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Clin Med II - GI Exam > Esophageal Disorders > Flashcards

Esophageal Disorders Flashcards

1
Q

define dysphagia

A

difficult progression of food bolus from mouth to stomach

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2
Q

types/etiology of dysphagia

A
  • oropharyngeal
  • esophageal
  • neuromuscular
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3
Q

describe oropharyngeal dypshagia

A
  • transfer

- oropharynx to prox. esophagus

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4
Q

describe esophageal dysphagia

A
  • transit

- prox. esophagus to stomach

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5
Q

dysphagia epidemiology

A

7%

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6
Q

dysphagia symptoms

A
  • non-cardiac chest pain
  • wt. loss
  • globus (sensation of FB)
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7
Q

dysphagia risk factors

A
  • hereditary

- Eagle Syndrome

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8
Q

dysphagia prevention

A
  • denture check
  • proper meal behavior
  • no ETOH w/meal
  • swallow eval w/ SLP
  • observe pts
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9
Q

dysphagia S+S

A
  • difficulty w/ both liquid and solid = motility
  • progression of difficulty from solid to liquid = mechanical
  • progression at all isa concern for CA/stricture
  • vitals signs (?fever)
  • anemia or scleroderma
  • CN
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10
Q

dysphagia diagnostic studies

A
  • CXR
  • barium esophagography (BE)
  • video esophagography
  • upper endoscopy (EGD)
  • esophageal manometry
  • esophageal pH recording and impedance test
  • capsular endoscopy
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11
Q

achalasia definition

A

failure of LES to relax which leads to obstruction and decr. peristalsis

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12
Q

achalasia etiology

A
  • esophageal n. cell degeneration
  • distal 2/3rds esophaguls decr. peristalsis
  • idiopathic
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13
Q

achalasia epidemiology

A

20-60 y/o

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14
Q

achalasia symptoms

A
  • gradual onset
  • MC = substernal discomfort
  • slow eater and uses manuver to clear food
  • regugitation
  • weight loss
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15
Q

achalasia diagnostic studies

A
  • CXR = air fluid level in distal esophagus
  • barium swallow = birds beak
  • EGD = r/o lesions
  • esophageal manometry
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16
Q

achalasia tx

A
  • botox injx
  • pneumatic dilation
  • surgery = modified Heller cardiomyotomy
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17
Q

achalasia complications

A

less than 3% perforate in young and old

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18
Q

diffuse esophageal spasm definition

A

uncoordinated, simultatneous, or rapid progression of peristalsis

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19
Q

diffuse esophageal spasm epidemiology

A
  • males more than females
  • white more than other races
  • under diagnosed
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20
Q

other types of diffuse esophageal spasm

A
  • nutcracker

- jackhammer (presents w/ incr. pain)

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21
Q

diffuse esophageal spasm symptoms

A
  • dysphagia
  • regurgitation
  • non-cardiac chest pain post prandial
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22
Q

diffuse esophageal spasm diagnostic studies

A
  • high resolution manometry
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23
Q

diffuse esophageal spasm treatment

A
  • CCB
    • botox injx*
    • nitrates*
  • tricyclic antidepressants
  • sildenafil w/ caution
  • surgery (dilation, myotomy, esophagetcomy)
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24
Q

scleroderma definition

A

connective tissue d/o related to sm. muscle atrophy

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25
Q

scleroderma forms

A
  • progressive systemic sclerosis

- CREST syndrome

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26
Q

describe progressive systemic sclerosis

A

diffuse scleroderma with fulminant involvement of internal organs

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27
Q

describe CREST syndrome

A
  • Calcinosis
  • Raynaud’s phenomenon
  • Esophageal dysfunction
  • Sclerodaetyly (sausage fingers)
  • Telangectasia
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28
Q

scleroderma symptoms

A
  • dysphagia in late dz
  • choking d/t dysmotility
  • GERD
  • non-cardiac chest pain
29
Q

scleroderma diagnostic studies

A
  • manometry
  • barium swallow
  • EGD
30
Q

scleroderma tx

A
  • PPI
  • prokinetic rx
  • diet restrictions: multiple small meals, avoid fatty food, no ETOH, no peppermint, no chocolate
31
Q

scleroderma complications

A
  • strictures
  • Barrett esophagus
  • adenocarcinoma
32
Q

esophagitis definition

A

inflammation or irritation of esophagus

33
Q

esophagitis etiology

A
  • infection
  • medication or pill-induced
  • caustic
  • eosinophilia
  • Barrett esophagus
34
Q

esophagitis S+S

A
  • odynophagia
  • dysphagia
  • non-cardiac chest pain
  • cough
  • GERD
  • hoarseness
  • morning paryngitis
35
Q

