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GIGU & Men’s Health > Esophageal Conditions > Flashcards

Esophageal Conditions Flashcards

1
Q

Esophageal Disorders: Red Flags

A

– Weight loss, mass, symptoms time worsening, abrupt onset after 50
– Other: muscle weakness,neurological signs, pain

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2
Q

Dysphagia

A

-Difficulty swallowing
-May say “food feels stuck”
-Liquids or colids

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3
Q

Causes of Dysphagia

A

NMS, obstruction of inflammation of esophagus

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4
Q

Odynophagia

A

-Pain with swallowing (often sharp)
-Usually associated with diffuse or severe inflammation

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5
Q

Pyrosis

A

Heartburn

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6
Q

In esophageal disorders, chest pain is often result of:

A

Motility issue which resembles heart

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7
Q

Regurgitation

A

Small amount of content comes up

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8
Q

Risk Factors of Dysphagia

A

-Older adults: Natural aging leads to decreased muscle tone*
-Neurological disorders/damage (ie. stroke)

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9
Q

Esophageal Disorders: Testing Procedures

A

-Palpation: lump, mass, hypertonic tissue
-Swallow (screening) test: pain, dysfunction
(Drinking water test)

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10
Q

Esophageal Disorders: Diagnostic Procedures

A

-Barium swallow (upper GI series)
-Endoscopic exam (upper GI endoscopy)
-CT, MRI

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11
Q

Functional vs. Pathological Swallowing Issues

A

-Functional: No evidence, globus hystericus
-Pathological: Evidence, most conditions

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12
Q

Oropharyngeal: Location, Symptoms

A

-Oral cavity to upper esophageal sphincter
Symptoms
• Trouble initiating swallowing*
• Nasal regurgitation
• Coughing, choking or gagging w/ attempts to swallow
• Halitosis
• Drooling

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13
Q

Oropharyngeal Conditions

A

• NMS
• Medications
• Oral conditions
• Structural
• Obstructive

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14
Q

Esophageal: Location

A

Upper to lower esophageal sphincter

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15
Q

Esophageal Conditions

A

• Mechanical
• Motility (DES/achalasia)
• Obstructive
• Inflammation/ infection
• Other: hiatal hernia, Barrett’s syndrome, etc

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16
Q

Esophageal: Main Symptoms

A

• Food “gets stuck” (patient may indicate mid to lower part of throat region)*
• Sternal pain/ heart burn (pyrosis)*

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17
Q

Oropharyngeal vs. Esophageal: Causes

A

-Oropharyngeal: muscle, nerve, structural
-Esophageal: mechanical, motility, obstructive

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18
Q

Globus Hystericus

A

• Sense of fullness or lump in throat
– Has no difficulty in swallowing
– No mass present

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19
Q

Globus Hystericus: Causes (3)

A

– No specific etiology
– May be due to pharyngeal muscle spasm
– May result from GERD
– May be symptom of certain mood disorders/stress

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20
Q

Globus hystericus can be confused with other disorders including:

A

Esophageal, GERD, skeletal muscle, mass lesions

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21
Q

Globus Hystericus: Diagnostic considerations

A

• Rule out true dysphagia conditions
-Consider other conditions: NMS, conditions causing post-nasal drip, psychosocial/stress

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22
Q

In Globus hystericus, a swallowing screen and palpation for neck masses will:

A

Come back normal

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23
Q

Diffuse Esophageal Spasm

A

Abnormal motility due to esophageal motor dysfunction

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24
Q

DES is more common in:

A

-Age: Mid 40s+
-More common in women

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25
Q

DES Symptoms

A

• Vague Sx
– Usually intermittent & variable
– May last minutes to hours

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26
Q

DES may evolve to:

A

Achalasia

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27
Q

DES is also called

A

Corkscrew esophagus or rosary bead

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28
Q

DES: Symptoms

A

-Retrosternal pain (may radiate to the back)
-Dysphagia
-Regurgitation
-May occur: at night or with exercise,

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29
Q

DES: Red Flags

A

Spasms can cause substernal pain w/o dysphagia
-Mimics angina pain*

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30
Q

DES: Other DDx (5)

A

Achalasia, esophagitis, GERD, diverticula, rings

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31
Q

DES: Diagnostic testing

A

-Barium swallow*

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32
Q

DES: Medication

A

-Ca channel blockers, nitroglycerin, antidepressants
-Botox injections

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33
Q

DES: Dietary Factors

A

-Small meals, pureed foods, quick swallow liquids

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34
Q

Achalasia

A

• Neurogenic esophageal motility disorder
A. Ineffective peristalsis of esophageal smooth muscle
B. Inadequate relaxation of lower esophageal sphincter
C. Results in functional obstruction of esophagus

