Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

GI II Exam 1 > DSA 1: Atypical CP, Dysphagia, Odynophagia > Flashcards

DSA 1: Atypical CP, Dysphagia, Odynophagia Flashcards

1
Q

Atypical CP is defined as?

A

CP that is not due to angina (it is not located L substernal, worse on exertion or does not radiate to L arm/neck).

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

30% of CP is atypical CP, due to _______.

A

An esophageal source.

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

Can we distinguish GI vs CV causes of chest pain, based on H&P?

A

No, they are clues, but we need diagnostics.

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

When evaluating chest pain, it is most important to do what?

A

1. Exclude cardiac (life-threatening; MI, aortic dissection, PE, pneumothorax) causes

- Also, exclude life threatening GI causes.

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

What are life-threatening GI causes of chest pain?

A
  1. Boerhaave Syndrome
  2. Iatrogenic esophageal perforation
  3. Peptic ulcer disease (PUD)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What diagnostics do you run for atypical chest pain?

A
  1. ECG and cardiac enzyme
  2. CXR
  3. CT angio of chest
  4. Barium swallow
  5. Manometry
  6. Video fluoroscopy
  7. EGD
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What finding can help to differentiate between MI and PE?

A

MI: ST

PE: S1Q3T3

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

Esophageal perforation can cause atypical CP.

  • Presentation:
  • Cause(s):
A
  • Pleuritic/retrosternal chest pain causing patients to be in distress and can be life-threatening.
  • Iatrogenic/spontaneous
    • Iatrogenic can be caused by trauma in nasogastric tube placement and endoscopy
    • Spontaneous can be caused by
      • forceful retching/vomiting
      • History of alcohol use
      • Boerhaaves
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Esophageal perforation can cause atypical CP.

Dx:

TX:

A

Dx:

  1. CXR with air in mediastinum/SubQ emphysema
  2. CT chest w/ contrast (Gastrografin, not barium, because barium will cause inflammation if there is a perforation)

Tx:

  1. NPO
  2. Parenteral ABX
  3. Surgery
  4. Endoscopic stenting
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What 3 symptoms are indicative of pneumomediastinum (air in mediastinum), seen in _______________.

A

Boerhaave’s perforation.

    1. SubQ emphysema in the neck or precordial area (30-90% of pts)
    1. Hammans signs- crunching sound heart w heart beat during systole while pt it L lateral recumbant (12-50%)
    1. Dyspnea (30-60%)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Peptic ulcer disease is a cause of _____________, most commonly occuring in where?

A

Atypical CP

  1. Duodenal bulb => duodenal ulcer (DU)
  2. Stomach => gastric ulcer (GU)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What important findings are seen on H&P for peptic ulcer disease?

A
  1. Epigastric pain that is gnawing, dull or aching that lasts up to several weeks, with months-years of no symptoms.
  2. GI bleeding, causing coffee ground emesis, melana, hemachezia
  3. Worsened with anxiety, stress, coffee, alcohol
  4. In uncomplicated PUD, PE is NL and only mild tenderness is seen with deep epigastric palpation.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What diagnostic testing is ESSENTIAL with PUD?

A
  1. EGD + biopsy to rule out cancer.
  2. Fecal antigen test to test for H.Pylori
    * Stop PPI 14 days before fecal or breath testing, bc can cause a false (-)

Other ways to test for H. pylori:

  • IgA AB in serum
  • Urea breath test
  • Upper endoscopy w/ gastric biopsy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Treatment plan for PUD?

A
    1. PPI/H2 blocker to supress acids
    1. Get rid of H.pylori
    1. Stop smoking, NSAIDS
  • 4. Repeat EGD testing w biopsy to excluse cancer
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What complications can occur in PUD?

A

If ulcer is located on posterior wall of duodenum or stomach, it can perforate into pancreas (pancreatitis), liver or gallbladder.

