to a severe illness, multisystem organ failure or major trauma

Question 52

________ ulcers most common peptic ulcers; associated w/ increased numbers of parietal cells, elevated gastrin levels, and rapid gastric emptying.

Answer 52

Duodenal

Question 53

Gastric ulcers develop near _____ cells.

Answer 53

Parietal

Question 54

Ischemic Ulcer

Answer 54

Develops within hours of an event

Question 55

Curling ulcer

Answer 55

Develops after a brain injury

Question 56

Curling ulcer

Answer 56

Develops after a burn injury

Question 57

Cushing ulcer

Answer 57

Develops as a result of head trauma or brain surgery from hypersecretion of hydrochloric acid from the vagal nuclei

Question 58

_____ is an inflammatory disorder of the gastric mucosa (acute or chronic)

Answer 58

Gastrities

Question 59

______ gastrities is an acute injury to protective ______ barrier.

Answer 59

Acute; Mucosal

Question 60

_____ gastrities is chronic inflammation, mucosal atropy & epithelial metaplasia that progresses over the years.

Answer 60

Chronic

Question 61

This disorder is also defined as type A or type B

Answer 61

Chronic gastrities

Question 62

Type A, is most rare severe form of chronic _____ gastritis. Associated with ________ to parietal cells & intrinsic factor, resulting in atrophy & pernicious anemia.

Answer 62

FUNDAL; autoantibodies

Question 63

Type B, is a chronic _____ gastritis ______ more common associated with H.Pylori, NSAIDs, alcohol, and tobacco.

Answer 63

ANTRAL; nonimmune

Question 64

Alkaline Reflux Gastritis

Answer 64

Stomach inflammation caused by reflux of bile & alkaline pancreatic secretions.

Question 65

Pyloric (gastric outlet) obstruction

Answer 65

Blocking or narrowing of the opening btw the stomach and duodenum

Question 66

Gastroparesis also called

Answer 66

“delayed gastric emptying” is a medical disorder consisting of WEAK muscular contractions (peristalsis) of the stomach, resulting in food & liquid remaining in stomach for a PROLONGED period of time.

Question 67

Gastric Cancer

Answer 67

More common in Asia decent (from lifestyle, smoking, alcohol)