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GI- Week 1 > Erickson: Esophageal Disorders and GERD > Flashcards

Erickson: Esophageal Disorders and GERD Flashcards

1
Q

What is odynophagia?

A

**Pain on swallowing

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2
Q

What is dysphagia?

A

**sx resulting from failure to move a food bolus from the mouth to the stomach

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3
Q

What happens during normal swallowing?

A

Liquids/solids move from mouth to esophagus

Transport along esophagus

Liquids/solids delivered from esophagus to stomach

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4
Q

You see a pt who is having difficulty swallowing. What may be causing this?

A
  1. Inadequate preparation of what’s being swallowed. (decreased saliva/mastication, neuromuscular disorder, impaired mental fxn)
  2. Abnormal muscle strenth/fxn (motility disorder)
  3. Esophageal passageway narrowed (mechanical obstruction)
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5
Q

Difficulty initiating swallowing…

A

oropharyngeal dysphagia

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6
Q

Food stops or STICKS after swallowing initiated

A

esophageal dysphagia

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7
Q

What is a manifestation of oral pharyngeal dysphagia?

A

Things go down the wrong pipe–>aspiration!

Elderly present w/ recurrent pneumonias

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8
Q

What are the goals of therapy for a pt w/ oropharyngeal dysphagia?

A

protect airway

maintain nutrition (may put in feeding tube)

relieve dysphagia

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9
Q

How do you treat oropharyngeal dysphagia?

A
  1. Speech/swallow therapy
  2. esophageal dilation (strictures)
  3. surgical myotomy (zenker’s diverticulum)
  4. NPO w/ nutrition support (PEG, PEJ, TPN) –Use gut first
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10
Q

What are causes of benign dysphagia in the esophagus?

A

peptic strictures
rings and webs
caustic scars (not seen often–drinking lye)

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11
Q

What cancers can cause esophageal dysphagia?

A

primary esophageal

extrinsic compression pushing on the esophagus

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12
Q

What are neuromuscular causes of dysphagia?

A

Primary esophageal disease (ACHALASIA, CHAGAS, motor disorders)

Secondary (GERD)

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13
Q

What is achalasia?

A

Loss of inhibitory innervation to the LES

Loss of VIP/NO so only have pro-contraction forces. Progresses as life long dysphagia over decades. Eat and then drink a lot of water to push food through.

Regurgitate
Chest pain
Weight loss

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14
Q

Manometry of a pt w/ achalaasia shows…

A

non relaxing LES

esophageal aperistalsis

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15
Q

Barium swallow in a pt w/ achalasia shows…

A

bird’s beak narrowing at LES

dilated esophagus

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16
Q

What can cause a secondary achalasia?

A

carcinoma at the esophagogastric jxn (mimics achalasia)

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17
Q

What are two treatments for achalasia?

A
  1. Nifedipine (Prevents contraction)
  2. Botulinum Toxin (Prevents release of ACh)
  3. Balloon dilation–> tear fibers of lower sphincter
  4. Esophagogastric myotomy–> tear fibers of lower sphincter
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18
Q

A pt presents to you w/ a diffuse esophageal spasm. What do you see on manometry and barium swallow?

A

Simultaneous contractions of the esophagus (should be nice and orderly)

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19
Q

What do manometry and a barium swallow show you in a pt w/ systemic sclerosis?

A

Sclerosis is a systemic disease that can lead to NO contractions in the esophagus. It becomes a lead pipe. So pt’s have acid reflux all the time

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20
Q

What is the MCC of GERD?

A

Transient LES relaxations

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21
Q

*A pt presents who intermittently can’t swallow solids?

A

Lower esophageal ring

Likely related to reflux

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22
Q

*A pt presents who progressively can’t swallow solids.

A

Peptic stricture

Cancer (esp if > 50)

23
Q

*A pt presents who intermittently can’t swallow solids/liquids.

A

Diffuse spasm
NEMD
Nutcracker

24
Q

*A pt presents who progressively can’t swallow solids or liquids.

A

Achalasia

Scleroderma

25
Q

What can cause painful swallowing?

A
  1. Tongue, tonsillar, pharyngeal pathology
  2. Inflammation of mucosa lining (esophagitis)
  3. Muscular spasm
  4. Mediastinal disease (structures around the esophagus that are inflamed)
26
Q

What external factors can cause GERD?

A

Diet
high fat foods
smoking
medication

27
Q

What can cause diminished esophageal clearance affecting GERD?

A

Peristalsis
Body position
Saliva

28
Q

What can cause an defective anti-reflux barrier leading to GERD?

A

LES
crural diaphragm
hiatal hernia

29
Q

What are gastric factors that can cause GERD?

A

Acid
bile acid
gastric emptying
gastric distension

30
Q

What is the classic sx of GERD?

A

HEARTBURN

31
Q

If you suspect that a pt has GERD, what do you ask them?

A
  1. do you feel substernal burning/regurgitaiton
  2. postprandial
  3. aggravated by change in position
  4. prompt relief by antacids
32
Q

What are common esophageal sxs of GERD

A

Heartburn
regurgitation
belching
water brash (increase in salivary secretion w/ heart burn)

33
Q

A pt presents w/ chest pain, hoarseness/laryngitis, loss of dental enamel, asthma/chronic cough, dyspepsia. You suspect…

A

Atypical GERD

34
Q

What sxs are associated w/ complications of GERD?

A

dysphagia
odynophagia (ulcer related to the bleeding)
bleeding

35
Q

How can hitatal hernias contribute to reflux?

A
  1. No diaphragmatic support of LES

2. HH is reservoir for gastric contents that causes irritation

36
Q

If a pt presents w/ heartburn/regurge, that is postprandial, postural and decreased w/ antacid. What do you do?

A

Start empiric tx

NO diagnostic studies needed…but make sure it’s not cardiac disease

37
Q

Why might we do a barium swallow?

A

widely available

inexpensive

Good at identifying hiatal hernia, or stricutres

38
Q

Why might we not do a barium swallow?

A

operator dependent

esophagitis, Barrett’s epithelium

39
Q

What is the best initial diagnostic study for pts w/ reflux sxs and dysphagia?

A

Barium swallow

40
Q

What is the best diagnostic study for evaluating mucosal injury?

A

Endoscopy w/ biopsy

Good for:

  • esophagitis, barrett’s epithelium
  • Hiatal hernia, strictures
41
Q

What is the best study to confirm GERD?

A

Ambulatory pH monitorying

42
Q

What assesses LES pressure peristalsis?

A

Esophageal manometry

43
Q

**What is the cornerstone of GERD therapy?

A

Life style modifications

  • elevate head of bed
  • no food 3 hrs before bed time
  • stop smoking
  • less fat/volume
  • avoid peppermint, onions, citrus juice, coffee, tomatoes
  • avoid harmful meds
  • OTS meds
44
Q

What drugs can decrease LES pressure and make GERD worse?

A

theophylline
anticholinergics
Ca blockers
nitrates

45
Q

What drugs can injure the mucosa and make GERD worse?

A 
tetracyclines--can directly injure mucosa
quinidine
aspirin/NSAIDS
K tablets
Fe salts
46
Q

Why are cimetidine, ranitidine, famotidine, and nizatidine all good treatments for you pt w/ GERD?

A

They all SUPPRESS ACID b/c they are H2 receptor ANTAGONISTS

47
Q

Why might omeprazole and lansoprazole also be good tx for your pt w GERD?

A

Both are PPIs and suppress ACID!

48
Q

What are anti-reflex operations?

A

Wrap part of the stomach around esophagus

Hill repair
Nissen repair
Belsey repair

49
Q

What is Barrett’s esophagus?

A

COLUMNAR epithelium replaces the SQUAMOUS epithelium in the DISTAL esophagus

50
Q

What causes barrett’s esophagus?

A

GER injures squamous epithelium and promotes repair by columnar metaplasia

51
Q

What is a major risk factor for esophageal adenocarcinoma?

A

Barrett’s esophagus

52
Q

What causes peptic esophageal strictures?

A

ulceration stimulates fibrosis

Often associated w/ NSAIDs

53
Q

How do you tx peptic esophageal strictures?

A

Aggressive acid suppression
dilation
surgery

54
Q

Mallory Weiss

A

Longitudinal esophageal tear related to repeated vomitting

GI- Week 1 (12 decks)

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