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

What is the difference between the definition/etiology of

  • - nutcracker esophagus
  • - diffuse esophageal spasm
A
  • Nutcracker esophagus: Hypertensive peristalsive: contractions are coordinated, but are too strong ( ↑ amplitude & ↑ duration)
  • Diffuse esophageal spasms: multiple spontaneous contractions (occur even when not swallowing) that are long and disrupt coordinated peristalsis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the difference between the lower esophageal sphincter (LES) of

- nutcracker esophagus

- diffuse esophageal spasm

A

- nutcracker esophagus:

  • LES relaxes normally, but has a higher pressure at baseline

- diffuse esophageal spasm:

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

What are the symptoms seen in

  • nutcracker esophagus
  • diffuse esophageal spasm
A

Both:

  1. Intermittant dysphagia to solids & liquids (NOT progressive)
  2. Atypical chest pain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are the diagnosis and treatments seen in

  • nutcracker esophagus
  • diffuse esophageal spasm
A
  • - nutcracker esophagus:
    • Manometry (Tests pressure of LES)
    • Video fluoroscopy
  • - diffuse esophageal spasm:
    • Manometry
    • EGD
    • Barium swallow (corkscrew esophageal spasm)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are the treatments used in

  • nutcracker esophagus
  • diffuse esophageal spasm
A

- Nutcracker esophagus

  1. Nitrates
  2. Calcium ANT
  3. Bc assx with depression and anxiety; check mental health

- Diffuse esophageal spasm

  1. Nitrates
  2. Calcium ANT
  3. Mental health
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is GERD?

A

Motility disorder of the esophagus that causes intermittant esophageal dysphagia (NOT PROGRESSIVE) to solids and liquids, when accompanied by weak peristalsis.

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

What are complications of GERD?

A

If thre patient develops Barretts esophagus, it can become adenocarcinoma.

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

How do we diagnose GERD?

A
  1. Usually GERD is diagnosed clinically, and empirical treatment is given.
  2. If alarm symptoms are present, conduct a EGD
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are the alarm symtpoms associated with GERD? (7)

A
  1. Anemia
  2. Loss of weight that is unexplained
  3. Adenopathy or palpable mass
  4. Recurring vomitting, causing dehydration
  5. Melena/hematemesis
    • Constant or severe pain
    • Dysphagia/odynophagia

