Esophagus 2 Flashcards
What is a Leiomyoma
MC benign tumor of esophagus
Arise from submucosa of distal esophagus
Usually ASx +/- dysphagia
How do you diagnose leiomyoma
Discovered incidentally; small solitary round firm mass
Can’t tell it is benign unless you surgically remove it
-SO- Tx is surgical excision!
General info about Squamous cell carcinoma of esophagus
Occurs in mid-portion of esophagus Smokers EtOH abuse southeast Asians and Af. Am. Plummer Vinson syndrome
General info about Adenocarcinoma of esophagus
Occurs in distal esophagus, MC in US Smokers Chronic reflux Obesity Caucasians and males Barret esophagus (pre-cancer)
RF for esophageal cancer are
Smoking
Chronic alcohol use (SCC)
Caustic agents (nitrosamines, fungal toxins, carcinogens)
HPV
How does Esophageal cancer present
Sx can be mild (it sticks when I swallow bread)
Progressive solid food dysphagia
Weight loss
Heartburn
Vomiting
Regurgitation, aspiration
Hoarseness (recurrent laryngeal nerve involvement)
How do you diagnose esophageal cancer
Barium esophagram (initial test): Apple Core lesion
Endoscopy w/ biopsy to make actual diagnosis
CT chest/abd, Endoscopic US w/ FNA Bx of lymph nodes, PET-CT, or Bronchoscopy to stage the cancer
How do you treat esophageal cancer
Surgery!
radiation and chemo can be used too
What is prognosis of esophageal cancer
Depends on stage at diagnosis, but MC poor
Mets goes to stomach and colon
Surgical resection w/ radiation and chemo has best prognosis
What is stomach A&P
Proximal: fundus and body. storage of food, decontamination chamber
Distal: antrum and pylorus. Phasic contracation, grind solids into small particles, control rate of emptying
What are mucosal cells
most SF
Secrete bicarbonate mucous
coat and lubricate gastric surface to protect spithelium from acid and chemicals
What are endocrine cells
Secrete gastrin which controls acid secretion and gastric motility
What are chief cells
Secrete pepsinogen which is an inactive precursor to pepsin
What are parietal cells
Secrete hydrochloric acid and Intrinsic factor (needed for B12)
Activate pepsinogen (becomes pepsin)
Has histamine, gastrin, and ACh receptors
What is gastritis
Inflammation of the stomach 2/2:
1. NSAIDs (decrease PG production= injury)
2. H. pylori (gram - associated w/ PUD and gastric cancer)
Stress (injury, burns, sepsis, surgery)
Alcohol
How does gastritis present
Dyspepsia (nausea, heartburn, early satiety, bloating, belching)
Abdominal pain
How do you diagnose gastritis
Endoscopy w/ biopsy (confirm H. pylori, ID gastritis)
Can also do Urea breath test (detects urease) and stool antigen H. pylori test, but they are $$$
Serology for H. Pylori, but has low Sn/Sp
What is H. pylori
a gram - bacillus that produces urease during it’s metabolism
How do you treat gastritis
Remove causative agent (EtOH, NSAIDs)
Tx underlying cause (PPI for NSAID induced; Tx for H. pylori x 14d, then test for eradication)
How do you treat H. Pylori (MC regimen)
Bismuth
Tetracycline
Metronidazole
PPI (BID)
H. Pylori gastritis is associated with
PUD
Gastric adenocarcinoma
Low grade B cell gastric lymphoma
What is PUD
Ulcer pf upper GI system associated w/ gastric cancer
Occurs 2/2 break in mucosa from injury, NSAIDs, stress, alcohol, or (MC) H. pylori infection**
How does PUD present
Abdominal pain (burning, gnawing pain radiating to back)
Feels empty even after eating
Worse AFTER eating
Leads to anorexia and weight loss
Dyspepsia (belching, bloating, distention, heart burn, regurgitation)
How can you tell the difference between gastric and duodenal ulcer (Sx)
Gastric: abdominal pain worse after eating
Duodenal: abdominal pain improves after eating
How do you diagnose PUD
*Endoscopy! dfferentiate gastritis from ulcer, allows biopsy and samples for culture/urease testing H. pylori testing (urea breath test, stool antigen test) Barium swallow (can miss a lot of ulcers)
How do you treat PUD
Avoid triggers (smoking, NSAIDs, alcohol)
Therapy for H. Pylori x 2-4 weeks
Gastric ulcers: PPI x 12 weeks
Duodenal ulcers: PPI x 4-8 weeks
PUD prophylaxis includes
Misoprostol (PGE analog) to prevent ulcers when using NSAIDs. *category X
Sucralfate (1 hr before meals)
PPI
Complications of PUD are
Obstruction 2/2 scarring (n/v, bloating, no appetite) GI bleed (hematemesis, melena) Ulcer perforation (rapid onset severe pain, air under hemidiaphragm on XR) Penetration, fistula (halitosis, vomiting)
What is gastroparesis
Delayed emptying of stomach (stomach stasis)
Caused by Idiopathic (MC), Diabetes (MC known reason), disease of smooth muscle, neuro dysfunction
How does gastroparesis present
Nausea Excess fullness (early satiety) Bloating, weight loss, abdominal pain
How do you diagnose gastroparesis
Endoscopy (to rule out masses)
Scintigraphy emptying study to diagnose
How do you treat gastroparesis
Diet mod: smaller meals, avoid carbonation
Prokinetic meds: Cisapride, Metoclopramide (reglan)
What is a hiatal hernia
protrusion of stomach through diaphragm via esophageal hiatus (stomach slides up and down)
Prevalence increases with age
How does hiatal hernia present
ASx
GERD
Chest discomfort
How do you diagnose hiatal hernia
Barium esophagram
Endoscopy
How do you treat hiatal hernia
Acid reduction
Surgical repair
What is a gastrinoma
Gastrin secreting tumor that can cause duodenal* ulcers
SKS Zollinger Ellison Syndrome
Associated with MEN1
How does a gastrinoma present
Abdominal pain and diarrhea *
GI bleed
How do yuo diagnose Gastrinoma
1: Fasting serum gastrin level (>150)
Secretin test to confirm ZES (should decrease gastrin level, so w/ a gastrinoma, gastrin will rise by 200+)
Endoscopy, CT, MRI
How do you treat gastrinoma
PPI
Surgery
Screen for MEN1
What is a Gastric adenocarcinoma
Neoplasm of older age (RARE <40)
RF are smoking**, H. pylori, and genetics
How does a gastric adenocarcinoma present
Dyspepsia, weight loss, anemia, GI bleed
Abdominal mass (not common)
Signs of mets
What are Sx of mets associated with gastric adenocarcinoma
Virchow Node: left supraclavicular LAD
Sister mary joseph nodule: Umbilical nodule
How do you diagnose Gastric adenocarcinomas
Endoscopy if 40+ w/ dyspepsia unresponsive to Tx
CBC: iron deficiency anemia is common
CT to determine extent
How do you treat gastric adenocarcinoma
Surgery!
+/- chemo and radiation
What is a Gastric lymphoma
Made up of: MALT (mucosa associated lymphoid tissue) and Diffuse large B cell lymphoma
Risk is 6x higher if + H. pylori infection
