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Clin Med II - Exam 3 > Dobbs - Esophagus > Flashcards

Dobbs - Esophagus Flashcards

1
Q

3 common complaints when esophagus is involved

A

heartburn

dysphagia

odynophagia

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2
Q

ddx for esophagus

A

GERD

zollinger-ellison syndrome

cardiac

lots

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3
Q

objective definition of GERD

A

endoscopy -> shows mucus injury

AND/OR

reflux monitoring -> abnormal acid

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4
Q

which sphincter is impaired in GERD

A

lower esophageal

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5
Q

incompetent lower esophageal sphincter leads to __

and compromised integrity of the __

A

impaired esophageal clearance

esophageal mucosa

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6
Q

causes of LES pressure reduction

A

tomato

citrus

spicy foods

coffee

acidic foods

chocolate

etoh

caffeine

pregnancy

hiatal hernia

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7
Q

what is a hiatal hernia

A

portion of the stomach is herniated thru diaphragm

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8
Q

what is a nonreducible hiatal hernia

A

gastric rugal folds remain above diaphragm btw swallows

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9
Q

T/F GERD is worse in pt’s w. nonreducible sphincter

A

T!

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10
Q

peristalsis is decreased at ___,

which can cause increased exposure to __

A

night

acidic refluxate

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11
Q

name 3 conditions associated w. reduced peristalsis

A

scleroderma

DM

achalasia

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12
Q

3 typical sx of GERD

A

heartburn

acid taste/refluxate

dysphagia

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13
Q

atypical presentation of GERD

A

cough

exacerbation of asthma

chronic laryngitis

sore throat

hoarseness

non cardiac cp

dental erosions

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14
Q

pe and labs for GERD will usually be

A

normal

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15
Q

2 special exams done for complicated/atypical cases of GERD

A

upper endoscopy (GI)

barium esophagography (barium swallow)

ambulatory esophageal pH monitoring

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16
Q

typical sx w. uncomplicated GERD can be treated/monitored for __ weeks before further testing needs to be done

A

4

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17
Q

which patients should receive an upper endoscopy (GI)

A

pt who doesn’t respond to pharm

pt who has sx suggesting complicated dz

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18
Q

what are signs of complicated GERD

A

dysphagia

odynophagia

occult or overt bleeding

IDA

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19
Q

gold standard test for documenting type/extent of tissue damage in GERD

A

UGI w bx

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20
Q

ambulatory esophageal pH monitoring is mostly unnecessary, but may be used to

A

unresponsive to pharm

detect amt of reflux/association btw reflux episodes and atypical symptoms

pt w. normal UGI and refractory sx

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21
Q

1st step in GERD dx

A

8 week-once before meal daily PPI trial

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22
Q

if you trial a GERD pt on PPI and there is complete relief, dx is __;

next you should __;

if sx reoccur, you should order __ to confirm dx

A

likely

discontinue PPI

EGD

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23
Q

in the previous pt, if the pt has a normal EGD, you should __;

if that is abnormal, dx is __;

if it is abnormal, you should __

A

reflux monitor off therapy

confirmed

consider other causes for symptoms

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24
Q

diagnostic test for GERD

A

8 week PPI trial

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25
Q

barium swallow studies are used to

A

evaluate dysphagia

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26
Q

endoscopy is used for (3)

A

alarm sx

screening of high risk pt

cp

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27
Q

esophageal bx is used to

A

exclude non GERD causes of sx

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28
Q

esophageal manometry is used for

A

pre operative evaluation for surgery

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29
Q

ambulatory reflux monitoring is used (3)

A

pre operatively for non-erosive dz

refractory sx

GERD dx in question

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30
Q

lifestyle interventions for GERD (5)

A

wt loss

head of bed elevation

avoidance of late evening meals

tobacco/etoh cessation

cessation of trigger foods

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31
Q

first step in GERD tx

A

lifestyle changes

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32
Q

is H.pylori testing recommended in GERD

A

no!

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33
Q

pharm for GERD

A
  1. antacids
  2. gaviscon (alginate antacid)
  3. H2 receptor blockers
  4. PPIs
  5. Metoclopramide → Reglan
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34
Q

how are H2 receptor blockers used for GERD (2)

A

PRN w. breakthrough nocturnal sx on PPI

low level symptoms

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35
Q

4 examples of H2 receptor blockers

A

pepcid (famotidine)

zantac

tagamet (cimetidine)

axid → nizatidine

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36
Q

what med is used for empiric tx of GERD

A

PPIs

37
Q

when should PPIs be used for tx of GERD

A

persistent sx after 6 weeks of H2 blocker tx

38
Q

PPI tx should be d/c’ed after __;

if relapse, consider __

A

2-3 mo

intermittent tx for 2-4 weeks

39
Q

when should PPI’s be taken

A

before meals

40
Q

long term PPIs can increase risk for (2)

A

PNA

osteoporosis

41
Q

PPI’s from least to most potent

A

Pantoprazole → Protonix

Lansoprazole → Prevacid

Omeprozole → Prilosec

Dexlansoprazole → Dexilant

Omeprazole and sodium bicarbonate → Zegerid

42
Q

what are the 2 most potent PPI’s

A
  1. Omeprazole and sodium bicarbonate → Zegerid
  2. Dexlansoprazole → Dexilant
43
Q

least 2 potent PPI’s

A
  1. pantoprazole → Protonix
  2. Lansoprazole → Prevacid
44
Q

GERD tx in pregnancy (4)

