Esophagus 2 Flashcards by Nayla Mansoor

What is a Leiomyoma

MC benign tumor of esophagus
Arise from submucosa of distal esophagus
Usually ASx +/- dysphagia

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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!

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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

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General info about Adenocarcinoma of esophagus

Occurs in distal esophagus, MC in US 
Smokers 
Chronic reflux 
Obesity 
Caucasians and males 
Barret esophagus (pre-cancer)

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RF for esophageal cancer are

Smoking
Chronic alcohol use (SCC)
Caustic agents (nitrosamines, fungal toxins, carcinogens)
HPV

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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)

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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

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How do you treat esophageal cancer

Surgery!

radiation and chemo can be used too

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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

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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

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What are mucosal cells

most SF
Secrete bicarbonate mucous
coat and lubricate gastric surface to protect spithelium from acid and chemicals

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What are endocrine cells

Secrete gastrin which controls acid secretion and gastric motility

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What are chief cells

Secrete pepsinogen which is an inactive precursor to pepsin

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What are parietal cells

Secrete hydrochloric acid and Intrinsic factor (needed for B12)
Activate pepsinogen (becomes pepsin)
Has histamine, gastrin, and ACh receptors

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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

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How does gastritis present

Dyspepsia (nausea, heartburn, early satiety, bloating, belching)
Abdominal pain

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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

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What is H. pylori

a gram - bacillus that produces urease during it’s metabolism

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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