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esophageal disorders Flashcards

gerd, achalasia

1
Q

.GERD presentation

A

heartburn; worse after meals and when lying down;

often relieved by antacids

may have regurgitation or dysphagia

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2
Q

.GERD workup

A

endoscopy(1st line diagnostic test) to assess for epithelial damage;

EKG (MI)

esophageal manometry if decreased LES pressure

24 pH monitoring(definitive-gold standard)

CBC is there is a bleed

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3
Q

.first line tx for GERD and why

A

*lifestyle modification first

PPI “prazole” for moderate to severe d/s or pts unresponsive to H2 blockers or have erosive gastritis

bring symptomatic relief and promote healing

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4
Q

.GERD tx

1) mild symptoms
2) significant night time symptoms

A

1) H2 blockers “tidine”, antacids, and alginic acid
2) combo of H2 blocker at night and PPI in the daytime

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5
Q

b agonists, a adrenergic antagonists, nitrates, CCB, anticholinergics, theophylline, morphine, merperidine, diazepam, barbituate

A

all decrease lower esophageal sphincter pressure;

avoid in GERD

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6
Q

.how common is infectious esophagitis

common cause

A

rare, except in immunocompromised patients

candida

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7
Q

.tetracycline, biphosphonates, iron, NSAIDs, anticholinergics, CCB, narcotics, benzos

A

all worsen GERD

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8
Q

.what is barrett’s esophagitis

dx test

monitoring/meds

low grade dysplasia

A

replacement of nml squamous epithelium with precancerous metaplastic columnar cells from stomach.

upper endoscopy with bx

monitored with an endoscopy every 3-5 years, take PPIs

low grade: monitor every 6-12 monts

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9
Q

.CMV and HSV are common causes of what

A

infectious esophagitis

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10
Q

.lab findings of

1) CMV/HIV
2) HSV
3) candida

A

CMV/HIV reveals large deep ulcers.

CMV has retinitis and colitis.

HSV has multiple small shallow ulcers; +Tzanck smear

candida has whiteyellow plaques that can be removed

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11
Q

.tx for infectious esophagitis

1) candida
2) HSV
3) CMV
4) last consideration for dx

A

1) candida: fluconazole
2) HSV: acyclovir
3) CMV: IV ganciclovir
4) last consideration for dx: HIV testing

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12
Q

HIV, mycobacterium TB, EBV,

mycobacterium avium intracellulare

A

uncommon causes of infectious esophagitis

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13
Q

.infectious esophagitis presentation

A

odynophagia, retrosternal CP, dysphagia in an immunocompromised pt

may have fever, lymphadenopathy, or rash

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14
Q

.neurologic factors

intrinsic/extrinsic blockage

malfunction of esophageal peristalsis

A

causes dysmotility of esophagus

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15
Q

what does neurogenic dysphagia cause

A

difficulty with both liquids and solids. caused by injury or disease of the brain stem or cranial nerves involved in swallowing (IX and X)

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16
Q

.what is zenkers diverticulum

symptoms

A

outpouching of the posterior hypopharynx that can cause regurgitation of theundigested food and liquid into the pharynx several hrs after eating

bad breath, neck pain, odynophagia, dysphagia

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17
Q

what is esophageal stenosis

dangerous?

A

causes dysphagia for solid foods. slow dysphagia means benign; fast is malignancy

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18
Q

.what is achalasia

patho

A

loss of peristalsis and failure of relaxation of LES

degeneration of auerbach’s plexus leads to increased LES pressure and impaired LES relaxation

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19
Q

.how to diagnose achalasia

A

initial test: barium swallow shows “parrot beaked” or “rat tail” appearance

manometry is definitive test: increased resting LES pressure and lack of peristalsis

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20
Q

tx for diverticula, achalasia, and stenosis

A

CCB(nifedipine), nitrates, botulinum or surgery

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21
Q

.what is a diffuse esophageal spasm

2 tests to order

tx (3)

A

esophageal motility d/o with severe non-peristaltic esophageal contractions (uncoordinated contractions)

barium swallow: corkscrew shaped esophagus

diagnostic manometry is diagnostic: high amplitude and simultaneous or premature contractions greater than 20% of swallows

tx: antispasmodics(CCB, TCA, or nitrates)

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22
Q

what disease can predispose a pt to symptoms and complications of reflux esophagitis

A

scleroderma causes decreased esophageal spincter tone

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23
Q

.dx tests for esophageal motility

A
  • barium swallow to show structural and motor abnormalities
  • endoscopy(EGD) to direct observation and bx
  • esophageal manometry to assess strength and coordination of peristalsis
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24
Q

tx for benign and malignant strictures

A

benign: dilation
malignant: resection

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25
Q

what accounts for 5-10% of upper GI bleeds

A

mallory weiss tear

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26
Q

.common types on esophageal neoplasms and risk factors

A

squamous (alcohol, tobacco)

adenocarcinomas (columnar metaplasia secondary to GERD, smoking, obese)

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27
Q

.location of barretts esophagitis vs squamous cell lesions

A

barretts is adenocarcinoma in the distal third of the esophagus and squamous is in proximal 2/3

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28
Q

do esophageal neoplasms spread?

A

yea to the mediastinum b/c esophagus has no serosa

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29
Q

.main clinical feature of esophageal neoplasm

A

progressive dysphagia for solid food assoc with marked wt loss. then for liquids

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30
Q

.tests to order when you suspect esophageal neoplasm

A

upper endoscopy with bx: diagnosic study of choice

double contrast barium esophagram

endoscopic u/s and CT for staging

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31
Q

.tx for esophageal neoplasm

prognosis

A

**surgery and chemoradiation first line tx

4-60% 5 year survival

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32
Q

.what is a mallory weiss tear

A

longitudinal superficial mucosal tear in the esophagus, generally at the gastroesophageal junction or gastric cardia that occurs with forceful vomiting or retching.

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33
Q

.what is a mallory weiss tear associated with and how to dx. tx

A

alcohol;

upper endoscopy test of choice

usually no tx, it is self limiting; supportive

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34
Q

.what is esophageal varices

A

dilations of the veins of the esophagus, generally at the distal end due to portal HTN

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35
Q

.what is esophageal varices from

A

portal HTN from cirrhosis or chronic viral hepatitis

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36
Q

what is budd-chiari syndrome

A

causes a thrombosis of the portal vein, leading to esophageal varices

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37
Q

pt has hematemesis and a history of cirrhosis

A

think esophageal varices; endoscopy will localize the bleeding

38
Q

.tx for esophageal varices

A

hemodynamic support with high volume fluid replacement and vasopressors.

do endoscopic therapy(ligation)

vasoconstriction(octreotide) 1st line medical mgmt

39
Q

.treating an active bleed from a mallory weiss tear

A

PPI

endoscopic injection of epi and thermal coagulation may be required if bleeding does not resolve on its own

40
Q

.esophageal varices presentation

dangers of large bleeds

A

painless upper GI bleed that can be bright red frank bleeding and coffee ground appearance

careful of hypovolemic shock ; life threatening

41
Q

.how to prevent variceal bleeding in cirrhotic pts

A

b blockers with or without isosorbide mononitrate

along with discontinuation of hepatoxic agents

endoscopic band ligation may be useful if medical therapy is insufficient

42
Q

.hemodynamic support for esophageal varices

A

high volume fluid replacement and vasopressors and immediate control of bleeding are necessary

43
Q

esophageal varices mortality rate

A

30% with the first bleed and 50% within 6 weeks

44
Q

.esophageal varices tx for an acute bleed

A

endoscopic band ligation

45
Q

.zenkers dx

A

barium esophagram initial test of choice

upper endoscopy usually perform for surgical evaluation

46
Q

barium swallow not good for what disorder

A

GERD; not helpful with diagnosis

47
Q

avoid endoscopy in what

A

zenkers

48
Q

.esophageal web def

A

noncirferential thin membrane in the mid to upper esophagus

dysphagia to solids

49
Q

difficulty for both liquids and solids

A

neurogenic dysphagia

50
Q

regurgitation of undigested food and liquid hours after eating

A

zenker diverticulum

51
Q

dysphagia for solid foods

can be slow or rapid

A

esophageal stenosis

52
Q

.peristalsis is decreased and lower esophageal spincter tone is increased

A

achalasia

53
Q

.slowly progressive dysphagia (solids and liquids same time)with episodic regurgitation and chest pain

A

achalasia

54
Q

.dysphagia or intermittent chest pain that may or may not be associated with eating

A

difuse esophageal spasm

55
Q

.what are protective factors in barretts esophagus?

A

aspirin and NSAIDs

56
Q

bright red frank bleeding or coffee ground appearance

A

esophageal varices

57
Q

what is an AIDs defining illness

A

candidal esophagitis

58
Q

describe musculature of the esophagus

A

upper third is skeletal

the lower 2/3rds is smooth muscle

59
Q

.most common cause of esophagitis

classic 3 symptoms

dx

A

gerd

hallmark is odynophagia, dysphagia, retrosternal CP

upper endoscopy

60
Q

.upper endoscopy shows linear yellow white plaques

A

candida, tx fluconazole

61
Q

.upper endoscopy shows large, superficial shallow ulcers

A

CMV. tx: ganciclovir

62
Q

.upper endoscopy shows small deep ulcers

A

HSV. tx acyclovir

63
Q

.endoscopy shows multiple corrugated rings in a child

A

eosinophilic esophagitis

tx remove food that triggered this. PPI maybe. inhaled corticosteroids WITHOUT spacer

64
Q

.common meds to induce pill esophagitis

A

NSAIDs, bisphosphonates, bb, ccb, KCL, iron, vit C

65
Q

.NSAIDs, bisphosphonates, bb, ccb, KCL, iron, vit C

A

common meds to induce pill esophagitis

66
Q

.tracheoesophageal fistula commonly associate with what

A

esophageal atresia

67
Q

.presents immediately after birth with excessive oral secretions that leads to choking, drooling, inability to feed, resp distress, coughing

A

esophageal atresia

68
Q

.gerd is incompetency of what

A

transient relaxation of LES

69
Q

.gerd hallmark symptom

A

heartburn(pyrosis), often retrosternal and postpradial.

70
Q

.hoarseness, aspiration pneumonia, wheezing, CP

A

atypical signs of gerd

71
Q

.Alarm symptoms for GERD

A

dysphagia, odynophagia, wt loss, bleeding

72
Q

.dysphagia, odynophagia, wt loss, bleeding

A

Alarm symptoms for GERD

73
Q

.adenocarcinoma and squamous esophageal neoplasm

age

race

r/f

A

adenocarcinoma: young white males
barretts.

squamous: blacks 50-70s

alcohol and smoking

74
Q

.achalasia s/s

A

dysphagia to both solids and liquids at the same time, regurgitation, cp, cough

75
Q

.when to perform an endoscopy on a pt with achalasia

A

performed in Achalasia prior to initiating tx to r/o esophageal squamous cell carcinoma

76
Q

.birds beak appearance of LES on barium esophragram

A

achalasia

77
Q

.what is Zenker’s diverticulum

A

pharynogoesophageal pouch(false diverticulum)

78
Q

.dysphagia, regurgitation, halotosis, choking sensation

A

zenkers

79
Q

.barium esophagram shows collection of dye behind the esophagus at the pharynesophageal junction

A

zenkers diverticulum

80
Q

.esophageal motility d/o with severe non-peristaltic esophageal contractions (uncoordinated contractions)

A

esophageal spasm

81
Q

.barium swallow: corkscrew shaped esophagus

diagnostic manometry is diagnostic: high amplitude and simultaneous or premature contractions greater than 20% of swallows

A

esophageal spasm

82
Q

.dysphagia to both liquids and solids at the same time. sensation of something stuck in the throat

A

esophageal spasm

83
Q

.esophageal motility d/s with increased pressure during peristalsis

A

hypercontractile esophagus

aka nutcracker/jackhammer esophagus

84
Q

.how to differeniate esophageal spasm and hypercontractile esophagus

A

manometry will show different peristaltic patterns

esophageal spasm: premature contractions

hypercontractile: increased pressure during peristalsis

85
Q

.what is boerhaave syndrome

mortality

A

full thickness rupture of left posterolateral wall of lower esophagus

40% mortality

86
Q

.retrosternal CP worse with deep breathing and swallowing, vomiting, hematemesis

A

boerhaave syndrome

87
Q

.crepitus on chest auscultation(subcutaneous emphysema)

Hamman’s sign: mediastinal crackling with every heart beat/ left lateral decubitus position

A

boerhaave syndrome

88
Q

.what is plummer vinson syndrome

at risk for what?

A

triad of dysphagia, cervical esophageal webs, fe def anemia

poss atrophic glossitis

esophageal squamous cell carcinoma

89
Q

.what is a shatzki ring?

location

A

circumferential diaphram of tissue that protrudes into the esophageal lumen

most common lower esophagus (at squamocolumnar junction

90
Q

.shatzki ring s/s

A

most asymptomatic.

episodic dysphagia, especially solid

bolus of food can get stuck in lower esophagus (steakhouse syndrome)

GI (14 decks)

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