ALARM + constant/severe pain & dysphagia/odynophagia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
If a patient with **GERD presents with alarm symptoms**, what should be done?
* 1. **EGD** (esophagogastroduodenoscopy) * 2. **Radiographic ABD imaging** * 3. Eval for **surgery**
26
What is the **treatment** and **management** for **GERD**?
* 1. **Supress acids** and **lifestyle modification** (↓ ETOH/caffeine, small low fat meals, lay at a incline) is *FLOT* * 2. **PPI** * 3. **Get rid of H.pylori,** if present
27
What is a **hiatal hernia?**
**Herniation of the stomach** into the mediastunum =\> through the diaphram (@ **esophageal hiatus)**
28
What are the 2 types of **hiatal hernias?**
**1. Sliding hiatal hernia** **2. Paraesophageal hernia**
29
What is the difference between **sliding hiatal hernias** and **paraesophageal hernias?**
* **Sliding hiatal hernias (90%)** is due to increased intraabdominal pressure due to obesity, pregnancy, and heriditary propensity to have GERD, causing the junction between the stomach and esopagus to slide up through esophageal hiatus. * **Paraesophageal hernia:** when a structure other than stomach herniates into mediastium (MCC colon), leading to an * upside down stomach * gastric volvus * strangulation
30
What is the **dx** and **tx** of sliding hiatal hernias and paraesophageal hernias?
* **DX:** Barium XR * **TX:** if asymptomatic, none. * When sx appear, surgery.
31
What is **food impaction?**
**Food bolus impaction** or **obstruction** that mostly passes spontaneously, causing the pt **not to swallow liquids, even their own saliva** (=\> hypersalivation, drooling, foaming)
32
How is **food impaction** managed and what are symptoms?
* Mostly managed endoscopically, but may require surgery * Severe chest pain/pressure, retching, vomitting, hypersalivation.
33
What is **dysphagia**?
**Difficulty swallowing** food/liquid through mouth, pharynx, and esophagus. The patient senses food sticking in path.
34
What is **global pharyngeus?**
When you **feel like there is a lump in the path**, but there is nothing there and you can still swallow.
35
**When looking at dysphagia consider the following** * - diff swalling in oral phase (oropharyngeal dysphagia) or in esophageal stage (esophageal dysphagia) * -Mechanical/ structural/ motility problem
36
2 important things to consider in history and 2 important things to consider in physical when considering **dysphagia** and **odynophagia**.
* **Hx**: Unintentional WL and hoarseness * **PE**: Neck exam (any masses that can impinge ESO) and skin exam (scleroderma)
37
How do we diagnose **orophargneal dysphagia?** **Esophageal dysphagia (**mechanical vs motor cause)?
1. **Oropharyngeal dysphagia** * Video fluoroscopy of swallowing * **Esophageal dysphagia** 1. *Mechanical* * Barium swallow * Esophagogastroscopy with biopsy 2. *Motor* * Barium swallow * Esophageal motility study (manometry)
38
How can we distinguish, based on symptoms between **orophargngeal dysphagia** vs **esophageal dysphagia?**
* **Orophargngeal dysphagia:** difficulty initiatinng swallowing of ***SOLIDS or LIQUIDS,*** causing the food to stick at suprasternal notch * dysphagia localized to *_neck and pt may have_* nasal regurg, aspiration and ENT sx. * **Esophageal dysphagia** * dysphagia localized to *_chest_* or *_neck_* and food impaction.
39
**Oropharyngeal dysphagia** that causes a hard time swallowing **solids only**, is most likely due to what?
**- Structural causes:** cancer, congenital/acquired webs
40
What are the causes of **oropharyngeal dysphagia?**
* **1. Neurologic disorders** * **2. Muscular and rheumotologic disorders** * Sjrogens * **3. Metabolic disorders** * Meds (anticholinergics) * **4. Infectious disease** * **5. Structural disorders** * **6. Motility disorders**
41
SUMMARY: Causes of **oropharyngeal dysphagia** discussed here
**1. Esophageal webs** **2. Zenkers diverticulum** **3. Sjrogens**
42
**Esophageal webs** cause what kind of dysphagias & what pattern?
* *Mainly **esophageal dysphagia,*** but if proximal, oropharyngeal that is intermittant (NOT PROGRESSIVE).
43
**Esophageal webs** are a __________ problem, making it difficult to swallow \_\_\_\_\_\_.
* **Structural** (thin, diaphragm like membranes of squamous mucosa located proximal or mid esophagus) * **Solids**
44
What is associated with **acquired esophageal webs**?
**1. Eosinophillic esophagitis** **2. \*\*\*Plummer vision syndrome**
45
**Dx** and **tx** for **esophageal web**?
* **Dx:** Barium swallow (esophagogram) * **Tx:** Dilatation via bougie dilator * If \<3 burn or need repeat dilation =\> use PPIs to treat long-term.
46
**Plummer vision syndrome** is associated with \_\_\_\_\_\_\_\_\_\_\_\_\_\_, occurs in _____________ and is associated with the following symptoms (5).
* **Acquired esophageal webs** * **Middle-aged women** * **Symptoms (THE _PLUMBER_ VINCENT _D.I.G.S_ A HOLE FOR THE IRON PIPE)** * **D**ysphagia from esophageal webs * **I**ron def. anemia * **G**lossitis/Angular chelitis (red tongue/red corner of mouth) * **S**ymptomatic proximal esophageal webs, * Other: Koilonychia (spoon nails),
47
**Zenker's diverticulum** cause what kind of dysphagias & what pattern?
**Oropharyngeal dysphagia** (bc upper esophagus is affected) that is *_gradual_* and *_insideous_* over the years.
48
**Zenkers diverticulum** is a __________ problem (describe)
**Structural** problem, creating a false diverticuli (does not involve ALL muscular layers) where the mucosa and submucosa herniatete through muscular layer of the esophagus posteriorly between the **[cricopharyngeaus muscle and inferior pharyngeal constrictor muscles]** =\> loss of elasticity of upper esophageal sphincter (UES), causing food to get stuck.
49
What symptoms are seen in **Zenker's diverticulum** and who does it **MC occur** in**??**
* Symptoms * Halitosis * Spontaneous regurg * Choking at night * Gurgling in throat * MC * Older males
50
**Dx** and **Tx** of Zenkers Diverticulum.
* **Dx:** _Video esophagography\*\*\*_ or Barium swallow; * perform these BEFORE EGD so we will not perforate lumen * **Tx:** Surgery
51
What is a rheumotologic cause of **oropharyngeal dysphagia?**
**Sjrogens syndrome**
52
What symptoms does **Sjrogens** cause?
**Sicca syndrome:** dry mouth, dry eyes, bad teeth =\> causing **oropharyngeal dysplsia**
53
**Sjrogens** is strongly associated with __________ and occurs most commonly in whom?
* **B-cell non Hodgkins lymphoma** * **F** in **mid-50s** that are **post-menopausal.**
54
**Dx** and **Tx** of Sjrogens.
* **Dx:** Lip biopsy and seriolgy * **Tx:** supportive
55
In **esophageal dysphagia**, food sticks ____________ and may be associated with what symptoms?
* **Mid** to **lower sternal area.** * **Regurg, aspiration** and **odynophagia**
56
What causes of **mechanical obstruction** can cause **esophageal dysphagia?** **What types of food do they affect?**
Mechanical obstruction affect **solid foods WORSE** than liquids 1. **Schatzki ring** 2. **Peptic stricture** 3. **Esophageal cancer** 4. **Eosinophillic esophagittis**
57
What **motility disorders** can cause **esophageal dysphagia?**
Motility obstruction affect **both** solid and liquid foods. 1. **Achalasia** 2. **Diffuse esophageal spasm** 3. **Scleroderma** 4. **Ineffective esophageal motility**
58
Describe clues for the following **mechanical obstructions**, which cause **esophageal dysphagia.** * - Schatzki ring * - Peptic stricture * - Esophageal cancer * - Eosinophillic esophagitis
* **- Schatzki ring (I, NP)** * Intermittant dysphagia that is NOT progressive * **- Peptic stricture (P)** * Progressive dysphagia with chronic heartburn that gets BETTER as stricture gets worse * **- Esophageal cancer (P)** * Progressive dysphagia over 50 YO. * **- Eosinophillic esophagitis** * **​**Young adults with small-caliber lumen, proximal strictures or white papules
59
Describe clues for the following **motility disorders,** which cause **esophageal dysphagia.** * - Achalasia * - Diffuse esophageal spasms * - Scleroderma * - Ineffective esophageal motility
* - **Achalasia (P)** * *Progressive* dysphagia W/O heartburn * **- Diffuse esophageal spasms (I, NP)** * *intermittant* dysphagia (*NOT progressive*) that may be assx with atypical CP * - **Scleroderma (P)** * *Progressive* dysphagia assx with chronic heartburn and Rayneuds * **- Ineffective esophageal motility (I, NP)** * ​*Intermittant* dysphagia (NOT progressive) commonly assx with GERD
60
What is **scleroderma**?
**_Scleroderma_** 1. Microangiopathy 2. Atrophy of smooth muscle of the esophagus 3. Fibrosing of skin and visceral organs = aperistaltic esophagus (motility problem) Causes **esophageal dysphagia of MAINLY solid foods**
61
**Scleroderma** is MC in whom? Pattern?
* **F 30-60YO.** * **Progressive dysphagia (↑** severity in AA)
62
**Scleroderma** assx symtoms
* 1. **Chronic heartburn** because LES is incompetent =\> reflux * 2. **Rayneuds**
63
**Dx** and **Tx** of Scleroderma
**Dx: Serology** * If diffuse scleroderma (topoisomerase I AB; Scl-70) * BAD prognosis * If limited scleroderma (anti-centromere AB) * GOOD prognosis **Tx**: Control sx to slow progression and improve quality of life
64
Which **Scleroderma** is considered a **CREST** syndrome?
**Limited scleroderma (good prognosis)** * Calcinosis cutis * Rayneuds * Esophageal dysmoltility * Sclerodactyly * Telangiectasia
65
Other causes of esophageal dysphagia:
**1. Hiatal hernia** **2. GERD**
66
What is the MCC of **reflux esophagitis**?
**GERD**
67
What are causes of **truly refractory (unresponsive) esophagitis?**
1. **Zollinger-Ellison syndrome (gastrinoma with gastric acid hypersection)** 2. **Pill-induced esophagitis** 3. **No response to PPIs** 4. **Noncompliance**
68
What are 2 complications of **GERD**?
**1. Esophogeal stricture** **2. Barrots esophagus**
69
