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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
Barrett's esophagus
-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
Barret's histo
metaplastic columnar epithelium goblet cells if high grade dysplasia --> larger nuclei, open chromatin, inc N:C, crowded
27
Barrett's progression to adenocarcinoma
specialized intestinal metaplasia --> dysplasia --> adenocarcinoma
28
Barrett's tx
- endoscopy surveillance every 1-3 yr | tx: PPIs, radio ablation
29
esophageal cancer
- 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
esophageal adenocarcinoma
~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
h.pylori infection may reduce risk of
esophageal adenocarcinoma (lower gastric acid)
32
esophageal squamous cell CA
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
esophageal squamous cell CA risk fx
``` 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
esophageal cancer prevention
PPIs aspirin, NSAIDs statins
35
esophageal dysphagia
food sticks
36
oropharyngeal dysphagia
difficulty initiating swallowing | coughing/choking/nasal regurg
37
odynophagia
pain w/ swallowing
38
Schatzki ring
lower mucosal esophageal ring, usu at GE junction typically associated w/ a hiatal hernia, thus located above the diaphragm
39
Achalasia
- 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
3 primary findings of esophageal motility study in achalasia
* Increased resting tone of the LES * Failure of the LES to relax with swallowing * Reduced, or absent, peristalsis in the esophageal body
41
barium swallow XR finding in achalasia
"bird beak esophagus" dilated esophagus and tapered narrowing of the distal esophagus
42
achalasia tx
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
esophageal gastric junction outflow obstruction
incompletely expressed achalasia high pressure LES sx: solid/liquid dysphagia
44
distal esophageal spasm
normal LES fxn multiple premature contractions sx: CP, solid/liquid dysphagia
45
jackhammer esophagus
- hypercontractile motility disorder - prolonged high amplitude contractions - LES pressure normal sx: CP, solid/liquid dysphagia
46
scleroderma
weak, low amp contractions low LES pressure sx: solid/liquid dysphagia sometimes w/ reflux esophagitis

Emma GI (18 decks)

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