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35
Q

Achalasia: Time of Onset

A

Slowly progressive over months or years
-Usually begins between 20-60

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36
Q

Achalasia is also known as

A

Esophageal aperistalisis

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37
Q

Achalasia: Symptoms

A

• Dysphagia (most common)
• Noctural regurgitation (33%)
• Chest pain possible
• Heartburn
• Weight loss:
– mild to moderate
– Rapid weight loss, may be secondary to tumor

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38
Q

Achalasia: Diagnostics

A

– Barium swallow preferred

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39
Q

Narrowing of the esophagus at lower esophageal sphincter

A

Bird beak

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40
Q

Esophageal dilation

A

Megaesophagus

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41
Q

Intrinsic Disorders of Esophagus

A

-Esophageal web
-Lower esophageal ring
-Esophageal tumors

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42
Q

Extrinsic disorders of esophagus

A

-Cervical bony exostosis
-Thoracic tumor
-Aortic aneurysm

43
Q

Esophageal web

A

Obstructive disorder in upper esophagus

44
Q

An esophageal web can develop with what disorder?

A

Untreated severe iron deficiency anemia

45
Q

An Esophageal Web is also known as

A

– Plummer-Vinson Syndrome
– Sideropenic Dysphagia

46
Q

Esophageal Web: Symptoms

A

-Dysphagia of solids
-Possible thoracic pain
-Fatigue

47
Q

Esophageal Web: Diagnostic Testing

A

-Barium swallow (preferred)
-Labs: Related to IDA

48
Q

Esophageal Web: Treatment

A

-Treat IDA: Iron supplement
-Determine/address cause of IDA

49
Q

Esophageal Web should include a diet of:

A

Iron rich foods

50
Q

Lower Esophageal Ring

A

-Mucosal structure causing narrowing at distal esophagus
-Causes obstruction of food passing into gastric making it difficult to swallow
-Probably congenital

51
Q

When do symptoms usually begin for Lower Esophageal Ring

A

After 25

52
Q

Lower Esophageal Ring: Symptom

A

Intermittent dysphagia of food

53
Q

Lower Esophageal Ring: Diagnosis

A

-Barium
-X-Rays

54
Q

Lower Esophageal Ring: Treatment

A

Dilation, chew food well

55
Q

Other names for Lower Esophageal Ring

A

-Schatzki Ring or B ring

56
Q

*GERD Vs. Acid Reflux

A

-Acid Reflux: Reflux is common but not frequently; may include heartburn
-GERD: Chronic reflux; Occuring more than 2x/week; Heartburn is most common symptom

57
Q

GERD

A

Reflux of gastric content into esophagus

58
Q

GERD is caused by:

A

Incompetency of LES

59
Q

GERD: Causes of Incompetency of LES

A

Medication, food/diet, pregnancy, hiatal hernia, diabetes, tobacco, weight gain

60
Q

GERD: Specific Populations

A

– Older adults: possible increase d/t coexisting diseases
– Infants: uncomplicated reflux
• Normal to have brief episodes of spitting up
• Disappear by 10 month though may last until 2 yo
• If GERD, may see slow weight gain

61
Q

Contributor to GERD

A

Hiatal hernia

62
Q

Chronic GERD can lead to (5)

A

– Esophagitis
– Esophageal ulcers
– Esophageal strictures
– Barrett’s esophagus
– Esophageal adenocarcinoma (rarely)

63
Q

GERD Symptoms

A

• Heartburn* main sx
• Regurgitation
• Sour taste
• Dysphagia
• Sensation of lump in throat
• Chest pain
• Early satiety
• Abdominal fullness
• Bloating

64
Q

GERD diagnosis is typically diagnosed through:

A

History

65
Q

Esophagitis

A

Inflammation of the esophageal lining

66
Q

Causes of esophagitis

A

-Reflux
-Infection: bacteria, virus (herpes), fungal (candida)
-Other irritants: vomiting, medications

67
Q

Esophagitis: Risk Factors

A

Alcohol, smoking, diet (Similar to GERD)

68
Q

Disorders that can lead to esophagitis

A

GERD & hiatal hernia

69
Q

Esophagitis can lead to other problems including:

A

– Ulcers
– Scars and strictures
– Barrett’s esophagus

70
Q

Esophagitis: Symptoms

A

• Heartburn (most common)
• Regurgitation
• Dysphagia
• Chest pain
• Epigastric discomfort

71
Q

Esophagitis: Diagnostics (4)

A

– Endoscopy or biopsy
– Upper GI series or barium swallow

72
Q

Esophagitis: When to refer

A

Because sx may look like other conditions like GERD, refer if :
• ER: chest pain lasting more than a few minutes or history of heart dx
• Other: when doesn’t improve after few days, doesn’t improve w/ meds.

