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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
Q

risk factors for boerhaave syndrome

A
  • male
  • alcohol/ alcohol withdrawal
  • overeating
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26
Q

treatment of boerhaave syndrome

A
  • requires surgical repair
  • IVF, abx
  • mediastinal/ pleural cavity drainage
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27
Q

esophagitis

A
  • inflammation, irritation, or swelling of esophagus
28
Q

different types of esophagitis

A
  • reflux
  • infectious
  • medication induced
  • radiation
  • systemic disease
  • eosinophilic
29
Q

reflux esophagitis

A
  • gastric contents regurg into esophagus and irritate mucosa
30
Q

infectious esophagitis

A
  • usually in immunocompromised pts

- can be fungal, viral, Tb

31
Q

medications that commonly cause esophagitis

A
  • doxycycline*
  • NSAIDs*
  • KCl
  • bisphosphonates
  • tetracyclines
  • vit C
  • chemotherapy
32
Q

symptoms of esophagitis

A
  • dysphagia**
  • heart burn and ches tpain
  • bitter/ sour tates
  • nausea
  • bloating/ satiety
  • abdominal pain in epigastric area
  • odynophagia
  • cough, wheeze, hoarseness
33
Q

risk factors for esophagitis

A
  • GERD*
  • NSAIDs, doxy, CCB, BB, nitrates
  • tobacco/ smoking
  • mediastinal radiation
  • obesity
  • pregnancy
  • scleroderma
34
Q

esophagitis diagnosis

A
  • history

- EGD- get biopsy, can be therapeutic if bleeding

35
Q

treatment for esophagitis

A
  • 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
Q

pain management for esophagitis

A
  • narcotics*
  • H2 blockers
  • liquid antacids or magic mouthwash
37
Q

what is in magic mouthwash

A
  • viscous lidocaine
  • liquid benadryl
  • liquid maalox
38
Q

complications of esophagitis

A
  • esophageal strictures
  • malnutrition
  • perforation and/or GI bleed
  • barretts esophagus -> cancer
39
Q

gastritis

A
  • inflammation of gastric mucosa
  • can be entire stomach vs. one region
  • can be erosive vs. non-erosive
40
Q

erosive gastritis cause and location

A
  • usually d/t NSAIDs

- occurs at greater curvature of stomach

41
Q

common cause of non-erosive gastritis

A
  • h pylori
42
Q

what is the overall most common cause of gastritis

A
  • h pylori
43
Q

causes of gastritis

A
  • drugs- NSAIDs*
  • h pylori
  • liquor
  • bile reflux
  • radiation therapy
  • acute stress- shock
  • trauma
  • ischemia
  • allergy/ eosinophilic
44
Q

diagnosis of gastritis

A
  • h pylori tests
  • EGD- only “true” way to dx
  • CT- not tool of choice but may see thick folds, inflamed nodules, etc.
45
Q

symptoms of gastritis

A
  • epigastric pain*, burning, gnawing
  • N/V +/- eating
  • melena, hematemesis, hematochezia, coffee ground emesis
46
Q

treatment for gastritis

A
  • if h pylori positive then triple therapy
  • d/c offending agents
  • antacids
  • sucralfate/ carafate
  • h2 blockers
  • PPI
47
Q

causes of GERD

A
  • LES impaired- LES transient relaxation or hiatal hernias
  • delayed gastric emptying
  • decreased esophageal motility
48
Q

hiatal hernia

A
  • cardia of stomach moves up into esophagus

- contents get sucked into esophagus

49
Q

how many pts with GERD develop esophagitis?

A
  • half
50
Q

sx of GERD

A
  • heart burn*- retrosternal burning
  • dysphagia*
  • regurgitation*
  • sour taste in mouth
  • night time cough, asthma, wheeze
  • chest pain
  • hoarseness/ dysphonia/ laryngitis
  • aspiration pna/ pneumonitis
51
Q

diagnosis of GERD

A
  • usually clinical
  • EGD for chronic GERD assessment
  • 24 hour esophageal pH monitoring- gold std, not used often
  • esophageal manometry
52
Q

treatment for GERD

A
  • lifestyle modifications
  • minimize gastric acid secretions
  • antacids
  • H2 blockers
  • PPI
  • corrective surgery (nissen fundoplication)- last line
53
Q

complications of GERD

A
  • strictures

- barret esophagus

54
Q

why is barrett esophagus problematic?

A
  • pts 30-40 X more likely to develop adenocarcinoma
55
Q

barrett esophagus

A
  • metaplastic conversion of squamous epithelium to columnar epithelium
56
Q

esophageal small cell carcinoma

A
  • upper half of esophagus
  • common in eastern europe and asia
  • due to smoking and alcohol
57
Q

esophageal adenocarcinoma

A
  • lower half of esophagus
  • common in north america and western europe
  • usually d/t GERD/ barrett esophagus
58
Q

risk factors for esophageal cancer

A
  • GERD/ barrett esophagus
  • alcohol, tobacco
  • obesity
  • significant vitamin deficiency
  • family hx
59
Q

clinical presentation of esophageal cancer

A
  • dysphagia- quick onset
  • weight loss > 50%, cachectic
  • regurgitate food
  • epigastric pain, retrosternal pain, bone pain from METS
  • chronic cough
  • hoarseness/ dysphonia
  • virschow node
60
Q

diagnosis of esophageal cancer

A
  • 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
Q

C/I for surgery in esophageal cancer pts

A
  • N2 or greater
  • METs to solid organs
  • invasion of local structures
  • severe comorbidities
62
Q

what is the most common type of gastric cancer

A
  • adenocarcinoma
63
Q

risk factors for gastric cacner

A
  • h. pylori*
  • genetics
  • smoking
  • pernicious anemia
  • obesity, diet
  • adenomatous polyps
  • radiation exposure
64
Q

sx of gastric cancer

A
  • insidious onset vague gastric sx
  • weight loss
  • gastric outlet obstruction
  • small bowel obstruction
  • palpable enlarged stomach
  • local spread, spread to liver
  • hepatomegaly
65
Q

diagnosis of gastric cancer

A
  • 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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