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Esophagus Flashcards

1
Q

What’s the normal physiologic process of the esophagus?

A

The return of the stomach’s contents into the esophagus

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2
Q

How does the lower esophageal sphincter work?

A

It opens to allow food to pass into the stomach and closes to prevent backflow

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3
Q

If a patient presents with heartburn after eating meals, that’s worse with lying down, odynophagia (pain with swallowing), and regurgitation with belching – what diagnosis are you thinking?

A

GERD

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4
Q

What is occurring in GERD?

A

When the LES is weak/relaxes inappropriately

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5
Q

What are some natural protective factors we have to prevent GERD?

A

gravity, tone of the LES, salivary flow, and motility

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6
Q

What are some risk factors to developing GERD?

A

Tetracycline abx, bisphosphates, iron, NSAIDS, anticholinergics, CCBs, narcotics, and benzos

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7
Q

What are some atypical presentations for GERD?

A

Sore throat, dental carries, chronic cough, asthma, halitosis, and hiccupping.

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8
Q

How would you confirm diagnosis of GERD?

A

many patients are treated empirically.

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9
Q

At what point do you need to do more to confirm diagnosis?

A

IF they are over 50 with new onset of symptoms, long-standing symptoms that have failed to respond to therapy, any symptoms indicating anemia, or recurrent vomiting. Also if they use heavy alcohol or tobacco products

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10
Q

So, your patient is over 50 has failed to respond to GERD therapy and is a heavy smoker/drinker, what do you do?

A

Upper endoscopy with biopsy (esophagogastroduodenoscopy) = EGD

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11
Q

What would you do if you have an elderly patient with recurrent pneumonias?

A

Get a modified barium swallow – to make sure they’re not aspirating

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12
Q

What if a person is younger than 50, and isn’t responding to GERD treatment?

A

Barium swallow first

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13
Q

In general, what are some lifestyle treatment recommendations you can suggest to treat GERD?

A

Avoid foods that weaken the LES – coffee, chocolate, peppermint, alcohol, fatty foods, wine, and orange juice. Avoid eating 2-3 hours before bed. *Elevate head & weight loss!

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14
Q

What are some pharmacologic recommendations you can suggest to treat GERD?

A

First line – H2 receptor antagonists = cimetidine, ranitidine
If no relief from H2 blocker after 6 weeks – PPI = omeprazole for 8-12 weeks

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15
Q

When would you use a PPI as first line treatment?

A

For moderate-severe disease

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16
Q

What’s important to remind our patients about PPI’s?

A

Need to take it continuously to prevent the release of acid

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17
Q

What can you prescribe to help patients with nighttime symptoms?

A

Combo – H2 at bedtime & PPI during the day

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18
Q

What can sometime occur with a weak LES that causes the retention of acid?

A

Hiatal hernia

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19
Q

What is occurring in a hiatal hernia?

A

When the upper part of the stomach moves into the esophagus acting as an additional sphincter

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20
Q

What is a complication of significant GERD?

A

Can cause a stricture or lead to Barrett’s esophagus

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21
Q

What if a patient has chest pain & dysphagia and has failed conservative treatment. You decide to get a barium swallow and the results show a nutcracker deformity, what diagnosis is this?

A

Esophageal spasm

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22
Q

What subsequent test can you do to confirm esophageal spasm? What would it show?

A

Esophageal manometry It will show hypercontractility at the LES

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23
Q

How can you treat esophageal spasm?

A

Nitrates or CCB (diltiazem)

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24
Q

IF a patient has dysphagia with solid food only, what is the cause?

A

Mechanical obstruction

25
Q

If a patient has dysphagia with solid AND liquid foods, what is the cause?

A

Neuromuscular

26
Q

What if your patient with chest pain and dysphagia that has failed conservative treatment. You decide to get a barium swallow and it shows a bird’s beak deformity, what diagnosis is this?

A

Archalasia

27
Q

Besides the barium swallow, how else could you diagnose Archalasia?

A

Chest x-ray

28
Q

What is occurring in Archalasia?

A

there is a loss in peristalsis – causing the LES to not relax, until the pressure of the food sitting there causes it to open

29
Q

What can cause Archalasia?