esophagitis risk factors

A
  • ETOH
  • smoking anything
  • surgery/radiation to chest
  • poor po fluids w/ pills
  • rx: bisphosphonates
  • repeated vomiting
  • immunocompromised, DM, steroids
36
Q

esophagitis complications

A
  • scarring
  • strictures leading to swallowing difficulties
  • Barrett esophagus
37
Q

causes of infectious esophagitis

A
  • candida albicans
  • CMV
  • HSV
38
Q

tx of candida albicans infectious esophagitis

A
  • fluconazole –> EGD w/ brushing and bx
39
Q

tx of CMV infectious esophagitis

A
  • HAART
  • ganciclovir (can cause neutropenia)
  • valganciclovir
  • foscarnet
40
Q

tx of HSV infectious esophagitis

A
  • immunocompetent = standard antivirals

- immunosuppressed = acyclovir

41
Q

risk factors for medication or pill-induced esophagitis

A
  • not enough H20
  • supine when taking po meds
  • hospitalized or bed bound
42
Q

diagnostic studies for medication or pill-induced esophagitis

A
  • EGD
43
Q

prevention of medication or pill-induced esophagitis

A
  • po meds w/ more than 4oz H2O

- upright x at least 30 mins after po dosing

44
Q

complications of medication or pill-induced esophagitis

A
  • strictures
  • hemorrhage
  • perforation
45
Q

caustic esophagitis S+S

A
  • burning chest pain
  • gagging
  • dysphagia
  • drooling
  • aspiration
46
Q

caustic esophagitis diagnostic studies

A
  • CXR
  • abdominal series XR
  • free air
  • pneumonitis
47
Q

caustic esophagitis tx

A
  • supportive

- psych referal

48
Q

caustic esophagitis complications

A
  • stricture
  • deep ulcer
  • necrosis
  • medlastinitits
  • peritonitis
  • hemorrhage
  • fistulas
  • CA
49
Q

define eosinophilic esophagitis & population

A
  • white exudates or papules, red furrows, corrugated concentric rings, strictures
  • MC in children
50
Q

eosinophilic esophagitis S+S (adult)

A
  • hx dysphagia w/ solids
  • hx food impaction
  • GERD
51
Q

eosinophilic esophagitis S+S (children)

A
  • chest pain/abdominal pain
  • vomiting
  • FTT
52
Q

eosinophilic esophagitis diagnostic studies

A
  • labs (CBC for eosinophilia, incr. IgE)
  • Barium swallow
  • EGD
  • test for food allergies (steak + hotdogs)
53
Q

eosinophilic esophagitis tx

A
  • PPI
  • food elimination diet
  • steroids
54
Q

eosinophilic esophagitis complications

A
  • strictures

- narrow lumen

55
Q

define mallory weiss tear

A
  • non-penetrating tear at GEJ
56
Q

mallory weiss tear etiology

A

MC = incr. trans abdominal pressure

57
Q

mallory weiss tear risk factor

A

ETOHism

58
Q

mallory weiss tear S+S

A
  • hematemesis

- hx of retching, straining, vomiting

59
Q

mallory weiss tear tx

A
  • EGD
  • fluid resuscitation
  • blood transfusion
  • endoscopic hemostasis
  • epinephrine
  • clipping or banding
  • arterial embolization
60
Q

define esophageal webs

A
  • thin membranes of squamous mucosa that typically occur in the mid to prox
  • may be multiple
61
Q

esophageal web etiology

A

congenital

62
Q

define Schatzki ring

A
  • smooth, circumferential in distal esophagus at squamocolumnar junction
  • seen w/ hiatial hernia
  • dysphagia w/ less than 13mm diameter
63
Q

esophageal web + ring

A
  • dilation

- PPI

64
Q

esophageal web + ring diagnostic studies

A

barium swallow better than EGD

65
Q

define esophageal varicies

A
  • dilated, submucosal veins in pts w/ portal HTN
66
Q

esophageal varicies etiology

A

MC = cirrhosis

67
Q

esophageal varicies S+S

A
  • acute UGI bleed (rebleed is common)
  • preceding retching, vomiting, dyspepsia
  • hypovolemia
  • shock
68
Q

esophageal varicies tx

A
  • resuscitation
  • not too much transfusion/liquids
  • correct coagulopathy
  • abx
  • vasoactive rxns
  • Vit K w/ abx PTT
  • endotracheal intubation
  • balloon tamponade
  • EGD
  • endoscopy banding or sclerotherapy
  • portal decompression procedures
  • non-selective BB
  • liver transplant

Clin Med II - GI Exam (14 decks)

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