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Summer FDTN Exam 5 > Esophagus 2 > Flashcards

Esophagus 2 Flashcards

1
Q

What is a Leiomyoma

A

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

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2
Q

How do you diagnose leiomyoma

A

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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3
Q

General info about Squamous cell carcinoma of esophagus

A 
Occurs in mid-portion of esophagus 
Smokers 
EtOH abuse 
southeast Asians and Af. Am. 
Plummer Vinson syndrome
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4
Q

General info about Adenocarcinoma of esophagus

A 
Occurs in distal esophagus, MC in US 
Smokers 
Chronic reflux 
Obesity 
Caucasians and males 
Barret esophagus (pre-cancer)
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5
Q

RF for esophageal cancer are

A

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

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6
Q

How does Esophageal cancer present

A

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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7
Q

How do you diagnose esophageal cancer

A

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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8
Q

How do you treat esophageal cancer

A

Surgery!

radiation and chemo can be used too

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9
Q

What is prognosis of esophageal cancer

A

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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10
Q

What is stomach A&P

A

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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11
Q

What are mucosal cells

A

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

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12
Q

What are endocrine cells

A

Secrete gastrin which controls acid secretion and gastric motility

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13
Q

What are chief cells

A

Secrete pepsinogen which is an inactive precursor to pepsin

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14
Q

What are parietal cells

A

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

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15
Q

What is gastritis

A

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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16
Q

How does gastritis present

A

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

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17
Q

How do you diagnose gastritis

A

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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18
Q

What is H. pylori

A

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

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19
Q

How do you treat gastritis

A

Remove causative agent (EtOH, NSAIDs)

Tx underlying cause (PPI for NSAID induced; Tx for H. pylori x 14d, then test for eradication)

20
Q

How do you treat H. Pylori (MC regimen)

A

Bismuth
Tetracycline
Metronidazole
PPI (BID)

21
Q

H. Pylori gastritis is associated with

A

PUD
Gastric adenocarcinoma
Low grade B cell gastric lymphoma

22
Q

What is PUD

A

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**

23
Q

How does PUD present

A

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)

24
Q

How can you tell the difference between gastric and duodenal ulcer (Sx)

A

Gastric: abdominal pain worse after eating
Duodenal: abdominal pain improves after eating

25
Q

How do you diagnose PUD

A 
*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)
26
Q

How do you treat PUD

A

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

27
Q

PUD prophylaxis includes

A

Misoprostol (PGE analog) to prevent ulcers when using NSAIDs. *category X
Sucralfate (1 hr before meals)
PPI

28
Q

Complications of PUD are

A 
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)
29
Q

What is gastroparesis

A

Delayed emptying of stomach (stomach stasis)

Caused by Idiopathic (MC), Diabetes (MC known reason), disease of smooth muscle, neuro dysfunction

30
Q

How does gastroparesis present

A 
Nausea 
Excess fullness (early satiety) 
Bloating, weight loss, abdominal pain
31
Q

How do you diagnose gastroparesis

A

Endoscopy (to rule out masses)

Scintigraphy emptying study to diagnose

32
Q

How do you treat gastroparesis

A

Diet mod: smaller meals, avoid carbonation

Prokinetic meds: Cisapride, Metoclopramide (reglan)

33
Q

What is a hiatal hernia

A

protrusion of stomach through diaphragm via esophageal hiatus (stomach slides up and down)
Prevalence increases with age

34
Q

How does hiatal hernia present

A

ASx
GERD
Chest discomfort

35
Q

How do you diagnose hiatal hernia

A

Barium esophagram

Endoscopy

36
Q

How do you treat hiatal hernia

A

Acid reduction

Surgical repair

37
Q

What is a gastrinoma

A

Gastrin secreting tumor that can cause duodenal* ulcers
SKS Zollinger Ellison Syndrome
Associated with MEN1

38
Q

How does a gastrinoma present

A

Abdominal pain and diarrhea *

GI bleed

39
Q

How do yuo diagnose Gastrinoma

A

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

40
Q

How do you treat gastrinoma

A

PPI
Surgery
Screen for MEN1

41
Q

What is a Gastric adenocarcinoma

A

Neoplasm of older age (RARE <40)

RF are smoking**, H. pylori, and genetics

42
Q

How does a gastric adenocarcinoma present

A

Dyspepsia, weight loss, anemia, GI bleed
Abdominal mass (not common)
Signs of mets

43
Q

What are Sx of mets associated with gastric adenocarcinoma

A

Virchow Node: left supraclavicular LAD

Sister mary joseph nodule: Umbilical nodule

44
Q

How do you diagnose Gastric adenocarcinomas

A

Endoscopy if 40+ w/ dyspepsia unresponsive to Tx
CBC: iron deficiency anemia is common
CT to determine extent

45
Q

How do you treat gastric adenocarcinoma

A

Surgery!

+/- chemo and radiation

46
Q

What is a Gastric lymphoma

A

Made up of: MALT (mucosa associated lymphoid tissue) and Diffuse large B cell lymphoma
Risk is 6x higher if + H. pylori infection

Summer FDTN Exam 5 (12 decks)

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