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Gastrointestinal System > Esophageal disorders and GERD > Flashcards

Esophageal disorders and GERD Flashcards

1
Q

normal indentations on the esophagus

A
  • aortic arch
  • left main bronchus
  • left atrium
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2
Q

symptopms of Zenker’s diverticula

A
  • regurgitation
  • bad breath
  • gurgling in the neck
  • protrusion through Killen’s triangle
  • more common in men over 60
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3
Q

Plummer Vinson syndrome

A
  • proximal esophageal web

- often seen in females with anemia who develop dysphagia

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4
Q

Candida esophagitis

A
  • more common in IC patients
  • present with painful swallowing (agonophagia)
  • cottage cheese like infection
  • bleeds when scraped
  • treat with antifungal
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5
Q

viral herpes simplex

A
  • obtained in youth but presents in an IC state
  • Kowvres bodies characteristic
  • yellowish tint
  • attacks squamous cells of the esophagus and form multinucleated giant cells
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6
Q

leiomyoma

A
  • tumor in wall of esophagus
  • can cause dysphagia
  • usually in distal esophagus
  • benign
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7
Q

caustic agents: acid

A
  • damages the stomach and spares the esophagus
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8
Q

caustic agents: basic

A
  • damages the esophagus and spares the stomach
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9
Q

paraesophageal hernia

A
  • projective vomiting
  • ulceration
  • hemorrhage
  • requires surgical intervention
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10
Q

Boerhaave syndrome

A
  • rupture of esophagus into mediastinum
  • usually on the left
  • pleural effusion will have amylase and barium will be in the esophagus
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11
Q

Mallory Weis tear

A
  • tear in esophagus

- vomit bright red blood

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12
Q

double aortic arches

A
  • could place the esophagus anterior to a posterior aorta

- causes stridor in infants, especially when flexing their head

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13
Q

dysphagia lusoria

A
  • subclavian artery anomaly where the subclavian goes posterior leading to dysphagia
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14
Q

3 components of UES

A
  • inferior constrictor
  • cricopharyngeus
  • proximal esophagus
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15
Q

steakhouse syndrome

A
  • acute obstruction of esophagus
  • chest pain
  • hyper salivation
  • treat if 20 mm
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16
Q

symptoms of GERD

A
  • chest or epigastric pain
  • worse when lying down or bending over
  • worse after meals
  • heartburn
  • atypically chest pain, sore throat, laryngitis, hiccups, cough
17
Q

classifications of GERD: erosive esophagitis

A
  • LA grade A: mucosal breaks no longer than 5 mm
  • LA grade B: breaks longer than 5 mm
  • LA grade C: mucosal breaks that extend between the tops of two or more mucosal folds
  • LA grade D: mucosal breaks that together involve atleast 75% of esophageal circumference
18
Q

major factors contributing to GERD

A
  • decreased LES resistance: hiatal hernia, weak LES
  • disturbed LES function: inappropriate transient relaxation
  • overwhelmed LES: high intraabdominal pressure
19
Q

NERD

A
  • in a minority of patients, exposure to refluxate is normal
  • GERD may be due to decreased mucosal resistance to refluxate
20
Q

hiatal hernia -GERD

A
  • may trap a reservoir of gastric contents above the diaphragm, increasing reflux
  • may compromise LES function
21
Q

lifestyle treatments of GERD

A
  • raise head of bed
  • decrease fat intake
  • avoid exacerbating foods
  • avoid lying down 3 hours after eating
  • stop smoking
  • lose weight if appropriate
22
Q

pharm treatments of GERD

A
  • antacids: prompt but temporary relief
  • prokinetics: only mild degrees of erosive esophagitis
  • H2RAs: cimetidine, ranitidine, famotidine, nizatidine
  • PPIs: more effective than H2RAs, taken once a day, more severe cases of GERD
  • surgery( avoid in NERD patients)
23
Q

treatment of NERD

A
  • PPIs: all end in “prazole”
24
Q

oropharyngeal dysphagia

A
  • arises from disease of the upper esophagus and pharynx or from UES dysfunction
  • problem of the striated muscle
25
Q

esophageal dysphagia

A
  • arises within the body of the esophagus, the LES, or cardia and is most commonly due to mechanical causes or a motility disturbance
26
Q

slceroderma

A
  • vascular obliteration and fibrosis in smooth muscle which causes weak LES, poor esophageal contractility, delayed gastric emptying
  • often associated with CREST
  • treat with high dose of PPIs
27
Q

achalasia

A
  • loss of peristalsis in the distal esophagus and a failure of LES to relax
  • caused by degeneration of ganglion cells within the esophageal myenteric plexus
  • demonstrated with CCK test, bird beak on barium swallow
  • treat with nitrates, Ca channel blockers, botox
28
Q

globus

A
  • persistent or intermittent nonpainful sensation of a lump of foreign body in the throat
  • occurs between meals
  • absence of dysphagia or odynophagia
  • absence of GERD
29
Q

eosinophilic esophagitis

A
  • in children: abdominal and chest pain, failure to thrive, vomiting, GERD like symptoms
  • in adults: solid food dysphagia, chest pain, refractory heart burn, food impaction is common
  • slightly more common in males
30
Q

endoscopic findings of EOE

A
  • atleast 15 eosinophils per high powered film
  • linear esophageal furrow which gives a railroad track appearance
  • hallmark is a dense mucosal eosinophilic infiltration of the esophagus
  • strictures
31
Q

treatment of EOE

A
  • in children: dietary restriction by using an amino-acid based formula, corticosteroids
  • adults: swallowed steroids
32
Q

laryngopharyngeal reflux disease

A
  • larynx has no defense or clearance mechanisms
  • arytenoid/ interarytenoid changes
  • granuloma
  • cobblestone appearance
  • symptoms persist after GERD
  • postnasal drip
  • gravelly/ squeaky voice
33
Q

diffuse esophageal spasm

A
  • 20% or more simultaneous contractions
34
Q

nutcracker esophagus

A
  • average distal esophageal peristaltic pressures exceeding 220 mmHg during 10 or more 5 mL liquid swallows
  • can cause non-cardiac chest pain
35
Q

hypertensive lower esophageal sphincter

A
  • resting lower esophageal sphincter pressure above 45 mmHg
  • exaggerated post relaxation contraction
  • different from achalasia in that this has normal peristalsis

Gastrointestinal System (12 decks)

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