A
  1. lifestyle changes
  2. antacids
  3. alginate
  4. sucralfate
45
Q

when should you consider fundoplication for GERD

A

severe dz w.:

ulceration,

stricture

barrett’s espophagus

dz at early age

46
Q

is endoscopic tx recommended for GERD

A

no

47
Q

what does the LINX device for GERD do

A

keeps LES closed to prevent reflux

expands to allow normal swallowing

48
Q

what 4 things should you consider in pt’s unresponsive to tx

A

zollinger-ellison

pill-induced esophagitis

resistance to PPI’s

non-compliance

49
Q

how to work-up pt’s non responsive to tx (2)

A

ambulatory esophageal reflux monitoring

upper endoscopy only if alarm sx

50
Q

in barrett’s esophagus, __ epithelium is replaced by

__ epithelium

A

squamous

metaplastic columnar

51
Q

test to confirm dx of barrett’s esophagus

A

endoscopic bx

52
Q

who should be screened for barrett’s esophagus

A

3-5 years of chronic GERD sx

plus

other risk factors

53
Q

risk factors for barrett’s esophagus (besides GERD)

A

>50 yo

male

hiatal hernia

elevated visceral fat

54
Q

barrett’s progression (6)

A

squamous esophagus →

chronic inflammation →

barrett’s metaplasia →

low-grade dysplasia →

high-grade dysplasia →

adenocarcinoma

55
Q

at what point in barrett’s progression is ablation recommended

A

low-grade dysplasia

56
Q

at what point in barrett’s is esophagectomy recommended

A

adenocarcinoma

57
Q

what do you think when you see gradual and progressive dysphagia w. solid foods over months to years

A

peptic stricture

58
Q

t/f peptic stricture can lead to reduction in heartburn

A

T!

59
Q

test to order to exclude malignant cause in peptic stricture

A

endoscopy w. bx

60
Q

tx for peptic stricture (2)

A

dilation (single or serial)

long term PPI

61
Q

what do you think when you see loss of peristalsis in distal ⅔ of esophagus

A

esophageal dysphagia/achalasia

62
Q

sx of esophageal dysphagia/achalasia

A

gradual, progressive dysphagia

substernal discomfort/postprandial fullness

regurgitation of undigested food

wt loss

63
Q

pe for esophageal dysphagia/achalasia

A

normal

64
Q

best initial study for esophageal dysphagia/achalasia

A

barium esophagagraphy/esophagram

65
Q

tx for esophageal dysphagia/achalasia

A

pneumatic dilation

surgical myotomy

botulinum toxin injxn

CCB/long acting nitrates

66
Q

3 common complications of GERD

A

barrett’s

strictures (peptic or esophageal)

schatzki’s ring

67
Q

mc cause of intermittent solid food dysphagia and food impaction

A

schatzki’s ring

68
Q

most sensitive test for schatzki’s ring

A

barium swallow

69
Q

tx for schatzki’s ring

A

PPI’s

70
Q

what are rings

A

circumferential mucosa or muscle in the distal esophagus

71
Q

what are webs

A

occupy only a part of the esophageal lumen

72
Q

webs are always __

and usually __

A

mucosal

proximal

73
Q

sx of rings/webs (if symptomatic)

A

intermittent solid food dysphagia

aspiration

regurgitation

74
Q

plummer-vinson syndrome triad

A

proximal esophageal webs

IDA

dysphagia

75
Q

plummer vinson syndrome increases risk for

A

squamous cell carcinoma of esophagus and pharynx

76
Q

most sensitive test for webs

A

barium radiography

77
Q

tx for webs

A

mechanical disruption

78
Q

75% of esophageal cancer pt’s present w.

A

wt loss

79
Q

rf for adenocarcinoma

A

obesity

GERD/barrett’s

scleroderma

80
Q

rf for squamous cell carcinoma

A

etoh/tobacco

prior esophageal injury

HPV

achalasia

81
Q

__ is used to identify metastasis in esophageal ca,

and __ is used to evaluate depth of invasion

A

CT

US

82
Q

sx of zenker’s diverticulum

A

oropharyngeal dysphagia

regurgitation

halitosis

cough

aspiration pna

83
Q

infectious esophagitis mc seen in

A

immunocompromised → HIV

84
Q

mc pathogens in infectious esophagitis

A

candida albicans

herpes simplex

CMV

85
Q

what do you think when you see, white exudates or papules, red furrows, currugated concentric rings

A

eosinophilic esophagitis

86
Q

ddx for hematemesis

A

mallory-weiss syndrome

esophageal varices

PUD

gastritis

87
Q

what do you think when you see, sudden onset, mucosal tear from vomiting, etoh

A

mallory-weiss syndrome

88
Q

what do you think when you see “bird’s beak” on barium study

A

achalasia

89
Q

what causes the bird’s beak

A

tapering at LES

narrowing at gastroesophageal junction

dilated esophagus

Clin Med II - Exam 3 (14 decks)

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