Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Clin Med 2 > Esophageal and Stomach > Flashcards

Esophageal and Stomach Flashcards

1
Q

What is the esophagus

A

muscular tube that connects pharynx to stomach

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

Twi sphincters of the esophagus and what they do

A

UES : Prevents aspiration; voluntary

LES: Prevents reflux of gastric content; less voluntary

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

Two sphincters of the stomach

A

Pyloric (dital; connects stomach to duodenum) and LES (gateway between esophagus and stomach

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

Fxn stomach

A
  • Movement and release of chemicals all controlled via the autonomic nervous system
  • Digest, Absorb, Store
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Patho dysmotility disorder

A

DYSFUNCTION OF COORDINATED PERSITALSIS/MOTILITY PATTERN OF THE ESOPHAGUS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Causes dysmotility disorder

A
  • Achalasia
  • Diffuse Esophageal Spasm
  • Nutcracker esophagus
  • Hypertensive LES
  • Scleroderma esophagus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is achalasia

A

Failure of the LES to relax–> obstruction and proximal dilation of the esophagus

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

What is Diffuse Esophageal Spasm

A

uncontrolled movement of the esophagus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is nutcracker esophagus

A

Increase in pressure in the distal esophagus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Hypertensive LES

A

relaxing LES has increase in pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Scleroderma esophagus

A

Smooth muscle atrophy–> replaced by fibrosis–> lack of function and tone of LES

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Clinical dysmotility disorder

A 
dysphagia
- progressive solid to liquid
- regurg at night and supine
- long duration of sx
Chest pain
- sudden, squeezing in the retrosternal
exacerbated by food and stress
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

DX dysmotility disorder

A

Barium Esophagram- birdbeak or corkscrew

Esophageal Manometry

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Tx dysmotility disorder

A 
Lifestyle
- eat slow, not at bed time
CCB/Nitrates
Botulism injection into LES
Pneumatic dilation
Heller Myotomy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Patho Esophageal strictures

A

NARROWING OF THE LUMEN OF THE ESOPHAGUS

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

Causes Esophageal distal strictures

A

Peptic- GERD
Adenocarcinoma
Collagen vascular disease (scleroderma, lupus)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Causes Esophageal proximal/mid strictures

A
  • caustic ingestion
  • malignancy
  • radiation
  • esophagitis (infectious, pill)
  • Eosinophilic esophagitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is Schatzki ring?

A

narrowing of the esophagus due to ring of tissue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Clinical Esophageal stricture

A
  • Dysphagia*- slow onset, solid to liquid
  • Odynophagia
  • Heartburn
  • Food impaction
  • Chest pain
  • Chronic cough, asthma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Clinical Schatzki ring

A
  • Dysphagia*- intermittent, non-progressive, solids only
  • Odynophagia
  • Heartburn
  • Food impaction
  • Chest pain
  • Chronic cough, asthma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Dx esophageal stricture

A
  • Barium Esophagram

* Endoscopy- can see pathology in the lumen

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

Tx esophageal stricture

A 
Lifestyle Modifications
o	Weight loss
o	Avoid exacerbate food and medications
o	Small meals & eat slowly and deliberately
Rx
o	PPI
o	Intralesion steroid injection- If PPI and/or dilation fails; Only benign lesion
EGD w/ Esophageal dilation*
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Patho Zenker Diverticulum

A

PROTRUSION OF PHARYNGEAL MUCOSA. CAUSING A PHARYNGOESOPHAGEAL DIVERTICULUM

Due to loss of elasticity in UES

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Clinical Zenker Diverticulum

A

halitosis, regurgitation of undigested food, gurgling in throat

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Dx Zenker Diverticulum

A

barium esophagram

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Tx Zenker Diverticulum

A

myotomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Patho Mallory Weiss Tear

A

Upper GI bleed d/t longitudinal mucosal lacerations @GIJ or gastric cardia typically d/t persistent retching/vomiting (sudden rise in esophageal pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Classic ptn for Mallory Weiss Tear

A

pregnancy; alcoholic males

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Clincal Mallory Weiss Tear

A

Hematemesis 85%
o Vomit/retch then hematemesis classic- blood streaked vomit
Melena
Hematochezia
Syncope/Assoc GI hemorrhagic hypovolemia
Guaic stool positive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Gold standard Mallory Weiss Tear

A

EGD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Tx Mallory Weiss Tear

A 
Stable patient- healing in 24-48hrs without intervention
•	IVF PRN
•	Anti-emetics
•	Sulcrafate for 1-2wks
•	PPI for 1-2wks
•	D/c home
Unstable Patient
•	H/H q6
o	pRBC for hemodynamic support PRN
o	HCT <30 w/ CAD and symptoms
•	Correct coagulopathy (warfarin)
o	Vitamin K/FFP/PCC
•	EGD
•	Admit
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Patho Boerhaave Syndrome

A

Transmural perforation of the esophagus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What is the most lethal perforation of the GI tract

A

Boerhaave Syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Clinical Boerhaave Syndrome

A
  • repeated episodes of retching and vomiting
  • severe chest pain lower thorax and upper abdomen radiating to the back or left shoulder.
  • Swallowing aggravates the pain
  • Shortness of breath
  • Mackler triad
  • Neck pain, upper chest pain, epigastric pain
  • rales (pleural effusion)
35
Q

Dx Boerhaave Syndrome

A

Chest radiography- unilateral effusion

Esophagraphy- confirm dx

36
Q

Tx Boerhaave Syndrome

A

IVF resuscitation
Broad Spectrum Antibiotics
Prompt Surgical Intervention (mainstay tx)- Left thoracotomy

37
Q

Causes pre-hepatic esophageal varicies

A
  • portal /splenic vein thrombosis

- portal vein stenosis

38
Q

Causes intra-hepatic esophageal varicies

A

cirrhosis- alcohol or chronic hepatitis

39
Q

Causes post-hepatic esophageal varicies

A

budd-chiari
extrinsic tumor compression
R. HF
IVC thrombosis

40
Q

Clinical esophageal varicies

A
  • Hematemesis
  • melena
  • hematochezia
  • Pale, hypotensive, lightheaded, syncope, orthostatic, tachycardic
  • Liver disease/Cirrhosis signs : jaundice, pruritus, ascites, encephalopathy/MS changes, muscle cramps, anorexia, spontaneous bleeding/easy bruising, abdominal pain, nausea/vomiting
41
Q

Dx esophageal varicies

A

EGD- Every 2-3yrs to monitor enlargement
Capsule endoscopy
Ultrasound*- Screen for portal HTN
CT/MRI- When ultrasound inconclusive

42
Q

Tx esophageal bleed

A
  • 2 large bore IV access/Central access
  • pRBC txn (target 25-30)
  • Octreotide 50mcg/hr
  • Desmopression 1-2 mg q 4 hours
  • Endoscopy *- Varix ligation (banding)
  • Band ligation*
    Last resort
    TIPS (transjugular intrahepatic portosystemic shunt)
    Angiotherapy
    Balloon tube tamponade
43
Q

Patho esophagitis

A

INFLAMMATION, IRRITATION OR SWELLING OF THE ESOPHAGUS

44
Q

Cause esophagitis

A
  • Reflux Esophagitis (GERD)
  • Infectious-HSV, Candida, CMV
  • Allergic/Eosinophilic
  • Pill-Esophagitis
  • Radiation induced
  • System Illness

45
Q

Clinical esophagitis

A
  • retrosternal pain
  • heart burn
  • odynophagia
  • dysphagia
  • water bursh
  • globus densation
  • food impaction
  • laryngitis
  • chronic cough
  • hematemesis
  • abdominal pain
  • weight loss
46
Q

MC site for pill induced esophagitis

A

aortic arch

47
Q

Dx pill induced esophagitis

A

Clinical and EGD

48
Q

Tx pill induced esophagitis

A

stop agent
take pill with 8oz water
stay upright for over 30 min after taking pill
eat in 30 min of pill
take antacids, sulcrafate, lidocaine, PPI

49
Q

Cause pill induced esophagitis

A 
aspirin
NSAID
tetracyclines
doxycyclines
clindamycin
bisphosphonates
**decrease pH to 3
50
Q

Infectious esophagitis due to

A

Candida
HSV
CMV

51
Q

Clinical Candida esophagitis

A

odynophagia
Immunocompromised ptn
Thrush

52
Q

Dx Candida esophagitis

A

Clinical; EGD

53
Q

Tx Candida esophagitis

A

Fluconazole

54
Q

Isolated Eosinophilia Esophagitis has a history of

A

atopy, asthma, food or medicine allergies

55
Q

Isolated Eosinophilia Esophagitis mainly occurs in

A

Men 20-30

56
Q

Isolated Eosinophilia Esophagitis associated with

A

achalasia, GERD, crohns, connective tissue dx.

57
Q

Dx Isolated Eosinophilia Esophagitis

A

Esophageal PH
EGD
PPI trial

58
Q

Tx Isolated Eosinophilia Esophagitis

A

Elimination and elemental diets
PPI
Topical Glucocorticoid- Fluticasone 440-880mcg BID
Esophageal dilatation to tx strictures

59
Q

Def GERD

A

CONDITION THAT DEVELOPS WHEN REFLUX OF STOMACH CONTENTS CAUSE TROUBLESOME SYMPTOMS OR COMPLICATIONS OF THE ESOPHAGUS

60
Q

Patho GERD

A

Transient lower esophageal sphincter relaxation; hypotensive lower esophageal sphincter; anatomic disruption of the GE junction

61
Q

RF GERD

A
  • Obesity
  • Pregnancy
  • +/- Foods (coffee, alcohol, chocolate, fatty meals)
  • +/- Tobacco/nicotine
  • Zollinger-Ellison Syndrome
62
Q

Clinical GERD

A
  • retrosternal pain
  • heart burn
  • odynophagia
  • dysphagia
    WATER BRUSH
  • globus densation
  • food impaction
    LARYNGITIS
  • chronic cough
  • hematemesis
  • abdominal pain
  • weight loss
63
Q

MC complication of GERD

A

esophagitis

Barrets esophagus

64
Q

DX GERD

A

Clinical; EGD

65
Q

GERD classification

A

Grade I – erythema
Grade II – Linear non-confluent 
erosions
Grade III – Circular confluent erosions
Grade IV – Stricture or Barrett Esophagus

Symptom
Mild symptoms or Intermittent <2 episodes/week
Severe or Frequent > 2 episodes/wk and severe

66
Q

Tx GERD

A 
Lifestyle modifications
o	Lose weight
o	Avoid exacerbating foods
o	Avoid large meals
o	Eat 3 hours before lying down
o	Elevate head of the bed
Meds
o	Antacids- symptomatic
o	H2RA- mild
o	PPI- severe
Surgery- Nissen Fundoplication
67
Q

GERD endoscopy screening

A

Patients > 50 yo age

Patients with chronic GERD symptoms >5 years
- identify Barret’s esophagus, to prevent transition to adenocarcinoma

68
Q

GERD Surgery indications

A
  • Desire to discontinue medical treatment
  • Medication non-compliance
  • Presence large hiatal hernia
  • Esophagitis refractory to treatment
  • Persistent symptoms
69
Q

Patho gastritis

A

INFLAMMATION OF THE LINING OF THE STOMACH ASSOCIATED WITH MUCOSAL INJURY

70
Q

Erosive v. non-erosive

A

Erosive- bleeding, ulceration

Non-erosive= inflammation

71
Q

Cause gastritis

A 
Infection - H.Pylori
Medications – NSAID #1
Alcohol
Smoking
Autoimmune: Crohn’s
Radiation therapy
Allergic/Eosinophilia
72
Q

Complication gastritis

A

PUD
MALT lymphoma
Pernicious anemia

73
Q

Clinical gastritis

A
  • Epigastric pain
  • Burning sensation
  • Gnawing Sensation
  • Nausea +/- vomiting
  • +/- Hematemesis (BR or coffee ground)
74
Q

Dx gastritis

A

Clinical Diagnosis
H. Pylori Testing- Breath, Stool, Serum
UGI series- Thick folds, inflammatory nodules, erosion
EGD

75
Q

Tx gastritis

A
  • H. Pylori – Triple therapy (PPI +Amoxicillin + Clarithromycin)
  • D/c offending agent
  • Antacids (Alka-Seltzer, Maalox, Mylanta, Rolaids)
  • H2RA: cimetidine (Tagamet), famotidine (Pepcid), e.g
  • PPI: omeprazole (Prilosec), lansoprazole (Prevacid), pantaprazole (Protonix
76
Q

Patho PUD

A

DEFECT IN GASTRIC OR DUODENAL MUCOSA THROUGH THE MUSCULARIS MUSCOSA INTO DEEPER LAYERS OF THE WALL

77
Q

RF PUD

A 
H. Pylori-Produce urease
NSAIDs
Age
Hypersecretory states (rare)
Genetic Factors
Acute physiologic stress- burns, cushing dz
78
Q

Complication PUD

A

GI bleed, perforation, obstuction

79
Q

Clinical PUD

A
  • Asymptomatic
  • Epigastric pain
    o Gastric – while eating
    o Duodenal – hours after eating or middle of the night
  • Early satiety
  • Nausea +/- vomiting
  • Belching, bloating, distention
  • Chest pain/heartburn
  • GI bleed– hematemesis, melena
  • Guaic + stools
  • Perforation – sudden onset of pain +/- peritoneal signs
80
Q

Dx PUD

A

H. Pylori Testing Options
o EGD Biopsy w/ Rapid urease testing
o Urea breath test- best in patient with active GI bleed
Endoscopy +/- biopsy- Gold standard

81
Q

Tx PUD

A
  • Consider PPI – Non H.Pylori and Non-NSAID ulcer

- Advise discontinue of tobacco, minimize alcohol, avoid spicy foods

82
Q

Consider long term PPI PUD

A

o Recurrent PUD
o Refractory PUD
o Continued NSAID or ASA therapy
o >50 yo age

83
Q

Tx active bleed PUD

A
  • IVF, Blood transfusion
  • High dose IV PPI (Protonix)bolus and drip
  • Endoscopic Intervention
    o Epinephrine injection
    o Hemoclips
    o Thermal coagulation
  • Surgery

Clin Med 2 (25 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions