Brainscape's Knowledge GenomeTM

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


See full index

Clin Med GI > Esophageal Disorders > Flashcards

Esophageal Disorders Flashcards

1
Q

2 types of dysphagia

A
  1. oropharyngeal (oropharynx to proximal esophagus)

2. esophageal (through proximal esophagus to stomach)

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

symptoms of dysphagia

A

non cardiac chest pain
weight loss
globus

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

epidemiology of dysphagia

A

7% during lifetime

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

prevalence of dysphagia

A

common compliant in primary care
impaired swallowing common in tertiary facilities
common post CVA
common in elderly

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

risk factors for dysphagia

A 
hereditary
congenital malformations
age >50
CVA
GERD
COPD
smoking/ETOH
obestiy
infections
medications
neuro events or disease 
HIV
Trauma
radiation Tx
anterior cervical
extrinsic mechanical lesions
iron deficiency
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

prevention of dysphagia

A 
denture check
educate on proper meal behavior (chewing/fluids/mechanical soft or pureed diets)
NO ETOH with meals
when concern get a swallow eval - more aggressive with those who have head/neck CA
closely observe your pts
meds
postures
LOC
oral hygiene
airway
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

etiology of dysphagia - mechanical issues

A 
carcinomas
epiglottis
carotid body tumors
pharyngitis
tonsillitis
diverticulum
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

etiology of dysphagia- esophageal mechanic lesions

A 
CA
esophageal diverticula
Webs
schatski's ring
strictures (peptic, chemical trauma, radiation
FB
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

etiology of dysphagia - extrinsic mechanical lesions

A 
peritonsillar abscess
thyroid disorders
tumors
enlarged LA
mediastinal compression (lung tumors)
AA
osteoarthritis C spine (eagle syndrome)
esophageal cysts
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

dysphagia to both solid/fluids indicates what?

A

motility issue

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

if dysphagia presents with solids and progresses to liquids think what?

A

mechanical obstrcution

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

progressive symptoms of dysphagia indicates what?

A

cancer or strictures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

intermittent dysphagia most often what?

A

LES issue

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

ROS questions for dysphagia

A
  1. heartburn?
  2. weight loss/anemia?
  3. hematemesis/coffee/ground/emesis/melena?
  4. undigested food regurg?
  5. respiratory symptoms?
  6. FB sensation/drooling/aspiration?
  7. Where? upper sternum posterior throat vs lower sternum?
    odynophagia? inflammation?
    globus sensation?
    bad taste in mouth? Halitosis?
    hx of chronic GERD?
    ETOH and tobacco use….the true story
    associated symptoms concerning for cardiac cause
    meds?
    connective tissue disorder?
    changes in speech think neuromuscular
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

common imaging for dysphagia

A
  1. CXR - AP views looking for abn filling of esophagus or absent gastric bubble - foreign body?
  2. barium esophagography or Barium Swallow
  3. upper endoscopy
  4. esophageal manometry
  5. esophageal pH recording and impedance testing
  6. capsular endoscopy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what is barium esophagography?

A

pt drinks a thick chalky substance and plain films are taken in a timed sequence to eval subtle esophageal narrowings

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

what is upper endoscopy

A

thin lighted tube inserted for direct visulatization and mucosal biopsies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what is esophageal manometry

A

measures changes in pressures within the esophagus that are caused by the contraction of the muscles that line the esophagus

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

what is esophageal pH recording and impedance testing

A

measures pH within the lumen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

