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Emma GI > Esophageal Disorders > Flashcards

Esophageal Disorders Flashcards

1
Q

esophagus boundaries

A

from cricopharyngeal m. in pharynx (C6) to LES at GE junction (T11/T12)

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2
Q

esophageal lacerations

A

usu via severe retching assoc w/ EtOH

tears mucosal or full-thickness

5-10% upper GI bleeds

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3
Q

Boerhaves syndrome

A

complete, full-thickness rupture at lower thoracic esophagus

CP, shock, Hamman’s sign (pneumomediastinum), subQ emphysema

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4
Q

Mallory-Weiss syndrome

A

incomplete tear of esophagus, only affects mucosa/submucosa

hematemesis

EtOH

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5
Q

GERD anti-reflux mech

A 
LES
Crural diaphragm ("external" sphincter)

^fail –> reflux

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6
Q

3 Dif mech of LES incompetence in gastroesophageal reflux

A
  • hypotensive LES
  • inc intrabd pressure
  • transient LES relaxation
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7
Q

dec LES pressure

A 
fatty foods
nicotine
theophylline
caffeine
secretin, CCK, progesterone
glucagon
anti-cholinergica
-alpha-antagonists
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8
Q

inc LES pressure

A 
proteins
gastrin
motilin
metaclopramide
cisapride
pancreatic polypeptide
substance P
bombesin
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9
Q

type I hiatal hernia

A

axial or sliding

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10
Q

type II hiatal hernia

A

paraesophageal

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11
Q

GERD

A

acid prod within normal range

acid in wrong place

GERD –> MOTILITY disorder

  • LES hypOtension
  • transient lower esophageal sphincter relaxations
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12
Q

heartburn in pregnancy

MOA, tx

A

hormonal (inc estrogen, progesterone –> LES dysfunction)
mechanical (inc intraabd P)

tx: antacids, H2-blockers, PPIs

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13
Q

GERD lifestyle modifications

A 
elevate head of bed
lose xs weight
adjust meds
avoid 
-tobacco, EtOH, late eating, fat, chocolate, peppermint
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14
Q

GERD med tx

A

antacids
H2 receptor antagonists (“-idine”)
PPIs (“-azole”)

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15
Q

fundoplication

A

surgical therapy for GERD, wrap fundus of stomach around lower esophagus to enhance LES

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16
Q

discontinue theophylline if experiencing

A

GERD

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17
Q

reflux esophagitis histo

A

intraepithelial eos

  • basal zone hyperplasia
  • papillary elongation
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18
Q

eos esophagitis

clinical manifestations

A

age <2 –> feeding disorders, failure to thrive

age 3-12 years –> dysphagia, esophageal food impaction

M>F (3:1)

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19
Q

eos esophagitis dx

A

sx related to esophageal dysfunction
>15 eos in at least one esophageal biopsy specimin
- eos limited to esophagus
- other causes: GERD, eos gastroenteritis, drug hypersensitivity

20
Q

eos esophagitis tx

A 
PPIs
inhaled steroid (fluticasone) is swallowed
lifestyle changes

no long term effects of Barrett’s esophagus or malig

21
Q

esophagitis: 4 clinical pictures

A

reflux (heartburn pt)
pill-induced (acne pt)
infections (immunocompromised pt)
eosinophilic esophagitis (allergic pt)

22
Q

pill-induced esophagitis

A
  • tetracycline, doxycycline (acne pt). + Odynophagia

- potassium chorine

23
Q

Odynophagia

A

pill-induced esophagitis

infectious esophagitis

24
Q

infectious esophagitis

A

HSV (odynophagia)

Candida (dysphagia)

25
Q

Barrett’s esophagus

A

-distal squamous mucosa = replaced by metaplastic columnar epithelium as a response to chronic injury from acid reflux

man risk factor for esophageal adenocarcinoma

mean age at dx = 60 yrs

nonhispanic white men

26
Q

Barret’s histo

A

metaplastic columnar epithelium

goblet cells

if high grade dysplasia –> larger nuclei, open chromatin, inc N:C, crowded

27
Q

Barrett’s progression to adenocarcinoma

A

specialized intestinal metaplasia –> dysplasia –> adenocarcinoma

28
Q

Barrett’s tx

A
  • endoscopy surveillance every 1-3 yr

tx: PPIs, radio ablation

29
Q

esophageal cancer

A
  • 9th most prevalent cancer worldwide
  • inc incidence in US, w/ shift from squamous cell –> adenocarcinoma

most pt = asymptomatic during early stages, present w/ advanced/mets

poor prognosis

30
Q

esophageal adenocarcinoma

A

~40-50% primary esophageal cancers

distal esophagus

> 50y/o, M>F, nonhispanic white men

progressive dysphagia, weight loss

risk fx: GERD, Barrett’s, tobacco, FHx, red meat, fats, processed foods

31
Q

h.pylori infection may reduce risk of

A

esophageal adenocarcinoma (lower gastric acid)

32
Q

esophageal squamous cell CA

A

more proximal esophagus compared to adenocarcinoma

dysphagia, anorexia, weight loss

M>F, >50, african-american

usu invasion into muscular propria @ presnetation

  • invasion of adjacent mediastinal structures that may cause fistula
  • node mets
  • distant mets

prognosis sim to adenocarcinoma

33
Q

esophageal squamous cell CA risk fx

A 
lack of fruits/veg
EtOH
TOBACCO (poss synergistic w/ EtOH)
achalasia
corrosive strictures (lye)
Plummer-vinson syndrome (esophageal web, Fe deficiency, anemia)
Radiation therapy
Squamous cell CA of other aerodigestive sites
34
Q

esophageal cancer prevention

A

PPIs
aspirin, NSAIDs
statins

35
Q

esophageal dysphagia

A

food sticks

36
Q

oropharyngeal dysphagia

A

difficulty initiating swallowing

coughing/choking/nasal regurg

37
Q

odynophagia

A

pain w/ swallowing

38
Q

Schatzki ring

A

lower mucosal esophageal ring, usu at GE junction

typically associated w/ a hiatal hernia, thus located above the diaphragm

39
Q

Achalasia

A
  • inflamm at LES
  • select destruction of NO containing neurons
  • unopposed ACh action at LES –> xs contraction
  • dilation of esophagus
  • sim to chagas

dx: barium swallow, upper endoscopy, esophageal motility study

40
Q

3 primary findings of esophageal motility study in achalasia

A
  • Increased resting tone of the LES
  • Failure of the LES to relax with swallowing
  • Reduced, or absent, peristalsis in the esophageal body
41
Q

barium swallow XR finding in achalasia

A

“bird beak esophagus”

dilated esophagus and tapered narrowing of the distal esophagus

42
Q

achalasia tx

A

endoscopic balloon dilation, botulinum toxin injection in the LES done at the time of upper endoscopy, or surgical treatment

Surgery involves cutting the LES muscle (myotomy)

43
Q

esophageal gastric junction outflow obstruction

A

incompletely expressed achalasia

high pressure LES

sx: solid/liquid dysphagia

44
Q

distal esophageal spasm

A

normal LES fxn

multiple premature contractions

sx: CP, solid/liquid dysphagia

45
Q

jackhammer esophagus

A
  • hypercontractile motility disorder
  • prolonged high amplitude contractions
  • LES pressure normal

sx: CP, solid/liquid dysphagia

46
Q

scleroderma

A

weak, low amp contractions

low LES pressure

sx: solid/liquid dysphagia

sometimes w/ reflux esophagitis

Emma GI (18 decks)

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