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Gastroenterology > Esophageal and GI Motility Disorders > Flashcards

Esophageal and GI Motility Disorders Flashcards

1
Q

This is a hollow muscular tube coursing through the posterior mediastinum joining the hypopharynx to the stomach with a sphincter at each end

A

Esophagus

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2
Q

What is the key function of the esophagus?

A

Transporting food and fluid between these ends

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3
Q

If there is pain in the chest, what is your first instinct?

A

Heart Problem, but if ruled out it can be GI, inflammation, infection, dysmotility, or a neoplasm.

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4
Q

This is a crucial part of the patient interview with esophageal diseases.

A

Clinical History

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5
Q

What are important history questions to ask about?

A
  1. Weight gain or loss
  2. GI bleeding
  3. Dietary Habits including the timing of meals
  4. Smoking and Alcohol Consumption
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6
Q

When there are “esophageal” symptoms what should you think about?

A
  1. Heartburn
  2. Regurgitation
  3. Chest Pain
  4. Dysphagia
  5. Odynophagia
  6. Globus Sensation
  7. Water brash
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7
Q

The term used when a person has the feeling of a lump in their throat when actually there is no lump present. Often occurs in the setting of anxiety or OCD.

A

Globus Sensation

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8
Q

This is a condition of excessive salivation resulting from a vagal reflex triggered by acidification of the esophageal mucosa.

A

Water brash

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9
Q

What are the diagnostic studies that can be completed the check for GI/Esophageal Issues

A 
Endoscopy
Radiography
Endoscopic US
Esophageal Manometry
Reflux Testing
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10
Q

Take a look at the pictures of different Esophageal Conditions. May be on the exam and need to identify the dz. (Endoscopy and Radiography)

A

Noharproble

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11
Q

The _________ is an opening in the diaphragm – the muscular wall separating the chest cavity from the abdomen.

A

Hiatus

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12
Q

Normally, the esophagus (food pipe) goes through the hiatus and attaches to the stomach. In a _______________ the stomach bulges up into the chest through that opening.

A

Hiatal Hernia (Structural Disorder)

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13
Q

This type of hiatal hernia is described as sliding. Comprised of at least 95% of the overall total. This increases the risk of GERD.

A

Type I

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14
Q

This type of hiatal hernia can lead to an upside down stomach, gastric volvulus, and even strangulation of the stomach. Because of this risk, surgical repair is often advocated.

A

Type II or III

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15
Q

This is a lower esophageal mucosal ring of unknown origin that is thin, membranous narrowing at the squamocolumnar mucosal junction. Is this symptomatic?

A

B Ring; Nope!

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16
Q

If the lumen of the esophagus is less than 13 mm, the distal mucosal rings would be called _________ and they are typically symptomatic because of episodic food dysphagia.

A

Schatzki rings

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17
Q

One of the most common causes of intermittent food impaction, also known as “steakhouse syndrome” as meat is a typical instigator. Symptomatic rings are easily treated by dilatation .

A

Schatzki Rings

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18
Q

False diverticula involving herniation of the mucosa and submucosa through the muscular layer of the esophagus. These lesions result from increased intraluminal pressure associated with distal obstruction .

A

Zenker’s Diverticula

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19
Q

Zenker’s Diverticulum obstruction is caused due to the stenosis of this muscle that is involved in the upper esophageal sphincter.

A

Cricopharyngeus

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20
Q

The hypopharyngeal herniation most commonly occurs in an area of natural weakness known as _____________.

A

Killian’s triangle

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21
Q

This type of esophageal cancer is strongly linked to reflux dz and Barrett’s Metaplasia and mostly affects white males in the distal esophagus

A

Adenocarcinoma

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22
Q

This type of esophageal cancer affects the proximal esophagus with the added risk factors of smoking, alcohol consumption, caustic injury, and HPV. Most commonly seen in black males.

A

Squamous Cell Carcinoma

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23
Q

What conditions can GERD cause?

A
  1. Esophagitis
  2. Stricture
  3. Barrett’s Esophagus
  4. Adenocarcinoma
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24
Q

A condition in which the tissue lining the esophagus—the muscular tube that carries food and liquids from the mouth to the stomach—is replaced by tissue that is similar to the intestinal lining

A

Barret’s Esophagus

25
Q

What are the typical symptoms of Gastroesophageal Reflux?

