Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Internal medicine > Esophagus > Flashcards

Esophagus Flashcards

1
Q

What is GERD?

A

reflux of stomach contents causing symptoms/complications

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

factors contributing to GERD

A 
impaired LES function
hiatal hernia
irritant effect of refluxate
abnormal esophageal clearance
delayed gastric emptying (gastroparesis)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

typical clinical features of GERD

A

asymptomatic
sour taste
water brash
retrosternal burning

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

atypical clinical features of GERD

A 
asthma
chronic cough
laryngitis
sore throat
non-cardiac chest pain
halitosis
dental erosions
yellow tongue
chronic sinusitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

alarming clinical features of GERD

A 
troublesome dysphagia
odynophagia
weight loss
iron deficiency anemia
persistent disease despite treatment
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

the classification system of severity of erosive esophagitis

A

Los Angeles grade A B C D

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

DDx of GERD (clinical and endoscopic)

A 
clinical:
motility disorders
peptic ulcer
angina
functional dyspepsia

endoscopic:
pill induced
eosinophilic esophagitis
infections

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

medical treatment for mild/intermittent GERD:

A

lifestyle changes and meds on need (antacids / H2R blocker)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

medical treatment for troublesome cases of GERD

A

PPI 1/day

if not controlled after 4 - 8 weeks, PPI 2/day

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Long term S/Es of PPI

A 
gastroenteritis
pneumonia
iron and B12 deficiency
impaired calcium absorption -> hip fractures
fundic gland polyps

gastric acid is antibacterial, thats why PPIs cause gastroenteritis and pneumonia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

_ months PPI for those with typical reflux symptoms

A

3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what do u do with the 5% of GERD patients who don’t respond to PPI 2/day or change of agent?

A

endoscopy, look for other diagnosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

u do endoscopy for a patient with suspected GERD unresponsive to treatment. what can be seen?

A

residual esophagitis (low dose or not compliant)

truly not responding:
gastrinoma
pill induced
resistance to PPI

could also be normal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

GERD not responsive to meds –> endoscopy

endoscopy normal –> ?

A

pH - impedance test

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Treatment of functional GERD (everything seems normal)

A

tricyclic antidepressants (cuz its probably cuz of stress)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

surgery for GERD

A

fundoplication

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

fundoplication offers good relief and healing of esophagitis in __% of properly selected patients

A

85

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

complications of fundoplication

A

recurrence (10 - 30 %)

new symptoms - dysphagia, bloating, dyspepsia, diarrhea (>30 %)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

indications for fundoplication in GERD

A
  • healthy patient w/ atypical symptoms
  • severe GERD but don’t wanna take PPIs for the rest of their life
  • large hiatal hernia
  • persistent reflux despite PPI
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

complications of GERD

A

Barret esophagus

Peptic stricture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

how does barret esophagus look?

A

orange gastric type epithelial tongue like projections into the esophagus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

what percentage of chronic GERD results in barret esophagus?

A

10%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

OGD goes down until where?

A

second part of duodenum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Barium swallow is pretty much useless in GERD (cuz mucosal damage doesn’t show on the x-ray), except in which case?

A

strictures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

In barret’s esophagus, the metaplasia can be into gastric cardiac/fundic epithelium or specialized intestinal epithelium.
which one is premalignant?

A

specialized intestinal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

symptoms of barret’s esophagus

A

no symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

does GERD treatment (PPI & anti-reflux surgery) cure Barret’s esophagus?

A

no, it just slows the progression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

what cancer develops from barrett metaplasia?

A

adenocarcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

how often do u do surveillance in barret esophagus?

A

every 3 - 5 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

if on Barrett’s esophagus surveillance u find LGD, what do u do?

A

repeat endoscopy to exclude HGD/Ca

if its only LGD, do yearly endoscopy

31
Q

__% of high grade dysplasia have unrecognized carcinoma

A

13%

32
Q

what do u do if u find high grade dysplasia on endoscopy for barrett esophagus?

A

repeat endoscopy to stage it & take biopsy
resection
EUS to exclude invasive Ca

33
Q

surgical treatments for HGD

A 
esophagectomy
snare resection
radiofrequency ablation (RFA)
argon plasma coagulation (APC)
photodynamic therapy (PDT)
laser
cryotherapy
3 monthly endoscopic surveillance with extensive biopsies until ca is detected (for ppl who can't have surgery)
34
Q

complications of HGD surgical treatments

A

bleeding
perforation
stricture

35
Q

what percentage of ppl with esophagitis develop peptic stricture?

A

5%

36
Q

how does peptic stricture manifest?

A

progressive dysphagia for solid foods over months to years

37
Q

progression of peptic stricture vs esophageal cancer

A

peptic stricture is slow (months to years), cancer is fast (month)

38
Q

benefit of peptic stricture

A

its like a natural defense mechanism against GERD, it is a barrier against reflux and decreases heartburn

39
Q

where in the esophagus are most peptic strictures found?