A

damage to the nerves (seen in diabetic patients), infection, age, and hereditary

30
Q

How can you treat archalasia?

A

nitrates or CCB; botox, pneumatic dilation (balloon stretch), or myotomy (cut the muscular ring)

31
Q

Your GERD patient has failed conservative treatment and excessively drinks and smokes. So you order an EGD, and it comes back with inflammation. What does this mean?

A

Esophagitis

32
Q

If you get the rare diagnosis of esophagitis, what does that indicate about this patient?

A

He is immunocompromised – most likely has CMV, HSV, Zoster, or Candida (thrush)

33
Q

What other symptoms would you note with HSV esophagitis? How would you treat it?

A

N/V and herpetic lesion on nose & lips. Treat with acyclovir

34
Q

What other symptoms would you note with Zoster esophagitis? How would you treat it?

A

Current outbreak of Zoster Treat with acyclovir

35
Q

What other symptoms would you note with CMV esophagitis? How would you treat it?

A

immunocompromised, ulcers Treat with gangcyclovir

36
Q

What other symptoms would you note with candida esophagitis? How would you treat it?

A

Immunocompromised, weird taste, itchy throat. Treat with Fluconazole

37
Q

If you get the diagnosis of esophagitis, what would you immediately need to test the patient for?

A

HIV!

38
Q

What is a complication of long-standing GERD?

A

Barrett’s Esophagus

39
Q

What is occurring in Barrett’s esophagus?

A

The squamous epithelium of the esophagus is being replaced by columnar cells of the stomach – which has a HIGH propensity for NEOPLASTIC changes

40
Q

How do you manage the diagnosis of Barrett’s esophagus?

A

repeat endoscopy every 2 years with a biopsy

41
Q

What does Barrett’s esophagus most likely develop into? Where is that located?

A

Adenocarcinoma

Located in Distal esophagus

42
Q

What about squamous cell carcinoma, where does that occur?

A

In the proximal 2/3 of the esophagus

43
Q

Is the incidence of Adenocarcinoma increasing or decreasing in America?

A

Increasing

44
Q

If regurgitated blood a common finding for a neoplasm of the esophagus?

A

No

45
Q

How do you confirm diagnosis of esophageal cancer?

A

Barium esophagram then endoscopy

46
Q

How do you treat esophageal cancer?

A

Generally surgical, sometime radiation & chemo

47
Q

What are two other diagnosis can we think of when a patient presents with dysphagia after eating solid foods?

A

Esophageal ring (Schatski’s) or web

48
Q

Which stricture (wed or ring) occurs in the mid-upper esophagus?

A

Web

49
Q

Which stricture (web or ring) occurs in the lower esophagus, near the junction of the stomach?

A

Ring

50
Q

How do you confirm diagnosis of a stricture (web or ring)?

A

Barium esophagram or EGD à NOT A BARIUM SWALLOW (as there is a perforation)

51
Q

If a patient has multiple bouts of vomiting followed by painless hematemesis, what diagnosis are you thinking?

A

Mallory-Weiss tear

52
Q

What is occurring in a Mallory Weiss tear?

A

linear tear from forceful vomiting

53
Q

How would you confirm diagnosis of Mallory-Weiss tear?

A

Endoscopy (see blood), chest x-ray, EKG, CBC, PT, PTT, BUN/Cr

54
Q

How would you treat a patient with a Mallory-Weiss tear?

A
  • Make sure their stable – blood transfusion. Gastric lavage & control bleeding endoscopically
  • Most resolve on their own. Can use a PPI once active bleeding is resolved
55
Q

What diagnosis are you thinking if you are working in an ER and a patient is brought in by ambulance for profuse vomiting of blood?

A

Varices

56
Q

What is happening that causes a varices?

A

There is portal HTN from alcoholism. Blood flow to the liver is diminished causing blood to increase around the esophagus à dilation of the blood vessels which can rupture.

57
Q

How would you treat a varices?

A

Immediate endoscopy to control bleeding

58
Q

What is the long term treatment for a varices?

A

Quit drinking. Abx, BB (propranolol), and nitrates

GI (6 decks)

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