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esophageal disease Flashcards

1
Q

longitudinal tears at GE junction or proximal gastric mucosa. usually due to severe retching associated with alcoholism

A

esophageal laceration

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2
Q

incomplete tear on the gastric side of the gastroesophageal junction which may extend to the distal esophagus

A

mallory-weiss syndrome

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3
Q

complete rupture at the lower thoracic esophagus which leads to bleeding into the posterior mediastinum

A

boerhaave’s syndrome

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4
Q

2 antireflux mechanism

A
  1. lower esophageal sphincter

2. crural diaphragm- external sphincter

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5
Q

three different mechanisms of LES incompetence in gastroesophageal reflux

A
  1. hypotensive LES
  2. increased intraabdominal pressure- obesity and pregnancy
  3. TLESR/ inappropriate LESR
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6
Q

factors that increase LES pressure

A
  1. Proteins
  2. gastrin
  3. metaclopramide
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7
Q

factors that decrease LES pressure

A
  1. fatty foods
  2. nicotine
  3. theophylline
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8
Q

transient lower esophageal sphincter relaxations motility disorder (LES hypotension)

A

GERD

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9
Q

NERD

A

GERD that is non-erosive

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10
Q

mechanism of heartburn in pregnancy

A
  1. hormonal due to the increase in estrogen and progesterone that leads to a dysfunctional LES
  2. mechanical with the increase in intra-abdominal pressure
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11
Q

treatment (2)

A
  1. lifestyle modifications

2. med such as antacids, H2A and PPI

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12
Q

causes of esophagitis (4)

A
  1. reflux
  2. pill-induced- ulcer formation with acne meds
  3. infectious- immunocompromised patient
  4. eosinophilic- allergic patient
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13
Q

histo triad for reflux esophagitis

A
  1. intraepithelial eosinophilia
  2. Basal zone hyperplasia
  3. papillary elongation
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14
Q

infectious esophagitis can be caused by

A

candida and herpes simplex

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15
Q

what is important about the diagnosis of eosinophilic esophagitis

A

the count we need > 15 eos in proximal and distal esophagus–> the eos limited to the esophagus

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16
Q

eosinophilic esophagitis results in barrett’s and malignancy

A

nope- no known long term effect

treatment is PPI, inhaled steroid and lifestyle changes to prevent food impaction

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17
Q

distal squamous mucosa is replaced by metaplastic columnar epithelium as a response to chronic injury from acid reflux

A

Barrett’s

18
Q

barretts is a major risk for

A

esophageal adenocarcinoma

19
Q

barrett’s treatment

A
  1. PPI
  2. radio-frequency ablation for those with dysplasia
  • endoscopic surveillance every 1-3 years
20
Q

esophageal cancer is the ninth most prevalent cancer worlwide but less than 1% of all cancers in US, but incidence has been increasing with a shift from

A

squamous cell carcinoma to adenocarcinomas

21
Q

reduced risk in developing esophageal adenocarcinoma

A

H.pylori infection- there is lower gastric acid

22
Q

location of esophageal adenocarcinoma

A

distal esophagus

23
Q

location of esophageal squamous cell CA

A

more proximal esophagus

24
Q

risk factor for esophageal squamous cell CAA

A

tobacco which might be synergistic with alcohol

25
Q

esophageal squamous cell CAA

  1. common in men or female
  2. ethnicity
A
  1. men

2. african american

26
Q

invasion into muscularis propria at presentation but 30-40% have invasion of adjacent mediastinal structures causing fistulas and 50% have lymph node metastases

A

esophageal squamous cell CAA

27
Q

prevention of esophageal cancer

A
  1. PPI
  2. aspirin and NSAIDs
  3. statins
28
Q

esophageal dysphagia

A

food sticks

29
Q

oropharyngeal dysphagia

A

difficulty in initiating swallowing with coughing, choking and nasal regurgitation

30
Q

solid food only dysphagia is

A

MECHANICAL OBSTRUCTION

31
Q

solid food and liquids dysphagia

A

NEUROMUSCULAR DISORDER

32
Q

solid food only dysphagia is a mechanical obstruction

  1. progressive symptoms
  2. intermittent symptoms
A
  1. progressive symptoms - chronic heartburn? peptic ulcer. age> 50 yr? carcinoma
  2. intermittent symptoms - esophageal ring
33
Q

solid food and liquids dysphagia is a neuromuscular disorder

  1. progressive symptoms
  2. intermittent symptoms
A
  1. progressive symptoms - chronic heartburn? scleroderma. respiratory symptoms? achalasia
  2. intermittent symptoms- chest pain? diffuse esophageal spasm
34
Q

esophageal ring can be identified by

A

barium swallow

35
Q

inflammatory disorder at LES with selective destruction of NO containing neurons. Unopposed ach action at lES leads to excessive contraction

A

achalasia

36
Q

achalasia can be diagnosed with

A
  1. barium swallowing- bird’s beak

2. motility tracing- LES hypertension

37
Q

treatment of alchalasia

A
  1. nitrates, calcium channel blockers
  2. pneumonic dilation
  3. myotomy
38
Q

esophageal gastric junction outflow obstruction results in

A

incompletely expressed achalasia due to the high pressures LES

39
Q

distal esophageal spasm has ______ LES function and multiple premature contractions

A

normal

40
Q

jackhammer esophagus

A

hypercontractile motility diosrder with prolonged high amplitude contractions but the LES pressure is normal

41
Q

weak, low amplitude contractions with low LES pressure . associated with reflux esophagitis

A

scleroderma

GI (26 decks)

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