73
Q

Barrett’s Esophagus

A

• Abnormal cellular changes in lining of lower esophagus

74
Q

Barrett’s Esophagus: Risk Factors

A

– Chronic acid reflux
– Increases with age
– Male, Caucasian
– Overweight, Smoking

75
Q

Conditions causing Barrett’s Esophagus

A

– GERD
– Esophagitis

76
Q

Barret’s Esophagus is associated with:

A

– increased risk in esophageal cancer

77
Q

Barrett’s Esophagus: Symptoms

A

NONE
-May have history of GERD

78
Q

Barrett’s Esophagus: Diagnostics

A

– Endoscopic
– Biopsy

79
Q

Barrett’s Esophagus: Treatment/Prognosis

A

-Treat underlying reflux (GERD): Medication/lifestyle
-Ongoing surveillance to detect cancerous change*

80
Q

Hiatal Hernia

A

• Stomach protrudes through diaphragmatic esophageal hiatus

81
Q

Most common type of hiatal hernia (of 3 types)

A

Sliding (above diaphragm)

82
Q

Hiatal hernia: Most common cause

A

– Increased abdominal pressure
• Coughing, vomiting, lifting
• Straining from bowel movement
• Pregnancy, obesity

83
Q

Hiatal Hernia: Risk Factors

A

– Obesity, aging (70% in those older than 70) , smoking
– Chronic constipation related to low fiber diets

84
Q

Hiatal Hernia is associated with:

A

GERD (<50%)

85
Q

Complications of Hiatal Hernia

A

Heartburn, stricture, Barrett esophagus, esophageal cancer
(Complications from Reflux)

86
Q

Hiatal Hernia: Possible Symptoms

A

• Most asymptomatic

Possible sx:
• Heartburn
• Regurgitation
• Dysphagia
• Chest pain
• GI bleed
– Ex: Mallory Weiss

87
Q

Hiatal Hernia: Treatment

A

• Medication
– Treat GERD
– Tighten muscles
• Surgery

88
Q

Mallory-Weiss Syndrome

A

• Nonpenetrating laceration in gastroesophageal junction region

89
Q

Mallory-Weiss Syndrome: Causes

A

– Primary condition causes significant vomiting or vigorous coughing
– This causes a tear in the GE junction
– Leading to hematemesis

90
Q

Mallory-Weiss Syndrome: Risk Factors

A

– Chronic alcohol abuse
– Bulimia
– Male
– Age: 40-60

91
Q

Mallory-Weiss Syndrome: Associated Conditions

A

– Hiatal hernia (present up to 90% of patients)
– Esophagitis
– Gastritis

92
Q

Mallory-Weiss Syndrome: Signs/Symptoms

A

• Hematemesis-100%
• Melena-10%

93
Q

Mallory Weiss Syndrome: Diagnostics

A

– Endoscopy for definitive diagnosis (will see tear)*
– No specific labs
– May do CBC for bleeding

94
Q

Esophageal Cancer is more common in:

A

Men

95
Q

Esophageal Cancer: Proximal 2/3

A

Squamous Cell Carcinoma

96
Q

Squamous Cell Carcinoma: Risk Factors

A

Alcohol, tobacco, achalasia, esophageal web

97
Q

Esopheageal Cancer: Distal 1/3

A

Adenocarcinoma

98
Q

Adenocarcinoma: Risk Factors

A

– Risk factors: Caucasian, smoking, Barrett’s esophagus, GERD

99
Q

Esophageal Cancer: Symptoms

A

– Dysphagia-progressive
– Weight loss

100
Q

Esophageal Cancer: Prognosis

A

Poor

101
Q

Mallory Weiss: Symptoms d/t vomitting

A

– Light-headedness
– Dizziness
– Syncope
– Abdominal pain
– Dyspepsia

102
Q

Esophageal: Other Symptoms

A

• Painful swallowing
• Regurgitation
• Coughing
• Sore throat
• Possible thoracic or upper abdominal pain

103
Q

DES: Can be initiated by

A

-Initiated by hot, cold or carbonated drinks

GIGU & Men’s Health (6 decks)

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