Esophageal disorders and GERD Flashcards
1
Q
normal indentations on the esophagus
A
- aortic arch
- left main bronchus
- left atrium
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
3
Q
Plummer Vinson syndrome
A
- proximal esophageal web
- often seen in females with anemia who develop dysphagia
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
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
6
Q
leiomyoma
A
- tumor in wall of esophagus
- can cause dysphagia
- usually in distal esophagus
- benign
7
Q
caustic agents: acid
A
- damages the stomach and spares the esophagus
8
Q
caustic agents: basic
A
- damages the esophagus and spares the stomach
9
Q
paraesophageal hernia
A
- projective vomiting
- ulceration
- hemorrhage
- requires surgical intervention
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
11
Q
Mallory Weis tear
A
- tear in esophagus
- vomit bright red blood
12
Q
double aortic arches
A
- could place the esophagus anterior to a posterior aorta
- causes stridor in infants, especially when flexing their head
13
Q
dysphagia lusoria
A
- subclavian artery anomaly where the subclavian goes posterior leading to dysphagia
14
Q
3 components of UES
A
- inferior constrictor
- cricopharyngeus
- proximal esophagus
15
Q
steakhouse syndrome
A
- acute obstruction of esophagus
- chest pain
- hyper salivation
- treat if 20 mm
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
