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GI 1 > Esophageal Disorders > Flashcards

Esophageal Disorders Flashcards

1
Q

sphincters and esophagus

A

upper esophageal sphincter and lower esophageal sphincter

both close between swallowing to prevent entry of air

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2
Q

3 phases of swallowing

A
  1. oral phase (voluntary control)
  2. pharyngeal phase
  3. esophageal phase
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3
Q

types of dysphagia

A
  1. oropharyngeal dysphagia

2. esophageal dysphagia

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4
Q

oropharyngeal dysphagia

A

difficulty INITIATING swallowing

caused by: neurologic or muscular disease (dementia, Parkinson, CVA, MS, MG, ALS)

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5
Q

esophageal dysphagia

A

food stops/sticks after swallowing

mechanical causes

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6
Q

oral dysfunciton

A

drooling, food spillage, pocketing, qsialorrhea

difficulty imitating swallow, dysarthria

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7
Q

esophageal dysfunciton

A

symptom onset following swallow

reflux, globus senstation, pain, spasm

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8
Q

pharyngeal dysfunction

A

food getting stuck, immediately upon swallowing

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9
Q

infectious esophagitis

A

rare in immunocompetent patients

HIV, underlying malignancy, significant immunosuppression

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10
Q

MC pathogens causing infectious esophagitis

A

candida, HSV 1, CMV, HIV

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11
Q

esophageal disease s/s +mc cause

A

mc 2/2 motor disorder

s/s: heartburn, dysphagia, odynophaga, globus sensation, chest pain

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12
Q

infectious esophagitis diagnosis

A

esophageal biopsy and culture (determine causative agent)

EGD

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13
Q

barium study of candy esophagitis

A

fine erosions and small plaques

immunocompromised

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14
Q

tx of oropharyngeal infxn esophagitis

A

clotrimazole troches or nystatin suspension (swish and spit)

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15
Q

esophageal candidiasis tx

A

systemic

fluconazole PO or IV

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16
Q

tx of HSV 1 esophagitis

A

immunocompetent: acyclovir 7-10 days
immunocompromised: -ciclovir 14-21 days

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17
Q

CMV esophagitis

A

ganciclovir or foscarnet

tx HIV w/ HAART

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18
Q

pill-induced esophagitis

A

pill is swallowed and causes esophageal irritation and ulceration due to prolonged contact

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19
Q

high risk for pill-induced esophagitis

A

swallowed without liquid

swallowed when supine (hospitalized or bed bound)

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20
Q

symptoms of pill-induced esophagitis

A

severe retrosternal ches pain, odynophagia, dysphagia hours after taking pill

radiates to back

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21
Q

management of pill esophatiits

A

treatment is symptomatic (viscous lidocaine)

prevention by taking pills with water and remain upright

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22
Q

eosinophilic esophagitis

A

inflammatory disorder characterized by dense eosinophilic infiltration of esophageal mucosa causing structural abnormalities and dysmotility

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23
Q

cause of eosinophilic esophagitis

A

delayed hypersensitivity reactions to food or allergens outside GI

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24
Q

epidemiology eosinophilic esophagitis

A

caucasians, young adult males (20-30)

most pts have another atopic disorder

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25
Q

symptoms of eosinophilic esophagitis in adults

A

dysphagia
food impaction
heartburn refractory to antacids/PPI
epigastric pain

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26
Q

symptoms fo eosinophilic esophagitis in children

A

feeding difficultuies

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27
Q

endoscopic findings eosinophilic esophagitis

A

narrowed lumen and strictures

feline esophagus

what papule (micro abscesses)

28
Q

when is a dx biopsy obtained?

A

2 months of PPI tx that fails to relieve symptoms

29
Q

eosinophilic esophagitis tx

A 
allergist 
non pharm (elimination, dilation of stricture)

pharm (PPI, swallowed inhaled steroids)

30
Q

fluticasone

A

swallowed corticosteroid

without a space and sprays WITHOUT inhaling

31
Q

rings mc occur

A

distal esophagus

32
Q

webs mc occur

A

anteriorly, cervical esophagus

33
Q

esophageal webs

A

congenital

associated with Fe decency anemia (plumber Vinson)

immunologic and term conditions

34
Q

Schatski ring

A

distal esophagus, very common but not often symptomatic

hiatal hernia and GERD (increased risk)

symptom: food impaction

35
Q

tx of webs and rings

A

dilation

endoscopic electrosurgical incision

36
Q

zenker’s diverticula

A

herniation of mucosa between two pharyngeal muscles

37
Q

pathophys zenker’s diverticula

A

high intrabolus pressure during swallowing

resistance to swallowing due to abnormalities

38
Q

epidemiology zenker’s diverticula

A

MC in caucasians (north European)

men, elderly

39
Q

zenker’s diverticula s/s

A

insidiously over years in older patients

vague oropharyngeal dysphagia

ASPIRATION risk, nocturnal choking, spontaneous regurgitation

40
Q

complications of zenker’s diverticula

A

aspiration pneumonia
ulceration and bleeding
carcinoma

41
Q

diagnosis of zenker’s diverticula

A

barium swallow

42
Q

esophageal stricture

A

narrowing of lumen

dysphagia of solids and liquids

43
Q

majority of benign strictures are due to

A

long standing GERD

44
Q

etiologies of esophageal stricture

A
  1. intrinsic disease (narrowed lumen)
  2. extrinsic disease (direct invasion, enlargement of lymph node)
  3. diseases that disrupt peristalsis and or LES function
45
Q

RF of esophageal stricture

A

GERD
prolonged NG tube
corrosive substance
infection

46
Q

diagnosis and tx of esophageal stricture

A

dx: endoscopy or barium swallow

txL endoscopic balloon dilation and underlying cause

47
Q

primary esophageal motility disorder

A

achalasia
spasm
hyper and hypo contraction of esophagus

48
Q

secondary motility disorders

A

scleroderma
chagas
DM
chronic GERD

49
Q

diagnositic w/u of dysphagia

barium swallow for

A

suspected injury

h.o. surgery for esophageal or laryngeal CA

suspected achalasia

50
Q

endoscopy if

A

barium swallow fails or another disease supsected

51
Q

esophageal manometry if

A

endoscopy is normal

neuro cause suspected

52
Q

achalasia patho

A

idiopathic degernation of neurons of myenteric plexus and vagal nuclei

53
Q

neuronal degeneration results in (achalasia)

A
  1. failure of LES to relax properly

2. dilated peristaltic esophagus above hyper contracted LES

54
Q

achalasia s/s

A

insidious dz

gradual progressive dysphagia 
regurgitation 
substernal discomfort 
difficulty belching
weight loss
55
Q

diagnostic signs achalasia

barium esophageam

A

bird’s beak (req. verification)

esophageal dilation

56
Q

test that confirms achalasia

A

esophageal monometry

57
Q

tx of choice achalasia

A

surgical therapies

pneumatic dilation
surgical myotomy

58
Q

pneumatic dilation

A

weakness in LES by tearing fibers

less invasive than sx

59
Q

surgical myotomt

A

laparoscopically

success rates up to 90%

60
Q

Botox achalasia

A

injected in LES blocking excitatory neurons

increase LES smooth muscle tone and producing therapeutic decrease in LES

61
Q

diffuse esophageal spasm

A

repetitive simultaneous and prolonged duration contractions

causes chest pain and dypshagia to both liquids and solids

62
Q

scleroderma

A

immune system activation, endothelial dysfunction and fibroblast activity coarsening distal 2/3 of esophagus

63
Q

diagnosis of scleroderma esophagus

A

confirms diagnosis, barium swallow maybe

LES with low resting pressure
free reflux
no peristalsis

tx PPI

64
Q

chagas dz

A

considered in pts from south and Central America

indistinguishable from achalasia

caused by parasite

65
Q

pseudoachalasia

A

primary or metastatic tumor that invades GE junction

GI 1 (12 decks)

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