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GI Week 1 - WLB > Esophageal Disorders & GERD - Erickson > Flashcards

Esophageal Disorders & GERD - Erickson Flashcards

1
Q

What is Odynophagia?

A

Pain on swallowing.

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2
Q

What is Dysphagia?

A

Symptom resulting from the failure to move a food bolus from the mouth to the stomach.

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3
Q

What factors contribute to Dysphagia?

A
  1. Inadequate preparation of what is being swallowed.
    • Reduced saliva or mastication
    • Neuromuscular disorders
    • Impaired mental function
  2. Abnormal muscle strength/function
    • Neuromuscular disorders
    • Motility disturbances
  3. Esophageal passageway narrowed
    • Mechanical obstruction
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4
Q

What are the goals of therapy in Oropharyngeal Dysphagia?

A
  • Protect airway
  • Maintain nutrition
  • Relieve dysphagia
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5
Q

What are the causes of Dysphagia?

A
  • Anatomic
    • Benign: peptic strictures, rings and webs, caustic scars
    • Cancer: primary esophageal and extrinsic compression
      • (increasing incidence of adenocarcinoma)
  • Neuromuscular
    • Primary esophageal disease: achalasia, Chagas’ disease, other motor disorders
  • Secondary
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6
Q

What is Achalasia?

A

Loss of inhibitory innervation to the LES

(lose NO/VIP => always contracting)

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7
Q

What organism causes Chagas’ disease?

A

Trypanosoma cruzi

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8
Q

What are the symptoms of Achalasia?

A
  • Dysphagia
  • Regurgitation
  • Chest pain
  • Weight loss
  • Cough
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9
Q

What is secondary achalasia?

A
  • Tumor on the other side of the Lower Esophageal Sphincter causing constriction
    • (carcinoma at esophagogastric junction mimics achalasia)
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10
Q

MOA of Nifedipine

A

Calcium channel blocker

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11
Q

MOA of Botulinum Toxin

A

Prevents release of ACh at cholinergic nerve ending

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12
Q

What are the surgical treatments for Achalasia?

A
  • Balloon Dilation
  • Esophagogastric Myotomy
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13
Q

What is CREST syndrome?

A
  • Multisystem connective tissue disorder.
  • “CREST”:
    • calcinosis
    • Raynaud’s phenomenon
    • esophageal dysmotility
    • sclerodactyly
    • telangiectasia
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14
Q

What questions should you ask a patient with likely esophageal dysphagia? What symptoms suggest particular diagnoses in Esophageal Dysphagia?

A
    1. Solids only? or Solids and/or Liquids?
    1. Intermittent or Progressive?
      * If intermittent with solids only => Lower esophageal ring
      * If progressive with solids only => Peptic stricture or cancer (esp. if >50 y.o.)
      * If intermittent with solids and liquids => diffuse spasm NEMD nutrcracker
      * If progressive with solids and liquids => Achalasia or Scleroderma
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15
Q

What are the possible etiologies of GERD?

A
  1. Diminished Esophageal Clearance
    • Peristalsis
    • Body position
    • Saliva
  2. Defective Anti-Reflux Barrier
    • LES
    • Crural Diaphragm
    • Hiatal Hernia
  3. Gastric Factors
    • Acid
    • Bile Acid
    • Gastric Emptying
    • Gastric Distention
  4. External Factors
    • Diet
    • High-fat foods
    • Smoking
    • Medication
  5. Impaired Esophageal Mucosal Resistance
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16
Q

What is Zollinger Ellingson Syndrome?

A
  • gastrin-secreting tumor of the pancreas
    • stimulates the acid-secreting cells of the stomach (parietal cells) to maximal activity
    • consequent gastrointestinal mucosal ulceration
17
Q

What are the common symptoms of GERD?

A
  • Heartburn
  • Regurgitation
  • Belching
  • Water brash
18
Q

What are the atypical presentations of GERD?

A
  • Chest pain
  • Hoarseness/laryngitis
  • Loss of dental enamel
  • Asthma/chronic cough
  • Dyspepsia
19
Q

What three symptoms are associated with complications of GERD?

A
  • Dysphagia
  • Odynophagia
  • Bleeding
20
Q

Are diagnostic studies needed when a patient presents with a classic history of GERD?

A

NO diagnostic studies needed. Start empiric treatment.

***RULE OUT cardiac etiology first though!

21
Q

What is the best diagnostic study for evaluating mucosal injury and diagnosing esophagitis, Barrett’s epithelium, hiatal hernia, or strictures?

A

Endoscopy

22
Q

What are the life-style modifications that have been effective in GERD therapy?

A
  • Elevate head of bed while sleeping
  • No food 3 hours before bedtime
  • Stop smoking
  • Modify diet:
    • decrease fat and volume
    • avoid peppermint, onions, citrus juice, coffee, and tomato products
  • Avoid potentially harmful medications
  • OTC medications PRN
23
Q

What is Barrett’s Esophagus?

A

Columnar epithelium replaces squamous epithelium in distal esophagus.

24
Q

What condition is a major risk factor for esophageal adenocarcinoma?

A

Barrett’s Esophagus → associated primarily with intestinal metaplasia

GI Week 1 - WLB (11 decks)

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