2 muscular layers of esophgus

A
  1. outer longitudinal layer

2. inner circular layer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

what type of cells line the esophagus

A

stratified squamous epithelium

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

what is the squamo-columnar junction

A

approx 2cm superior to the gastro-esophageal junction recognized as irregular Z line on EGD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

how is the upper esophageal sphincter closed

A

continuous contraction of crico-pharyngeal mucscles

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

closing of LES

A

has a high resting tone and prevents gastric content reflux

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

what prevents excessive ingested air into esophagus

A

UES

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

3 types of esophageal contractions

A
  1. primary peristalsis
  2. secondary peristalsis
  3. tertiary peristalsis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

s/s of esophageal disorders

A 
odynophagia
dysphagia
sub sternal chest pain
heartburn
acid taste in mouth
chronic cough or asthma exacerbation
vomiting/ can occur with leaning forward/regurg undigested food
muscle weakness
neck pain/mass/nodes
abrupt onset sx
hiccups
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

how would you focus your physical exam for esophageal disorders?

A
  1. vital signs: hypovolemic? hypotensive? fever?
  2. inspection: overall well being, demeanor, position/color
    - mouth/throat/oropharynx by direct laryngoscopy
  3. palpate - floor of mouth to look at the base of the tongue and buccal mucosa for lesions
    - upper body for lymphadenopathy
  4. observe the pt - drink water or eating crackers
  5. complete neuro exam - motor function
  6. labs may reveal chronic dz, anemia, eosinophilia - LFTs CBC
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

what is heart burn

A

feeling of sub sternal burning can radiate to anterior neck
caused by reflux of acidic or rarely alkaline material into esophagus
GERD is hb with related dysfunction?

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

what is dysphagia

A

difficulty swallowing food bolus or impaired transport of bolus thru the esophagus
-oropharyngeal, pharyngeal, esophageal

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

what is odynophagia

A

sharp sub sternal pain occurring with swallowing limits oral intake

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

what is globus pharyngeus hystericus

A

sensation of FB in throat

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

definition of dysphagia

A

difficult progression of food bolus from the mouth to the stomach

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

mechanical obstruction - which is harder to swallow - solids or liquids?

A

solids are worse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

motility disorder - which is harder to swallow - solids or liquids?

A

equal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

classification of esophageal disorders

A
  1. primary

2. secondary - caused by antoehr dz

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

no matter what classificationof motility disorder, they all cause the same things:

A
  1. dysphagia with solids and liquids
  2. episodic and unpredictalbe
  3. can be progressive
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

3 important causes of motility disorders

A
  1. achalasia
  2. diffuse esophageal spasm
  3. scleroderma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

what is achalasia

A 
uncommon idiopathic swallowing disorder 
1:100,000
esophageal nerve cell degeneration (decr peristalsis distal 2/3; LES relaxation impaired
ages 20-60yo
no cure but can be treated
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

s/s of achalsia

A
  • onset months to years
  • substernal discomfort is main complaint
  • eats slowly and often uses a maneuver to clear food
  • regurgitation - nocturnal or with meals
  • weight loss
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

imaging for achalasia

A

CXR - may show air fluid level in distal esophagus

  1. barium esophagography - bird’s beak
  2. EGD - excludes lesions
  3. esophageal manometry (DIAGNOSTIC**) absent peristalsis or incomplete LES relaxation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

ddx of achalasia

A
  1. chagas (endemic areas Central and south american) immigrants are making it more common
  2. primary or metastatic tumors
  3. small cell lung cancer, paraneoplastic syndrome
  4. esophageal spasm5. scleroderma
  5. peptic stricture
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

tx of achalasia

A
  1. botox injection with 65-85improvement
    - recurrence in 6-9 months 50%
    - most appropriate for pts with comorbidities who are candidates for other tx
  2. pneumatic dilation with 90% improvement
    - normal 103 sessions
    - less effective in
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

complication of achalasia

A

perforations

45
Q

surgery for achalasia

A

modified heller cardiomyotomy of the LES and cardiac with over 90% in symptom relief

  • surgeons usually perform fundoplication at same time
  • there is >25% chance for recurrence in 10 years
46
Q

epidemiology of diffuse esophageal spasm

A

1:100,000/year in US
women>men
white>other
mortality rare morbidity common depending on severity
worldwide data unknown since not all who suffer seek care

