Brainscape's Knowledge GenomeTM

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


See full index

GI > Esophageal disorders > Flashcards

Esophageal disorders Flashcards

1
Q

2 parts of the GI tract that are made up of squamous epithelium? What is rest of bowel made up of?

A
  • esophagus and anus: made up of squamous epi

- rest of bowel: columnar and cuboidal

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

Parts of esophagus, fxn?

A
  • muscular tube that conveys food from pharynx to stomach
  • inner circular muscle
  • no serosa (infection and cancer can spread quickly)
  • unforgiving organ
  • food passes through quickly because of peristalsis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

2 main types of movement?

A
  • peristaltic: moves food forward

- segmental: mixing

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

27 yo male, presents with prog. increasing difficulty in swallowing over one month period

  • dysphagia started with solid food, now trouble with liquids
  • wt loss, no previous swallowing problem
  • PE unremarkable findings
  • what is dx? How do we dx?
A
  • achalasia

- UGI: birds beak (barium swallow study)

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

Causes of dysphagia?

A 
in the lumen: tumor
 in the wall: 
- achalasia, tumor, GERD
- plummer vinson syndrome 
- scleroderma (CT disorder)
- chagas' disease
 outside of wall: 
-pressure of enlarged lymph nodes
- Thoracic aortic aneurysm
- bronchial carcinoma
- retrosternal goiter

neuromuscular disorders:

  • stroke
  • myesthenia gravis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Distance b/t UES and LES?

A
  • 18-24 cm
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Normal phases of swallowing? (voluntary, involuntary, and b/t swallows)

A

voluntary: oropharyngeal phase - bolus is voluntarily moved into pharynx
involuntary:
-UES relaxation
-peristalsis (aboral movement)
-LES relaxation
b/t swallows:
- UES prevents air entering the esophagus during inspiration and prevents esophagopharyneal reflux
- LES prevents gastroesoph reflux
- persistaltic and non-peristaltic contractions in response to stimuli
- capacity for retrograde movement (belch, vomiting) and decompression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

origin of esophageal disorders?

A
  • motility
  • anatomic and structural
  • reflux
  • infectious
  • neoplastic
  • miscellaneous (perf, burns, bleeding)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

3 common sxs pt will present with esophageal disorder?

A
  • pain
  • obstruction (dysphagia)
  • bleeding
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Upper esophageal motility disorders are due to what?

A

oropharyngeal dysphagia (transfer dysphagia):

  • pts complain of difficulty swallowing
  • tracheal aspiration may cause sxs

pharyngoesophageal neuromuscular disorders:

  • stroke
  • parkinsons
  • poliomyelitis
  • ALS
  • MS
  • diabetes
  • myasthenia gravis
  • dermatomyositis and polymyositis

upper esophageal sphincter (cricopharyngeal) dysfxn may occur in HTN

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

What is achalasia?

A
  • incomplete relaxation of LES during swallowing leading to fxnl obstruction and proximal dilation
  • aperistalsis, incomplete relaxation, increased resting tone
  • ganglion cells of myenteric plexus are diminished or absent
  • histology: inflammation in area of M. plexus
  • hypotheses: autoimmune, viral infections
  • 5% develop squamous cell carcinoma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Clinical picture of achalasia?

A 
- hx:
dysphagia (MC)
regurgitation
chest pain
heartburn
wt loss
- details:
25-50% report episodes of retrosternal chest pain
80-90% experience spontaneous regurg
- some pts may present with signs or sxs of pneumonia (aspiration)
  • Physical exam - noncontributory
  • lab studies: noncontibutory
  • imaging studies:
    UGI: birds beak
    EGD: normal or dilated esophagus
    manometry
    *** radiologic exam of choice in dx of achalasia is barium swallow study with fluoroscopic guidance
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

When is esophagela manometry used?

A
  • to assess LES pressure and peristalsis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Tx of achalasia?

A
  • goal: relieve sxs by eliminating outflow resistance caused by hypertensive and nonrelaxing LES
  • medical and surgical management
  • low surgical risk: laraposcopic myotomy, if fail - refer to have repeat myotomy done or pneumatic dilation or esophagectomy done
    or can try graded pneumatic dilation - if fail try laparoscopic myotomy
  • if high risk for surgery: botox - if fail - nifedipine (CCB)/ isosorbide dinitrate
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How does diffuse esophageal spasm (DES) present?

A
  • chest pain
  • intermittent dysphagia
  • segmental non-peristaltic contractions
  • corkscrew esophagus
  • muscular hypertrophy
  • this can be extremely painful (mistaken for MI - rule this out first!!!)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is a nutcracker esophagus?

A
  • high pressure peristaltic contractions
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is esophageal atresia?

A
  • congenital abnormalitiy in which mid portion of esophagus is absent
  • occurence: 1 in 3,570 and 1 in 4,500
  • try to introduce NG tube but it just coils back around
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is a TE fistula?

A
  • most common form of atresia
    esophagus fused into trachea
  • fluid can accumulate and be regurgitated - into trachea
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What does gasless abdomen suggest?

A
  • that pt has either atresia w/o a fistula or atresia with a proximal fistula only
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is GERD?

A
  • syndrome not a disease

- mucosal damage produced by abnormal reflux of gastric contents into the esophagus

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

PP of GERD?

A
  • primary barrier to GER is LES
  • LES normally works in conjunction with diaphragm
  • if barrier disrupted, acid goes from stomach to esophagus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

4 major physiologic mechanism that protect against esophageal acid injury?

A
  • clearance mechanisms in upper esophagus
  • mucosal integrity
  • LES competence
  • gastric emptying
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Classic GERD sxs?

A
  • heartburn (pyrosis): substernal burning discomfort

- regurg: bitter, acidic fluid in the mouth when lying down or bending over***

24
Q

Extraesophageal manifestations of GERD?

A 
- pulm:
asthma (esp at noc)
aspiration pneumonia
chronic bronchitis
pulmonary fibrosis
- ENT:
hoarsenss
laryngitis/pharyngitis
chronic cough
globus sensation
dysphonia
sinusitis
subglottic stenosis
laryngeal cancer
25
Q

Potential oral and laryngopharyngeal signs assoc with GERD?

A
  • edema and hyperemia of larynx
  • vocal cord erythema, polpys, granulomas, ulcers
  • hyperemia and lymphoid hyperplasia of posterior pharynx
  • interarytenyoid changes
  • dental erosion
  • subglottic stenosis
  • laryngeal cancer
26
Q

Etiology of GERD?

A

combo of factors:

  • hiatal hernia
  • incompetent LES
  • decreased esophagus clearance
  • decreased gastric emptying
  • meds
  • anything that results in esophageal irritation and inflammation
27
Q

What is a hiatal hernia? Types?

A
  • herniation of portion of stomach adjacent to esophagus through opening in diaphragm (slipped valve)
  • opening in diaphragm which allows this to happen is called hiatus, these are common, most are harmless but they do promote reflux
  • types:
    sliding and paraesophageal/rolling
28
Q

Why do hiatial hernias occur? Etiologies?

A
  • food lodges in pouch: inflammation of mucosa, reflux of food up to esophagus, dysphagia
  • often incompetent gastro-esophageal sphincter
  • contributing factors: shortening of esophagus, weakness of diaphragm (phrenic nerve cut), increased abdominal pressure
- factors:
structural changes
obesity
pregnancy 
heavy lifting
29
Q

Complications of hiatal hernia?

A
  • GERD
  • hemorrhage (from acid reflux)
  • stenosis of esophagus
  • ulcerations
  • strangulation of hernia
  • regurgitation
  • increased risk for resp. disease
30
Q

Clinical manifestations of hiatal hernia?

A
  • may be asx
  • heartburn
  • dysphagia
  • reflux with lying down
  • pain, burning when bending over
31
Q

Tx goals for GERD?

A
  • eliminate sxs
  • manage or prevent complications
  • maintain remission
32
Q

Lifestyle goals to prevent GERD?

A
  • avoid large meals
  • avoid acidic foods (citrus/tomato), ETOH, caffeine, chocolate, oninon,s garlic, peppermint
  • decrease fat intake
  • avoid lying down w/in 3-4 hrs after a meal
  • elevate head of bed 4-8 inches
  • avoid meds that may potentiate GERD (alpha agonists, theophylline, sedatives, NSAIDS)
  • avoid clothing that it is tight around the waist
  • lose wt
  • stop smoking
33
Q

Tx of GERD?

A
  • antacids: OTC suppressants and antacids approp initial therapy (approx 1/3 pts with heartburn sxs use at least twice weekly)
  • H2-receptor antagonists (H2RAs): cimetidine (tagamet), Ranitidine (zantac), famotidine (pepcid), nizatidine (axid)
  • PPIs: Omeprazole (prilosec), lansoprazole (prevacid), rabeprazole (aciphex), esomeprazole (nexium)
    (these are safe during preg)
  • surgery:
    reduce hiatal hernia
    repair diaphragm
    strengthen GE jxn
    strengthen antireflux barrier via gastric wasp
    75-90% effective at alleviating sxs of heartburn and regurgitation
34
Q

Postsurgery studies of hiatal hernias?

A
  • 10% have solid food dysphagia
  • 2-3% have perm. sxs
  • 7-10% have gas, bloating, diarrhea, nausea, and early satiety
  • w/in 3-5 yrs 52% of pts back on antireflux meds
35
Q

Complications of GERD?

A
  • erosive esophagitis
  • stricture
  • barrett’s esophagus
36
Q

What is erosive esophagitis?

A
  • responsible for 40-60% of GERD sxs

- severity of sxs often fail to match severity of the erosive esophagitis

37
Q

What is an esophageal stricture?

What may be needed?

A
  • result of healing of erosive esophagitis - collagen is replacing normal lining - narrowing
  • may need dilation
38
Q

What is Barrett’s esophagus? What is the pt at risk for now?

A
  • acid damages lining of esophagus and causes chronic esophagitis
  • damaged area heals in a metaplastic process and abnormal columnar cells replace squamous cells
  • this specialized intestinal metaplasia can progress to dysplasia and adenocarcinoma
39
Q

When should you perform dx tests on pt with GERD?

A
  • uncertain dx
  • atypical sxs
  • sxs assoc with complications
  • inadequate response to therapy
  • recurrent sxs
40
Q

Dx tests for GERD?

A
  • barium swallow
  • endoscopy
  • ambulatory pH monitoring
  • esophageal manometry
41
Q

When is a barium swallow a first dx test?

A 
- for pts with  dysphagia:
stricture (location, length)
mass (location, length)
birds beak
hiatal hernia (size and type)
42
Q

What is ambulatory 24 hr pH monitoring?

A
  • physiologic study
  • quantify reflux in proximal/distal esophagus
  • % time pH is less than 4
  • consecutively lower than 4: chronic reflux
43
Q

When is an esophageal manometry used in GERD?

A
  • limited role in GERD
  • assess LES pressure, location and relaxation
  • assists placement of 24 hr pH catheter
  • assess peristalsis: prior to antireflux surgery
44
Q

What is infection indued esophagitis? Bugs? More common in?

A
  • more common in pts with impaired immunity (HIV)
  • fungal: candida
  • viruses: herpes and CMV
45
Q

What is eosinophilic esophagitis? Assoc with? Tx?

A
  • esophageal bx: many intraepithelial eosinophils (80/high power field)
  • assoc with food allergies
  • tx: oral steroid (fluticasone) therapy, 220 mcg 2 puffs/day
46
Q

Cause of mallory-weiss tear? Clinical presentation?

A
  • caused by severe retching and vomiting
  • longitudinal tear at gastroesophageal jxn
  • clincial setting: chronic alcoholics after a bout of severe vomiting
  • tear may be superficial or deep affecting all layers
  • clinical picture: pain, bleeding, superimposed infection
  • hiatal hernia is found in 75% of pts
  • most often bleeding stops w/o intervention but life-threatening hematemesis may occur
47
Q

What are esophageal varices? Secondary to?

A
  • tortuous dilated veins in submucosa of distal esophagus
  • etiology: portal HTN secondary to liver cirrhosis, anything that increases pressure: coughing can start massive bleed
  • asx until they rupture leading to massive hemorrhage
  • 50% subsides spontaneously
  • 20-30% die during first episode
  • rebleeding occurs in 70% of cases within one year
48
Q

What is esophageal diverticula? diff types? Sx?

A
  • saclike outpouching of one or more layers of the esophagus
  • zenker’s diverticulum: most common of esophageal diverticulum, located above UES
    sxs:
    dysphagia
    wt loss
    regurg
    chronic cough
    aspiration
  • epiphrenic diverticulum: arises in distal esophagus, just above diaphragm, pulsion diverticulum that probably related to incoordination of esophageal peristalsis and relaxation of LES
49
Q

Tx of esophageal diverticula?

A
  • clients learn to empty esophagus by applying pressure
  • limit foods (blenderize - yum!)
  • endoscopic surgery
50
Q

What is scleroderma?

A
  • chronic CT disease
  • motility pattern:
    proximal 1/3 striated muscle = normal peristalsis
    distal 2/3 smooth muscle: impaired motility
    (primarily affects smooth muscle)
  • patulous GE jxn: GE reflux can cause distal stricture
51
Q

Causes of esophageal perforation?

A
  • iatrogenic: 75% - endoscopy is #1 cause

- boerhaave syndrome: 10-15%: due to ETOH or emesis

52
Q

How common is esophageal rupture?

A
  • rare, 300 cases reported per year
  • dx is commonly missed/delayed
  • mortality is high: most lethal GI perf, mortality falls with early dx/intervention
53
Q

What can an esophageal perforation lead to?

A
  • esophageal contents - leak and may cuase necrotizing mediastinhtis and polymicrobial infection - this can lead to shock
  • pleural/peritoneal space: rapidly progressive infection/ shock
  • can lead to empyema
54
Q

What pops are we worried about with swallowed FBs?

A
  • peds (80%) of all cases
  • prisoners, psych, edentulous adults
  • adults = meat and bones
  • kids = coins, toys, crayons, pen caps
  • pysch and prisoners: unlikey objects, spoons, razors
  • most pass spontaneously
  • 10-20% require some intervention
  • 1% surgical
  • most are at anatomic narrowings
55
Q

Common causes of burns in the esophagus?

A
  • lye (goose) vs. acid (stomach)
  • risk of perforation
  • call someone!!

GI (21 decks)

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