A

gastroesophageal junction (GEJ)

40
Q

when a patient has peptic stricture, what is the mandatory test to do?

A

endoscopy with biopsy to exclude cancer

41
Q

treatment for peptic stricture

A

dilatation with bougies/balloons
long term PPI to prevent recurrence
triamcinolone injection

42
Q

most common treatment method for peptic strictures is

A

bougie/balloon dilation (90%)

43
Q

what is the lumen diameter required to relieve dysphagia?

A

13 - 17 mm

44
Q

Types of esophagitis other than GERD (reflux esophagitis)

A

infective
pill induced
caustic
radiation

45
Q

infective esophagitis is more common in

A

immunosuppressed people

46
Q

most common pathogens causing infective esophagitis

A

CMV
HSV
Candida

47
Q

most common symptoms of infective esophagitis

A

odynophagia and dysphagia

sometimes substernal chest pain

candida is sometimes asymptomatic

48
Q

oral thrush is present in __% of candida esophagitis and __-__% of viral esophagitis

A

75 %

25 - 50 %

49
Q

oral ulcers (herpes labialis) are usually associated with what type of esophagitis?

A

HSV esophagitis

50
Q

Endoscopic findings in esophagitis
candida
CVM
HSV

A

candida: diffuse yellow white plaques adherent to mucosa
CVM: one to several large superficial ulcers
HSV: multiple small deep ulcers

51
Q

treatment of candida esophagitis

A 
systemic treatment with
fluconazole
itraconazole suspension
voriconazole
IV caspofungin
amphotericin B

for 2 - 3 weeks

52
Q

treatment for CMV esophagitis

A

AIDS: HAART

initially: IV ganciclovir or foscarnet for 3 - 6 weeks
once controlled: oral vanganciclovir

53
Q

S/Es of foscarnet

A

renal failure
hypocalcemia
hypomagnesemia

54
Q

HSV esophagitis treatment

A

if immunocompetent: symptomatic treatment

if immunesuppressed: oral or IV acyclovir for 2 - 3 weeks
oral famiciclovir or valcyclovir

if not responding: IV foscarnet for 21 days

55
Q

Pill induced esophagitis is frequently cuz of what drugs?

A 
NSAIDs
KCl
quinidine
zalcitabine
zidovudine
alendronate
risedronate
emperonium
56
Q

why are hospitalized patients at higher risk for pill esophagitis?

A

cuz they r sick they take a lot of pills and then lie down

57
Q

clinical features of pill esophagitis

A 
severe retrosternal chest pain
odynophagia and dysphagia
starts few hrs after taking drug
may be sudden and persist for days
old ppl: no pain but dysphagia
58
Q

pill esophagitis endoscopic finding

A

1 or more discrete ulcers (deep/shallow)

59
Q

chronic injury from pill esophagitis might cause

A

stricture
hemorrhage
perforation

60
Q

does withdrawal from drug in pill esophagitis cure it?

A

yea healing is fast

61
Q

when prescribing drugs for ppl with dysmotility, dysphagia, or strictures, what do u need to keep in mind?

A

avoid drugs that cause pill esophagitis

62
Q

caustic injury to esophagus can be caused by ___ and ___ agents

A

Acidic and alkaline

63
Q

ingestion of a caustic substance causes what symptoms and reactions?

A 
severe burning
chest pain
gagging
dysphagia
drooling
wheeze & stridor (if there was aspiration)
64
Q

why does aspiration of caustic substance cause stridor?

A

laryngeal edema

65
Q

what might u see on CXR and AXR after caustic injury?

A

pneumonitis and free perforation

66
Q

treatment and management of caustic injury

A

initial:
supportive treatment, IV fluids, analgesia
12 - 24 hrs later: endoscopy
psychological assessment (they must have some mental problem if they drank acids and bases!)

if mild:
liquids for 1 - 2 days then back to normal diet

if severe:
emergency esophagectomy and colon/jejunal interposition
nasogastric tube after 24 hrs
oral feeding of liquids after 2-3 days

no steroids or antibiotics

67
Q

mild mucosal injury in caustic injury signs:

A

edema
erythema
exudate
superficial ulcers

68
Q

signs of severe caustic injury

A

deep/circumferential ulcers

black necrotic lesions

69
Q

black necrotic lesions of severe caustic injury has a __% risk of acute complications

A

65%

70
Q

complications of severe caustic injury (deep ulcers and necrotic lesions)

A

perforation + mediastinitis and peritonitis
bleeding
stricture
esophago-tracheal fistula

71
Q

in severe caustic injury, what percent develop strictures? and when?

A

70%

weeks to months later

72
Q

treatment of stricture after caustic injury

A

recurrent dilatation

intralesional triamcinolone between sessions

73
Q

risk of Ca after caustic injury is _ - _ % after _ - _ years

A

2- 3 % after 15 - 20 years

74
Q

years after someone had caustic injury, what do u need to do?

A

surveillance for cancer

Internal medicine (7 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions