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Medicine I: Gastroenterology > Esophageal Cancer, Disorders and GI Motility Disorders > Flashcards

Esophageal Cancer, Disorders and GI Motility Disorders Flashcards

1
Q

What are the 2 principal types of esophageal carcinomas?

A

Most commonly squamous cell carcinoma followed by adenocarcinoma.

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2
Q

What causes have been tied to these esophageal carcinomas?

A

Adenocarcinoma - associated with chronic acid reflux

SCC - associated with smoking and EtOH abuse

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3
Q

How do both esophageal carcinomas initially manifest?

A

Due to chronic irritation and inflammation.

  • Clinical Presentation as a mechanical obstruction.
  • Dysphagia with solids first then liquids.
  • Odynophagia
  • Anemia, weight loss, adenopathy
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4
Q

How is each esophageal carcinoma typically diagnosed and staged?

A

Labs: Barium swallow, EGD with biopsy

Treatment: Esophagectomy &/or Chemotherapy

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5
Q

What are the 2 gastroesophageal (anatomical) barriers to stomach acid?

A
  • Crural diaphragm and LES
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6
Q

Understand the difference between paraesophageal and hiatal hernias – what type can require surgical amendment?

A

Paraesophageal hernias can require surgical amendment

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7
Q

What is achalasia?

A

Achalasia is tonically contracted LES that fails to relax appropriately during swallows along with a dilated, aperistaltic esophagus.

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8
Q

How is achalasia diagnosed?

A

Bird-beak appearance, dilated fluid-filled

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9
Q

What are the basic surgical and pharmacologic treatments for achalasia?

A

Heller myotomy, Balloon dilation, Nitrates/CCBs

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10
Q

What are the esophageal manifestations of systemic scleroderma?

A

Dilated, aperistaltic esophagus

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11
Q

How is systemic scleroderma treated?

A

treated with PPI to reduce reflux/gastritis

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12
Q

What is the composition of a Schatzki’s ring and what is it almost always associated with? How does it manifest and how is it treated?

A

Schazki’s ring is a circumferential mucosal ring in the setting of a hiatal hernia (“steakhouse syndrome” solids dysphagia); dilation during EGD.

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13
Q

What is Plummer-Vinson syndrome and what are 2 symptoms?

A

Esophageal webs that form in the proximal esophagus in association with iron deficiency anemia;

Symptoms include the web, fatigue, pica etc.

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14
Q

What is the most common disorder of the esophagus?

A

GERD

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15
Q

Although GERD can often be diagnosed empirically based on history of symptoms and response to PPI medications, how can it be documented and graded?

A

GERD can be documented and graded based on severity and classified into four grades according to the Los Angeles Classification

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16
Q

What are the symptoms and complications of GERD?

A

Heartburn, epigastric pain, dysphagia, odynophagia, water brash etc.

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17
Q

How are mild, moderate and severe GERD treated?

A

Mild/moderate are treated with H2-antagonists/PPIs, antacids temporarily, lifestyle changes;

Severe can be treated by laparoscopic fundoplication

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18
Q

What is gastroparesis?

A

Delayed gastric emptying resulting in early satiety, bloating, N/V, anorexia, wt loss

Inflammation of the stomach

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19
Q

What are the symptoms of gastroparesis and what are possible underlying causes?

A

Mechanical, endocrine/metabolic (DM is the most common), CNS, miscellaneous causes;

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20
Q

What are effective treatments for gastroparesis?

A

Treated by dietary changes and with medications including erythromycin, Zithromax, domperidone, metaclopramide etc.

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21
Q

How is gastroparesis diagnosed?

A

x

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22
Q

How is GERD treated?

A
  • Lifestyle modifications
  • Antacids (Magnesium or Aluminum based)
  • H2 receptor blockers
  • Proton pump inhibitors
  • Promotility agents
  • Surgery
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23
Q

What are the symptoms of achlasia?

A

Dysphagia, Regurgitation of nonacidic material

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24
Q

What are the radiographic findings of achlasia?

A
  • Dilated, fluid-filled esophagus

- Distal bird-beak stricture

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25
Q

What are the manometric finding for the LES in achlasia?

A

High resting pressure and an Incomplete or abnormal relaxation with swallow

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26
Q

What are the manometric finding for the body of the esophagus in achlasia?

A

Low-amplitude, simultaneous contractions after swallowing

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27
Q

What are the symptoms of scleroderma?

A
  • Gastroesophageal reflux disease

- Dysphagia

28
Q

What are the radiographic findings of scleroderma?

A
  • Aperistaltic esophagus
  • Free reflux
  • Peptic stricture
29
Q

What are the manometric finding for the LES in scleroderma?

A

Low resting pressure

30
Q

What are the manometric finding for the body of the esophagus in scleroderma?

A

Low-amplitude peristaltic contractions or no peristalsis

31
Q

What are the symptoms of diffuse esophageal spasm?

A
  • Substernal chest pain (angina-like)

- Dysphagia with pain

32
Q

What are the radiographic findings for diffuse esophageal spasm?

A

Simultaneous non-coordinated contractions

33
Q

What are the manometric finding for the LES in diffuse esophageal spasm?

A

Normal Pressure

34
Q

What are the manometric finding for the body of the esophagus in diffuse esophageal spasm?

A
  • Some peristalsis

- Diffuse and simultaneous non-peristaltic contractions, occasionally high amplitude

35
Q

What is the etiology of GERD?

A

Loss or lack of resting LES tone, this allows reflux of gastric contents into the esophagus.

Persistent irritation of squamous epithelium leads to metaplastic columnar epithelium, called Barrett’s esophagus.

36
Q

What are the clinical features of GERD?

A

Heartburn, worse with bending over or lying down, belching, regurgitation.

37
Q

What are the red flags of GERD?

A

Progressive dysphagia, recurrent pneumonia, persistent cough, bleeding.

38
Q

What labs are preformed in diagnosing GERD?

A

pH monitoring, Berstein test, EGD

X-ray: Barium swallow- injury, ulcer, stricture, hernia

39
Q

What are the common causes of gastritis?

A
  • Stress: from CNS injury, burns, sepsis, surgery
  • Helicobacter pylori: gram-negative flagellated rod
  • NSAIDS: cause injury by decreasing local prostaglandin production in the stomach or direct injury to the cells by the pill
40
Q

What is the clinical presentation of gastritis?

A
  • Due to underlying cause

- Dyspepsia and abdominal pain

41
Q

What labs are preformed in a patient with gastritis?

A
  • EGD with biopsy

- Tests for H. pylori (Urea breath test)

42
Q

What is the treatment for gastritis?

A

Treat the underlying cause or remove the causative agent

43
Q

What are the risk factors for esophageal carcinomas?

A

SCC: smoking, alcohol, achalasia, RT

Adenocarcinoma: linked to Barrett’s esophagitis which is a complication of GERD

44
Q

What is Schatzki ring?

A

Circumferential, lower esophageal ring

45
Q

What are characteristics of a Schatzki ring?

A

Intermittent solid dysphagia

Always associated with hiatal hernia

46
Q

What is the treatment for a Schatzki ring?

A

Savary Bougies/Maloney dilators

47
Q

What are types of esophageal strictures?

A

Schatzki ring, Esophageal Webs and Zenker’s diverticulum

48
Q

What is Zenker’s diverticulum?

A

A protrusion of pharyngeal mucosa at proximal esophagus (cricopharyngeus)

49
Q

What are the symptoms of Zenker’s diverticulum?

A

Dysphagia, regurgitation, halitosis

50
Q

What is the treatment for Zenker’s diverticulum?

A

Surgery, Often secondary to achalasia

51
Q

What is a Esophageal web?

A

Non-circumferential, thin, squamous, mucosal, membrane in the mid or upper portion of esophagus.

52
Q

What are esophageal webs associated with?

A

Associated with severe iron deficiency, Plummer-Vinson Syndrome

53
Q

What are Esophageal Varices?

A

Dilated submucosal veins

54
Q

What causes Esophageal Varices?

A

Secondary to portal hypertension

Due to cirrhosis (hepatic vascular congestion)

55
Q

What are the signs and symptoms of Esophageal Varices?

A

Signs and symptoms of acute upper GI bleed

56
Q

How do we treat Esophageal Varices?

A

Endoscopic banding/sclerotherapy

57
Q

What is a Mallory Weiss Tear?

A

Non-penetrating mucosal tear at the GE junction, due to raise in transabdominal pressure

58
Q

_______ strong predisposing factor for a Mallory Weiss Tear.

A

Alcoholism, Prior history of vomiting, retching

59
Q

How is a Mallory Weiss Tear diagnosed?

A

Endoscopy

60
Q

How is a Mallory Weiss Tear treated?

A

Usually self limiting

61
Q

What are common esophogeal motor disorders?

A

Three common causes:

  • Achalasia
  • Diffuse esophageal spasm
  • Scleroderma
62
Q

What is the etiology of Achalasia?

A

Loss of ganglion cells in Auerbach’s plexus leads to increased tone and impaired relaxation of the LES, absent peristalsis.

63
Q

What causes Esophagitis?

A

Infectious esophagitis usually seen in immuno-compromised patients.

Causes: Candida, herpes, CMV

64
Q

How does a patient present with esophagitis?

A

Odynophagia, dysphagia

65
Q

What is the treatment for esophagitis?

A

Candida: Fluconazole, ketoconazole
Herpes: Acyclovir
CMV: Ganciclovir

Medicine I: Gastroenterology (16 decks)

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