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Clin Med III > esophageal disorders, gastritis, GERD > Flashcards

esophageal disorders, gastritis, GERD Flashcards

1
Q

what are the dysmotility disorders

A
  • achalasia
  • diffuse esophageal spasm (DES)
  • nutcracker esophagus
  • hypertensive LES
  • scleroderma esophagus
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2
Q

achalasia

A
  • loss of ganglion cells -> LES unable to relax
  • more common in elderly
  • causes dysphagia and obstruction -> proximal dilation of esophagus
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3
Q

diffuse esophageal spasms (DES)

A
  • multiple areas of esophagus spasm at same time
  • imbalance between excitatory and inhibitory pathways
  • manometry with > 20% simultaneous contractions
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4
Q

nutcracker esophagus

A
  • LES exerts very high pressures during peristalsis

- > 220 mmHg

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5
Q

hypertensive LES

A
  • LES always elevated resting tone

- > 45 mmHg

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6
Q

clinical presentation of dysmotility disorders

A
  • depends on disorder
  • progressive dysphagia
  • regurg esp at night and in supine
  • chest pain, sudden onset and intermittent- likely to get cardiac work up
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7
Q

work up for dysmotility disorders

A
  • EKG/ troponins, and CXR to r/o cardiac issues
  • barium esophagram
  • endoscopy- r/p mechanical and inflammatory lesions
  • manometry- last line
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8
Q

what does a birdbeak on esophagram suggest

A
  • achalasia
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9
Q

what does a cork screw on esophagram suggest

A
  • DES
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10
Q

treatment for dysmotility disorders

A
  • dietary modifications
  • nitrates and CCB
  • TCAs
  • botox in LES- achalasia and HTN LES
  • endoscopic pneumatic dilation
  • if fail dilation twice then consider surgery
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11
Q

esophageal strictures

A
  • narrowing of lumen of the esophagus

- need to r/o malignancy- often assoc with GERD

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12
Q

what causes distal esophageal strictures

A
  • GERD
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13
Q

what causes proximal or mid esophageal strictures

A
  • inflammation

- esophagitis, malignancy etc.

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14
Q

schatzki ring

A
  • benign stricture at distal part of esophagus
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15
Q

symptoms of esophageal strictures

A
  • dysphagia- slow onset without weight loss
  • odynophagia
  • heart burn and chest pain
  • food impactoin
  • chronic cough, asthma- mainly d/t GERD
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16
Q

work up for esophageal strictures

A
  • barium esophagram- det location, length, and diameter
  • endoscopy*- biopsy to det if malignant
  • CT for staging
  • esophageal manometry if everything else is normal
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17
Q

treatment for esophageal strictures

A
  • PPI
  • life style modifications
  • avoid meds that cause pill esophagitis
  • EGD- esophageal dilation
  • possible intralesional steroid injection if PPI or dilation fails
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18
Q

mallory weiss tears

A
  • upper GI bleed d/t longitudinal mucosal lacerations
  • at of GEJ or gastric cardia
  • stomach prolapses into esophagus -> tears in distal esophagus
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19
Q

what is the most common cause of mallory weiss tears

A
  • persistent retching/ vomiting

- usually due to alcohol abuse

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20
Q

clinical presentation of mallory weiss tears

A
  • hematemsis- vomit a lot THEN vomit blood
  • melena
  • syncope/ assoc hemorrhagic hypovolemia
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21
Q

treatment for mallory weiss tears

A
  • usually none- spontaneously heal
  • antiemetic
  • PPI +/- sucralfate
  • can do EGD- most have stopped bleeding and low risk rebleed
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22
Q

boerhaave syndrome

A
  • transmural rupture of esophagus
  • “worse version of mallory weiss”
  • high mortality rates
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23
Q

where does boerhaave syndrome usually occur

A
  • distal 1/3 of esophagus
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24
Q

si/sx of boerhaave syndrome

A
  • repetitive retching/ vomiting then sudden chest pain
  • pain may radiate to back/ intrascap region
  • no hematemesis
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25
risk factors for boerhaave syndrome
- male - alcohol/ alcohol withdrawal - overeating
26
treatment of boerhaave syndrome
- requires surgical repair - IVF, abx - mediastinal/ pleural cavity drainage
27
esophagitis
- inflammation, irritation, or swelling of esophagus
28
different types of esophagitis
- reflux - infectious - medication induced - radiation - systemic disease - eosinophilic
29
reflux esophagitis
- gastric contents regurg into esophagus and irritate mucosa
30
infectious esophagitis
- usually in immunocompromised pts | - can be fungal, viral, Tb
31
medications that commonly cause esophagitis
- doxycycline* - NSAIDs* - KCl - bisphosphonates - tetracyclines - vit C - chemotherapy
32
symptoms of esophagitis
- dysphagia** - heart burn and ches tpain - bitter/ sour tates - nausea - bloating/ satiety - abdominal pain in epigastric area - odynophagia - cough, wheeze, hoarseness
33
risk factors for esophagitis
- GERD* - NSAIDs, doxy, CCB, BB, nitrates - tobacco/ smoking - mediastinal radiation - obesity - pregnancy - scleroderma
34
esophagitis diagnosis
- history | - EGD- get biopsy, can be therapeutic if bleeding
35
treatment for esophagitis
- pain mangament* - PPI X 2-4 weeks - sucralfate - if infectious or systemic then treat the cause - eosinophilic- avoid food allergen, give leukotriene inhibitors and steroids - d/c any offending agents - lifestyle modifications
36
pain management for esophagitis
- narcotics* - H2 blockers - liquid antacids or magic mouthwash
37
what is in magic mouthwash
- viscous lidocaine - liquid benadryl - liquid maalox
38
complications of esophagitis
- esophageal strictures - malnutrition - perforation and/or GI bleed - barretts esophagus -> cancer
39
gastritis
- inflammation of gastric mucosa - can be entire stomach vs. one region - can be erosive vs. non-erosive
40
erosive gastritis cause and location
- usually d/t NSAIDs | - occurs at greater curvature of stomach
41
common cause of non-erosive gastritis
- h pylori
42
what is the overall most common cause of gastritis
- h pylori
43
causes of gastritis
- drugs- NSAIDs* - h pylori - liquor - bile reflux - radiation therapy - acute stress- shock - trauma - ischemia - allergy/ eosinophilic
44
diagnosis of gastritis
- h pylori tests - EGD- only "true" way to dx - CT- not tool of choice but may see thick folds, inflamed nodules, etc.
45
symptoms of gastritis
- epigastric pain*, burning, gnawing - N/V +/- eating - melena, hematemesis, hematochezia, coffee ground emesis
46
treatment for gastritis
- if h pylori positive then triple therapy - d/c offending agents - antacids - sucralfate/ carafate - h2 blockers - PPI
47
causes of GERD
- LES impaired- LES transient relaxation or hiatal hernias - delayed gastric emptying - decreased esophageal motility
48
hiatal hernia
- cardia of stomach moves up into esophagus | - contents get sucked into esophagus
49
how many pts with GERD develop esophagitis?
- half
50
sx of GERD
- heart burn*- retrosternal burning - dysphagia* - regurgitation* - sour taste in mouth - night time cough, asthma, wheeze - chest pain - hoarseness/ dysphonia/ laryngitis - aspiration pna/ pneumonitis
51
diagnosis of GERD
- usually clinical - EGD for chronic GERD assessment - 24 hour esophageal pH monitoring- gold std, not used often - esophageal manometry
52
treatment for GERD
- lifestyle modifications - minimize gastric acid secretions - antacids - H2 blockers - PPI - corrective surgery (nissen fundoplication)- last line
53
complications of GERD
- strictures | - barret esophagus
54
why is barrett esophagus problematic?
- pts 30-40 X more likely to develop adenocarcinoma
55
barrett esophagus
- metaplastic conversion of squamous epithelium to columnar epithelium
56
esophageal small cell carcinoma
- upper half of esophagus - common in eastern europe and asia - due to smoking and alcohol
57
esophageal adenocarcinoma
- lower half of esophagus - common in north america and western europe - usually d/t GERD/ barrett esophagus
58
risk factors for esophageal cancer
- GERD/ barrett esophagus - alcohol, tobacco - obesity - significant vitamin deficiency - family hx
59
clinical presentation of esophageal cancer
- dysphagia- quick onset - weight loss > 50%, cachectic - regurgitate food - epigastric pain, retrosternal pain, bone pain from METS - chronic cough - hoarseness/ dysphonia - virschow node
60
diagnosis of esophageal cancer
- endoscopy* with bx - endoscopic US for staging - CT for METs - bronchoscopy - PET and bone scans - laproscopic staging- common to have intraabdominal mets that arnt picked up on CT
61
C/I for surgery in esophageal cancer pts
- N2 or greater - METs to solid organs - invasion of local structures - severe comorbidities
62
what is the most common type of gastric cancer
- adenocarcinoma
63
risk factors for gastric cacner
- h. pylori* - genetics - smoking - pernicious anemia - obesity, diet - adenomatous polyps - radiation exposure
64
sx of gastric cancer
- insidious onset vague gastric sx - weight loss - gastric outlet obstruction - small bowel obstruction - palpable enlarged stomach - local spread, spread to liver - hepatomegaly
65
diagnosis of gastric cancer
- labs, esp CEA - EGD for definitive dx and biopsy - CT for staging - endoscopic US for tumor staging

Clin Med III (26 decks)

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