A
  1. Heartburn
  2. Regurgitation
  3. Frequent Belching
26
Q

What are the aypical symptoms of Gastroesophageal Reflux?

A
  1. Non-cardiac CP
  2. Hoarseness
  3. Wheezing (Adult Onset Asthma)
  4. Chronic Cough
27
Q

What can cause GERD to occur?

A
  1. Diminished esophageal clearance
  2. Defective anti-reflux barrier
  3. Gastric Factors (gastroparesis, hypersecretion of HCl)
  4. Impaired mucosal resistance (meds/saliva)
  5. External Factors (diet, meds)
  6. Obesity
28
Q

How do you dx GERD?

A
  1. History!!!
  2. Endoscopy to check for esophagitis
  3. Esophageal pH study (checks for abnormalities and duration of acid reflux episodes)
29
Q

Why do we do so many tests to check for GERD?

A

It needs to have other causes excluded.

  1. Infection
  2. Pill Esophagitis
  3. Eosinophilic Esophagitis
  4. Peptic Ulcer Dz
  5. Dyspepsia
  6. Biliary Colic
  7. CAD
  8. Esophageal Motility D/o
30
Q

How do you treat GERD?

A
  1. Dietary/Lifestyle Modifications
  2. PPIs&raquo_space; Histamine2 Receptor Antagonists&raquo_space; Placebo
  3. Laparoscopic Nissen Fundoplication
31
Q

What is a Laparoscopic Nissen Fundoplication?

A

The proximal stomach is wrapped around the distal esophagus to create an antireflux barrier. Surgerical intervention for chronic GERD

32
Q

WTH is Eosinophilic Esophagitis?

A

Immunologic Response to ingested inhaled allergens. Most commonly a disease of young-midage adults (though formerly a child dz). It is essentially the mucosal infiltration of eosinophils.

33
Q

A patient comes into clinic complaining of difficulty swallowing for the past couple days. Some complaints of vomiting. What are we thinking in this DDx?

A
  1. GERD
  2. Peripheral Eosinophilia
  3. Assc with Asthma
34
Q

A patient comes into clinic complaining of difficulty swallowing for the past couple days. Some complaints of vomiting. We put them on a PPI and the effects seem to persist. What are we thinking now?

A

Eosinophilic Esophagitis, let’s do an endoscopy!

35
Q

What do we see on an endoscopy for a patient with Eosinophilic Esophagitis?

A
  • Normal mucosa in 1/3 pts
  • Short or long esophageal strictures, anywhere by proximally
  • Multiple esophageal rings, furrow, erythema, “feline esophagus”
  • Small caliber esophagus
36
Q

How do you treat Eosinophilic Esophagitis?

A
  1. Eliminate food allergens!
  2. Allergy Testing (though limited specificity on causative foods)
  3. Topical Steroids, i.e. swallowed fluticasone, oral viscous budesonide
  4. Systemic Steroids (severe pts only)
  5. Esophageal Dilation should be approached cautiously in pts with stricure b/c of concerns for inc. risk of esophageal mural disruption and perforation.
37
Q

Esophageal Motility Disorders are:

A
  1. Achalasia
  2. Diffuse Esophageal Spasm (DES)
  3. Scleroderma Esophagus
38
Q

This condition is caused by the incompleted lower esophageal sphincter relaxation, hypertensive lower esophageal sphincter, or aperistaltic contractions of the esophageal body.

A

Achalasia

39
Q

Clinical Manifestations of Achalasia

A
  1. Dysphagia
  2. Regurgitation
  3. Chest pain
  4. Weight loss
40
Q

Patients with advanced achalasia are at risk for what?

A
  1. Bronchitis
  2. Pneumonia
  3. Lung Abscess

All due to chronic regurg and aspiration

41
Q

What is the most sensitive diagnostic test for achalasia (and other early diseases of the esophagus).

A

Manometry

42
Q

How do you treat Achalasia?