**Esophageal stricture** is a ________ problem that can cause ________ dysphagia.
* **Structural** problem (MC located at **GE junction)** * **Esophageal**
70
What is the **MCC** of **esophageal stricture**?
**Peptic ulcers** caused by GERD.
71
Pt with **esophogeal stricture** will report what on history?
**Progressive** worsening that is **gradual** (months-years) that begins with s**olids =\> solids & liquids.** As it gets worse, **reflux/heartburn gets BETTER.**
72
Dx and tx of **esophageal stricture**
**Dx:** * **Barium swallow** * **_EGD_** is **_MANDATORY_** to differentiate peptic stricutre from esophageal cancer. **Tx:** * Dilation at the time of EGD * Long-term: PPI
73
What is **Barrett's esophagus?**
**Metaplastic columnar cells** (like in intestine) replace **NL stratified squamous** cells in _distal 1/3 esophagus_ due to _GERD_ or _truncal obesity_ * Proximal displacement of _[squamocolumnar junction]_ progresses to esophageal adenocarcinoma.
74
Who is at greatest risk for **Barrett's esophagus**?
**Obese white M \>50 who smoke**
75
**Hx** and **Diagnostics** for Barretts esophagus.
* **Hx:** Most pts are asymptomatic, however other pts will have long hx of GERD (heart burn and regurg). * **Diagnostics:** * **​EGD + biopsy** * ​Orange, gastric epithelium that goes up from stomach =\> distal 1/3 of the esophagus cirfumferentially * **Biopsy**: goblet + columnar cells
76
**Tx** and **management** of Barrets ESO.
**_Tx:_** 1. **PPI** for reflux sx 1. maaaaay reduce risk of cancer. 2. **Endoscopic ablation** to remove dysplastic eptihelium \*\*\* * Surgery (esophagectomy) is not recommended bc causes death. **_Management_** 1. **Survellience endoscopy** every 3-5Y to monitor for *adenocarcinoma* if have [BE or risk factors for cancer]
77
what are risk factors for **adenocarcinoma** of **esophagus**?
Obese, white M older than 50 who is [**obsese**, has **chronic GERD** or **hiatal hernia]**.
78
What is the most common cancer of the esophagus and who is more likely in?
**Squamous cell carcinoma** of the esopahgus ## Footnote **AA M \> 50**
79
Sx, Dx and Tx of **squamous cell carcinoma** of **esophagus**.
* **Sx**: progressive dysphage, WL, anorexia, bleeding, hoarsness and cough * **Dx**: EGD with biopsy (50% occur in middle 1/3 of esophagus) * **Tx**: Surgery (esophagectomy.
80
Who is adenocarcinoma of the esophagus MC in?
**White Males**
81
What part of esophagus **adenocarcinoma** is MC in and why?
**Distal 1/3** of the esophagus due to **Baretts metasplasia** =\> dysplasia =\> adenocarcinoma.
82
Dx and Tx of **adenocarcinoma** of esophagus.
* **Dx**: EGD with biopsy * **Tx**: Endoscopic therapy (ablation)
83
**Esophageal ring (schatzki)** is a ________ problem that causes _______ dysphagia
**structural** (smooth, think, circumferential mucosal structures located distally) **esophageal**
84
Esophageal ring (schatzki) is associated with \_\_\_\_\_\_\_\_\_\_\_.
**Hiatal hernias**
85
**Esophageal ring** sx pattern and affects what?
**Intermittant (N.P),** making it hard to **swallow solids.** **Reflux/GERD is common.**
86
**Dx** and **Tx** of esophageal ring (schatzki)
* **Dx**: Barium swallow (esophagram) * **Tx**: Dilation (bougie dilator)
87
\_\_\_\_\_\_\_ is also called **steakhouse syndrome**. Large, poorly chewed food bolus causes it. Tx: drinking extra liquids and if impacted, endoscopic.
**Esophageal ring (schatzki)**
88
**Achalasia** is a _________ problem that causes _________ dysphagia
**motility** **esophageal**
89
What is **achalasia**?
**[Distal 2/3 of esophagus loses peristalsis]** and **[LES is tight (fails to relax)]** due to denervation of esophagus when NO-producing inhibitor neurons in the myenteric plexus are lost, causing _progressive dysphage of solids and liquids_
90
What are the causes of **Achalasia**?
* 1. **Primary** (**idiopathic**) is due to loss of NO-producing inhibitory neurons in mytenteric plexus * 2. **Secondary**: Chagas disease (reduviid bug that transmits trypanaoma cruzi) * pt may from from/traveling from endemic area
91
Hx of **achalasia**?
**Gradual**, **progressive** onset of dyspagia of solids and liquids, causing **regurigitation of undigested food** (diff from Zenkers). Nocturnal regurg can provoke coughing or aspiration.
92
PE and diagnostics of **achalasia**
**PE**: Painless swelling around eye (romana sign) **Diagnostics**: * Labs: peripheral blood smear shows parasite if Chagas * **Barium esophagogram** (birds beaks distal esophagus) * **EGD** * **Esophageal manometry** confirms diagnosis * compelte absence of NL peristalsis and failure of LES to relax when swallowing \*\*\*
93
What 3 findings do you see on **manometry** in achalasia?
* 1. LES does not relax * 2. Increase LES tone (high esophageal resting pressure) * 3. Aperistalsis
94
What is **odynophagia**?
Pain when swallowing
95

GI II Exam 1 (19 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions