Esoph CA, Disorders, GI motility Disorders Flashcards
What are the 2 principle types of esophageal carcinoma?
Adenocarcinoma
SCC
What are the main causes of each? (adenocarcinoma, SCC)
Adenocarcinoma- Chronic acid reflux
SCC- smoking and EtOH
What are the 2 gastroesophogeal barriers to stomach acid?
Crural diaphragm
LES
What is the difference btwn paraesophageal and hiatal hernias?
Which one can require surgical amendment?
With Hiatal hernias you have an increased risk of GERD
Paraesophageal hernias can lead to upside down stomach, gastric volvulus, strangulation of stomach
Can require surgical amendment
What is achalasia?
Achalasia is tonically contracted LES that fails to relax appropriately during swallows along with dilated, peristaltic esophagus
How is achalasia diagnosed?
Manometry
What are the basic surgical techniques and pharmacological treatments for achalasia?
Heller myotomy
Balloon dilation
Nitrates/CCBs
What are the esophageal manifestations of systemic scleroderma?
Dilated
Aperistaltic esophagus
Free reflux
Peptic stricture
How is scleroderma it treated?
Treated with PPI to reduce reflux/gastritis
What is the composition of a Schazki’s ring?
Circumferential mucosal ring in the setting of hiatal hernia
How does a Schazki ring manifest and how is it treated?
Dysphagia upon swallowing (steakhouse syndrome)
Dilation with EGD
What is Plummer-Vinson syndrome?
Esophageal webs that form in the proximal esophagus in association with iron deficiency anemia
What are the symptoms for Plummer-Vinson syndrome?
Web
Fatigue
Pica
What is the most common disorder of the esophagus?
GERD
How is GERD documented and graded?
Based on severity and classification by the Los Angeles classifications
How do you classify by LA classifications?
By EGD and 24-48 hr pH probe placed above the Z ling (GJ junction)
What are the symptoms and complications of GERD?
Hearburn Epigastric pain Dysphagia Odynophagia Water brash
How are mild, moderate and severe GERD treated?
Mild/moderated- H2-antagonists/PPIs, antacids temporarily, lifestyle changes
Severe- Laparascopic fundoplication
What is Gastroparesis?
Delayed gastric emptying
What are the symptoms for gastroparesis?
Early satiety Bloating N/V Anorexia Wt loss Endocrine/metabolic disorders (DM) CNS
What are effective treatments for gastroparesis?
Low fat diet
Meds- erythromycin, zithromax, domperidone, metaclopramide
Simple (lifestyle) Measures for GERD
Elevate head of bed Avoid food/liquid 2-3 hrs before bedtime Avoid fatty/spicy foods Avoid alcohol/cigarettes Weight loss Liquid antacid 30mL, 30 mins after meals and at bedtime OR otc H2 antagonist
What is the radiological appearance of achalasia?
Dilated, fluid-filled esophagus, distal bird-beak stricture
What is the radiological appearance of Scleroderma?
Aperistaltic esophagus
free reflux
peptic stricture
What is the radiological appearance of diffuse esophageal spasm?
Simultaneous non-coordinated contractions
What are the manometric findings of achalasia?
LES- High resting pressure
Incomplete/abnormal relaxation w/ swallow
Body- low amp, simultaneous contractions AFTER swallowing
What are the manometric findings of scleroderma?
LES- Low resting pressure
Body- low amp peristaltic contraction or no peristalsis
What are the manometric findings of diffuse esophageal spasm?
LES- normal pressure
Body- Some peristalsis
Diffuse and simultaneous non-peristaltic contractions, occasionally high amp
What are the symptoms for diffuse esophageal spasm?
Substernal chest pain (angina-like)
Dysphagia with pain
