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GI Week 1 > Esophageal Disorders and GERD Clinical > Flashcards

Esophageal Disorders and GERD Clinical Flashcards

1
Q

How do odynophagia and dysphagia differ?

A

odynophagia is pain on swallowing

dysphagia is a symptom resulting from the failure to move a food bolus from the mouth to the stomach - more of a discomfort than pain

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2
Q

In general, what are three factors that contribute to dysphagia?

A
  1. inadequate preparation (reduced saliva, imparied mental functoin)
  2. abnormal lunch strength or function (neuromusclar disorders or motility disturbances)
  3. esophageal passageway narrowed
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3
Q

What is dysphagia which includes difficulty initiating swallowing?

A

oropharyngeal dysphagia

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4
Q

What is dysphagia where food stops and “sticks” after swallowing is initiated?

A

esophageal dysphagia

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5
Q

What are some anatomical causes of oropharyngeal dysphagia?

A

postcricoid web
cervical osteophyte
hypopharyngeal diverticulum
head and neck tumors

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6
Q

What are some muscular diseases that cause oropharyngeal dysphagia?

A

oculopharyngeal muscle dystrphy
myotonic dystrophy
myasthenia gravis

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7
Q

What are some neurological disorders that can cause oropharyngeal dysphagia?

A 
CVA
poliolyelitis
ALS
parkinson's disease
cerebral palsy
tumors
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8
Q

What are the three main goals of treatment in oropharyngeal dysphagia?

A

protect the airway
maintain nutrition
relieve dysphagia

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9
Q

What are the 4 general therapeutic modalities for oropharyngeal dysphagia?

A

speach/swallowing therapy
esophageal dilation
surgical myotomy
NPO with nutrition support

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10
Q

What are some anatomic causes of esophageal dysphagia?

A

peptic strictures
rings and webs
caustic scars
cancer - either primary esophageal or extrinsic compression

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11
Q

What are some neuromuscular causes of esophageal dysphagia?

A

achalasia from chagas’ disease

other motor disorders

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12
Q

What is achalasia?

A

It’s basically where the lower esophageal sphincter is constantly constricted - they have ACh causing contraction, but they lose the inhibitory neurons that would secrete VIP and NO so you never get relaxation (or inappropriate relaxation)

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13
Q

How do most people with achalasia present?

A

with progressive lifelong dysphagia that starts with solids and then progresses to both solids and liquids.

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14
Q

How can we diagnose achalasia?

A

manometry to measure pressures - will show a non-relaxing LES and aperistalsis in the esophagus

barium swallow will show a bird’s-beak narrowing at the LES and a dilated esophagus

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15
Q

Why do you always get endoscopy after a barium swallow suggests achalasia?

A

carcinoma at the esophagogastric junction can mimic achalasia and you wouldn’t be able tot tell the difference on a barium swallow

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16
Q

How can we treat achalasia? Drugs and procedures….

A

calcium channel blockers and botulinum toxin, balloon dilation and esophagogastric myotomy

17
Q

What happens in diffuse esophageal spasm?

A

you get different parts of the esophagus contracting simultaneously instead o f in a wave-like pattern like it’s supposed to. this means food doesn’t get pushed down

contractions can be severe and painful

make sure you rule out heart attack though!

18
Q

What affect can systemic sclerosis from scleroderma have on the esophagus?

A

it basically paralyzes it such that they don’t get peristaltic contractions and there’s no tone in the LES. Basically the esophagus becomes a lead pipe and they’ll have constant reflux and dysphagia

19
Q

What’s the most common cause of GERD?

A

transient LES relaxations

20
Q

What are some other causes of GERD?

A 
weak or failed esophageal peristalsis
hypotensive LES at baseline
gastroparesis
duodenogastric reflux
hiatal hernia
21
Q

dysphagia for solids only, intermittent….

A

lower esophageal ring

22
Q

dysphagia for solids only, progressive….

A

peptic stricture or cancer (esp if over 50)

23
Q

Dysphagia for solids and liquids, intermittent…

A

diffuse esopahgeal spasm
NEMD
nutcracker

24
Q

Dysphagia for solids and liquids, progressive…

A

achalasia or scleroderma

25
Q

How ften do most people with GERD have symptoms?

A

monthly

26
Q

What are some external factors that can contribut to the pathophysiology of GERD?

A

diet
high-fat foods
smoking
medications

27
Q

What are the common esophageal symptoms of GERD?

A

heartburn
regurgitation
belching
water brash - increased salivary secretion

28
Q

What are some atypical presentations of GERD to be aware of?

A 
chest pain
hoarseness/larygnitis
loss of dental enamel
asthma/chronic cough
dyspepsia
29
Q

What are some symptoms associated with COMPLICATIONS of GERD?

A

dysphagia from strictures

odynophagia and bleeding from inflammation and ulcers

30
Q

What are the two mechanisms by which hiatal hernias may contribute to reflux?

A

no diaphragmatic support of the LES

the hernia acts as a reservoir for gastric contetns

31
Q

Are diagnostic studies needed with a classic history of GERD?

A

he says rule out cardiac, otherwise no

32
Q

What are some ways you can test for GERD

A

a barium sallow to see hiatal hernia or strictures, endoscopy to see lots of things, ambulatory pH monitoring, esophageal manometry to check LES and peristalsis

33
Q

What are some lifestyle modifications you can make in GERD therapy?

A 
elevate bed
no food 3 hrs before bed
modify diet (decrease fat and avoid peppermint, onions, cirtus, etc)
avoid harmful meds
OTC meds prn
34
Q

What drugs are classic for decreasing LES pressure leading to GERD?

A

theophylline
anticholinergis
calcium channel blockers
nitrates

35
Q

What drugs are classic for injurying the esophageal mucosa?

A 
tetracyclines
quinidine
NSAIDS
potassium tablets
iron salts
36
Q

What two groups of meds do we use to treat GERD?

A

H2 receptor antagonists

Proton pump inhibitors

37
Q

What percentage of patients with GERD develop barrett;s

A

10-15%

38
Q

Barrett;s esophagus is a risk factor for what cancer?

A

esophageal adenocarcinoma

39
Q

What other complication can GERD cause in the esophagus contributing to dysphagia?

A

strictures - in aobut 10% of people with GERD

it’s ulceration that stimualtes fibrosis

GI Week 1 (13 decks)

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