A
  1. Laparoscopic Heller Myotomy
  2. Endoscopic Pneumodilation
  3. Botox Injection
  4. Per-Oral Endoscopic Myotomy
43
Q

This condition is defined as episodes of dysphagia and chest pain attributable to abnormal esophageal contractions with normal deflutitive LES relaxation.

A

Diffuse Esophageal Spasm (DES)

44
Q

Because esophageal pain mimics that on angina pectoris. What are ways to determine if it is from the esophagus?

A
  1. Non-exertional
  2. Prolonged
  3. Interrupts sleep
  4. Meal-related
  5. Relieved with Antacids
  6. Accompanied with Heart burn, dysphagia, or regurg.
45
Q

How do you treat DES (Diffuse Esophageal Spasm)?

A
  1. nitrates
  2. calcium channel blockers
  3. hydralazine
  4. botulinum toxin
  5. anxiolytics ***only one with shown efficacy
  6. Sx – severe weight loss or unbearable pain
46
Q

This condition is defined by hypotensive LES, aperistaltic contractions of the body (low amplitude), GERD and Dysphagia occurring.

A

Scelerodermal Esophagus – Motor Disorder

47
Q

How would you treat Sclerodermal Esophagus D/o?

A
  1. Acid suppression (PPI)
  2. Gastroprokinetics (Metoclopramide, Bethanechol erythromycin suspension, azithromycin liquid)
  3. Lifestyle modifications
48
Q

What are the most common causes of Infectious Esophagitis?

A
  1. Candida
  2. Herpetic
  3. Cytomegalovirus
  4. HIV
49
Q

What are the most common causes of mechanical taruma and iatrogenic injury?

A
  1. Esophageal perforation
  2. Mallory-Weiss tear
  3. Radiation esophagitis
  4. Corrosive Esophagitis
  5. Pill Esophagitis
  6. Foreign Bodies
  7. Food impaction
50
Q

A 52 year-old man has GERD symptoms for the last 3 months. Symptoms are partially relieved by antacids or tagamet when use as PRN. There are no other problems. What is the best course of action?

A. EGD for biopsy
B. A trial of daily PPI
C. Continue present treatment

A

B!

51
Q

A 51 year-old man has acid reflux symptoms for 8 years. He uses a PPI intermittently. He comes to you for recurrent symptoms. What is your best course of action?

A. EGD for biopsy
B. PPI daily
C. PPI daily plus a prokinetic agent

A

A!

52
Q

A 62 year-old patient with known Barrett’s esophagus and no dysphagia is asymptomatic. When would you order follow-up endoscopic biopsies?

A. Every year
B. Every 2-3 years
C. Not until he becomes symptomatic

A

B!

53
Q

A 61-year old patient c/o dysphagia for solid food initially that gradually progress to include liquids. Barium swallow shows a stricture in the esophagus. Next step?

A. EGD for biopsy
B. EGD for dilation

A

A!

54
Q

A 63-year old patient with Barrett’s esophagus is found to have low-grade dysplasia. Patient is started on a PPI. What is the next step?

A. Repeat endoscopic biopsies in 1 month
B. Surgery (Esophagectomy)
C. Repeat endoscopic biopsies in 3-6 months
D. Observation

A

C!

55
Q

A 53-year old man has long-standing heartburn and Barrett’s esophagus. EGD shows high-grade dysplasia. What is the management?

A. Increase the dose of omeprazole and repeat EGD in 3 months
B. Fundoplication
C. Surgical consult for esophagectomy

A

C!

56
Q

A barium swallow shows corkscrew deformity. What is the treatment?

A

Nitrates!

57
Q

A 32-year old patient has dysphagia for solid and liquid food. Barium swallow showed dilated esophagus with bird beak appearance. What is your next best choice?

A. 24 hour pH monitoring
B. Endoscopy with biopsy
C. Motility study
D. Trial of omeprazole

A

B!

58
Q

A 24-year old man c/o mid-sternal severe chest pain when ingesting hot or cold liquid food. Barium swallow is normal. Cardiac work-up is also unremarkable. What is the diagnostic test of choice?

A. 24 hour pH monitoring
B. EGD
C. H2 blockers
D. Manometry

A

D!

Gastroenterology (12 decks)

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