47
Q

what is diffuse esophageal spasm

A

uncoordinated, simultaneous, or rapidly propagated

48
Q

what is hypertensive peristalsis

A

“nutcracker esophagus”
“jackhammer esophagus”
present more with pain

49
Q

s/s of diffuse esophageal spasm

A

vague:
dysphagia
regurg
non cardiac chest pain typically post prandial
-under diagnosed and not adequately understood

50
Q

imaging for diffuse esophageal spasm

A

currently, high-resolution manometry is the best diagnostic modality

51
Q

ddx of diffuse esophageal spasm

A 
GERD
esophagitis
MI
any other non cardiac chest pain cause
perforated ulcer
food bolus
52
Q

tx for diffuse esophageal spasm

A 
CCB
botox
nitrates
tricyclic antidepressants, trazodone, nortiptyline (many dysmotility associated with psychiatric illness)
**Sildenafil - CAUTION*
53
Q

surgery for diffuse esophageal spasm

A

dilatation
myotomy
esophagectomy
research is ongoing to determine the underlying causes to improve diagnostic capabilities and therapeutic

54
Q

what is scleroderma

A

-secondary esophageal disorder
-esophageal connective tissue disorder related to smooth muscle atrophy and fibrosis
scleroderma involves the esophagus >=75% of pts

55
Q

two forms of scleroderma

A
  1. progressive systemic sclerosis PSS: characterized by diffuse scleroderma, and a more fulminant form with early involvement of internal organs
  2. CREST syndrome: characterized by
    Calcinosis
    Raynaud’s phenomenon
    Esophageal dysfunction
    Sclerodactyly
    Telangiectasia
56
Q

imaging for scleroderma

A
  1. barium swallow

EGD

57
Q

DDX of scleroderma

A

same as others?

58
Q

symptoms of scleroderma

A

dysphagia usually late in dz
chocking due to dysmotility
GERD
non cardiac chest pain

59
Q

tx for scleroderma

A

PPI
Prokinetic drugs - metoclopramide, erythromycin
diet restrictions - multiple small meals rather than larger heavy meals, avoiding fatty foods, alcohol peppermint, and chocolate

60
Q

surgery for scleroderma

A

none

61
Q

complications of scleroderma

A

strictures
barretts esophagus
and adenocarcinoma of esophagus

62
Q

risks for esophagitis

A 
ETOH
any smoking
surgery/radiation to chest
poor po fluid intake when taking pills
meds: alendronate, doxy/tetra,ibandronate, risedrontate, vitC
repeated vointing
immunocompromised pts
63
Q

complications of esophagitis

A

repeated offense leads to scarring
strictures
advances to swallowing difficulties
BE if untreated for eyars

64
Q

what is candidal esophagitis

A

caused by candida albicans
opportunistic
common in immunocompromised/immunosuppressed hosts
oral thrush in 75%

65
Q

tx of candidal esophagitis

A

systemic meds indicated
empriric trial first without scoping
initial: fluconazole if no response do EGD with brushings and bx (rule out other causes or resistance)

66
Q

alterante txfor oral thrush in 75%

A

itraconazole susp OR voriconazole if refractory
capsofungin
ampohtericin B (reserved for ID to sue)

67
Q

2 viral causes of esophagitis

A

cytomegalovirus & herpetic

68
Q

tx of cytomegalovirus esophagitis

A

if immunocompromised - control CD4 with HAART

  • ganciclovir = can cause neutropenia
  • once neutropenia resolves: oral valganciclovir
  • if not tolerated foscarnet = toxicity can cause renal injury hypocalcemia, hypomagnesemia
69
Q

what does herpetic esophagitis cause

A

multiple shallow ulcers

70
Q

tx of herpetic esophagitis in immunocompetent hosts

A

tx symptomatic hosts with standard antivirals

71
Q

tx of herpetic esophagitis in immunosuppressed hosts

A

oral acyclovir or oral valacyclovir
foscarnet for refractory cases

most respond, relapse possible, may require suppressive treatment

72
Q

meds or pill induced esophagitis caused by which meds

A 
NSAIDS
KCl pills
quinidine
zalcitabine
zidovudine
alendronate
risedronate
emepronium bromide
iron
vitC
certain ABX
73
Q

s/s of med induced esophigitis

A 
retrosternal CP
odynophagia
dysphagia
can occur immediately or several hours after ingestion and persist for days
elderly may show very mild s/s
74
Q

risks of med induced esophagitis

A

not enough water, pt supine when taking meds

hospitalized or bed bound

75
Q

EGD findings of med induced esophagitsis

A

will show one to several discrete ulcers that may be shallow or deep

76
Q

complications of med induced esophagitis

A

strictures
erosion to the point of hemorrhage
erosion to the point of perforation

healing will occur with removal of offending agent

77
Q

prevention of med induced esophagitis

A

take meds with at least 4oz water

upright for 30 min post op dosing

78
Q

caution using pills/capsules to avoid induced esophagitis

A

esophageal dysmotility disorders
known dysphagia being worked up
known strictures

79
Q

what is caustic esophagitis

A

accidental
intentional

aka crystalline alkali - drain cleaners & acid

80
Q

s/s of caustic esophagitis

A 
burning CP
gagging
dysphagia
drooling
aspiration (wheezing,stridor)
81
Q

PE for caustic esophagitis

A

-circulatory status
airway patency
oropharyngeal mucosa
-pts who don’t display major sx (SOB, drooling, oral, burns, hematemesis) are less likely to have severe GI injury, OBS warranted
-severe injuries noted: ICU, may require airway preotection

82
Q

dx imaging for caustic esophagitis

A

CXR
abdominal series
free air
pneumonitis

83
Q

tx for caustic esophagitis

A 
supportive
IV fluids
IV PPI bolus and drip
direct laryngoscopy to eval for airway issues if pt is in resp distress
EGD within 12-24hrs 
psych referral when appropriate
84
Q

complications of caustic esophagitis

A
  • mild sx recover quickly with littler risk of stricture
  • severe sx are high risks with deep ulcers and risk of perf, necrosis, mediastinitis, periotonitis, hemorrhage, strictures, esophageal tracheal fistulas
  • close ICU monitoring and may require emergent esophagectomy and colonic or jejunal interposition
  • nutrition = naso enteric feeding tube until stable
  • esophageal cancer risk 2-3% warranting surveillance by EGD
  • life long strictures and intralesional steroid injections
85
Q

what is eosinophilic esophagitis

A

white exudates or papules, red furrows, corrugated concentric rings, strictures
can be grossly normal on EGD
-food or environmental antigens stimulate inflammation
-seen often in children
-hx of allergies/atopic conditions in 50% of pts

86
Q

s/s of eosinophilic esophagitis

A

adults: long hx dysphagia for solids
hx of food impaction
GERD
children: CP/abd pain, vomiting, FTT

87
Q

labs for eosinophilic esophagtitis

A

occasional eosinophilia on CBC

elevated IgE

88
Q

diagnostics for eosinophilic esophagitis

A

barium swallow may reveal small caliber lumen, strictures, multiple concentric rings

  • EGD is pertinent for dx - bx and histo, multiple from proximal to distal end of
  • highly recommended testing for food allergies
89
Q

tx for eosinophilic esophagitis

A

before making DX - empiric trail PPI
repeat EGD to exclude GERD and PPI responsive eosinophilia
35% of pts will improve after PPI trial
-refer to allergist
-foo elimination diet
-topical steroids for symptoms - budesonide suspension, fluticasone

90
Q

complications of eosinophilic esophagitis

A

strictures
narrow lumens - may need to be dilated, caution due to higher risk of perforation
thin wall?

91
Q

what is mallory weiss tear

A

non penetrating tear at the GEJ that is most likely d/t a rise in trans abdominal pressures
ETOH is a risk
makes up 5% of UGI bleeds

92
Q

s/s of mallory weiss tear

A

hematemesis

hx of retching, straining, vomiting, in 50% cases

93
Q

ddx of mallory weiss tear

A

PUD
erosive gastritis
AV malformations
Varices

94
Q

tx of mallory weiss tear

A
  1. EGD once pt stable
  2. aggressive fluid resusc
  3. blood transfusions
  4. endoscopic hemostasis used for pts that don’t resolve
  5. direct epinephrine injection, cautery with a bipolar or hearter probe device
  6. mechanical compression with clipping or bnding
  7. OR for arterial embolization or operative intervention for those who fail endoscopic measures
95
Q

what are esophageal webs

A

thin membranes of squamous mucosa that typically occur in the mid to proximal and may be multiple
congenital but can bbbe related to secondary causes

96
Q

what are schatzki rings

A

smooth, circumferential in the distal esophagus at the squamo-columnar junction

  • cause is controversial
  • seen in nearly all HH*?
  • most webs and rings are over 20mm
  • bolus obstructions occur mostly due to poorly chewd food
  • intermittent not progressive
97
Q

at what diameter does dysphagia begin in schatzki rings

A

dysphagia begins when rings are less than 13mm diameter

98
Q

tx of webs and rings in esophagus

A

barium swallow better than EGD

dilation PPI if recurrent

99
Q

what are esophageal varices

A

dilated submucosal veins seen in pts with portal HTN with pressures over 10mmHg

  • normal pressure bw portal vein and inferior vena cava is 2-6 mmHg
  • varicose veins of esophagus
  • most common cause of emergent UGI bleeding
  • occurs in the distal 5cm
100
Q

cuase of esophageal varices

A

most common cause = cirrhosis

  • rebleed is common
  • hospital mortality is 15%
101
Q

risks of esophageal varices

A

size of varices
dilated venules on the varux surface on EGD
severity of liver dz
active ETOH abuse

102
Q

s/s of esophageal varices

A

acute UGI bleeding
can see proceeding retching, vomiting, dyspepsia, hypovolumemia,
shock

103
Q

what % of chronic liver dz pts with UGI will have non variceal source?

A

20%

104
Q

tx of esophageal varices

A
  1. acute resuscitation
  2. over transfusion and fluids should be avoided, increases venous pressures
  3. correct the coagulopathy - FFP, plts if less than 50K
  4. ABX prophylaxis - fluoro’s, ceftriaxone
  5. vasoactive drugs can reduce portal pressure and help prevent re bleed
  6. vitK if abnormal Prothrombin time
  7. advanced liver dz is a poor prognostic indicator –>ICU–>most of the time palliative care
105
Q

invasive tx of esophageal varices

A
  1. endotracheal intubation
  2. balloon tamponade - control bleeding
  3. emergent EGD - exclude other causes
    - acute endoscopic banding or sclerotherapy can be performed to gain hemostasis
    - sclerotherapy is used when visualization is an issue. injections of sclerosing agent into variceal trunks
106
Q

complications of balloon tamponade

A

ulcers, perforations, aspiration, airway obstruction

107
Q

esophageal varices tx - TIPS

A

portal decompression procedures

  • catheter fed into the jugular vein to the liver parenchyma creating a portosystemic shunt
  • can control bleeding in 90% of pts
  • mortality is 40% if actively bleeding
  • reserved mainly for those who have failed all other measures
108
Q

what can be used by GI specialists to initiate for esophageal varices

A

non selective beta blockers

band ligation and BB proved to be superior

109
Q

what can be considered for all chronic liver dz pts but is strict and most pts do not adhere to guidelines

A

liver transplatation

Clin Med GI (3 decks)

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