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Gastrointestinal STEP 2 > Esophagus > Flashcards

Esophagus Flashcards

1
Q

the essential feature of the majority of esophageal disorders

A

dysphagia

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2
Q

dysphagia vs odynophagia - dentition (both can lead to ….(another symptom))

A

dysphagia: difficulty swallowing
odynophagia: pain while swallowing
BOTH CAN LEAD TO WEIGHT LOSS

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3
Q

when severe, some forms of esophageal disroder will give

A

anemia and heme (+) stool

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4
Q

esophageal disorders - alarm symptoms

A
  1. weight loss
  2. Blood in stool
  3. Anemia
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5
Q

esophageal disorders with alarm symptoms - next step

A

indication for endoscopy

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6
Q

Achalasia - definition

A

it is the inability of the LES to relax due to a loss of nerve plexus (myenteric) within the esophagus. Also there is aperistalsis of the esophageal body

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7
Q

achalasia - age / associations with RFs

A 
young patient (under 50)
NO association with alcohol + tobacco use
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8
Q

achalasia - etiology

A

not clear

2ry to Chagas disease (T. cruzi) or extraesophageal malignancies (mass effect o paraneoplastic)

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9
Q

achalasia - characetiristic presentation

A

progressive dysphagia to BOTH solds and liquids at the SAME TIME

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10
Q

achalasia - diagnostic tests (only the names of the tests) - which is the most accurate

A
  1. Barium esophagram
  2. Manometry (the most accurate)
  3. Chest x-ray
  4. Upper endoscopy
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11
Q

achalasia - Barium esophagram

A

bird’s beak as the esophagus comes down to a point

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12
Q

achalasia - manometry

A

the most accurate

failure of the lower esophageal sphincter to relax

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13
Q

achalasia - chest x-ray

A

abnormal wideningof the esophagus,

NEITHER SENSITIVE NOR SPECIFIC

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14
Q

achalasia - upper endoscopy

A

normal mucosa in achalasa –> However useful to exclude malignancy

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15
Q

esophagus disorders - best first test

A

barium studies are acceptable to do first in most patients, ALTHOUGH RADIOLOGIC TESTS ALWAYS LACK THE SPECIFICITY OF ENDOSCOPIC procedures

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16
Q

esophagus - biopsy

A

in the esophagus, only CANCER and BARRET are diagnosed by biopsy

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17
Q

achalasia - treatment (explain - only names)

A

it cannot exactly be cured - nothing can resore the normal function of the missig neuroloical control. All the treatment is based on simple mechanical dilation of the esophagus:

  1. Pneumatic dilation
  2. Surgucal secioning or myotomy
  3. Botulinum toxin injection
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18
Q

achalasia treatment - pneumatic dilation - describe

A

place an endoscope with the ability to inflate a device that will enlarge the esophagus

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19
Q

achalasia treatment - pneumatic dilation - effective?

A

effective in more than 80-85% of patients

it can lead to perforation in less than 3% of patients

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20
Q

achalasia treatment - surgical sectioning or myotomy

A

to alleviate symptoms

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21
Q

achalasia treatment - pneumatic dilation vs surgeon

A

surgeon is more effective and more dangerous

HARD to choose between them

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22
Q

achalasia treatment - Botulinum injection - describe

A

relax tha LES

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23
Q

achalasia treatment - Botulinum injection - effective?

A

the effects will wear off in about 3-6 months, requiring reinjection

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24
Q

esophageal cancer - age / RF

A
  • 50 or older
  • more than 5-10 years of GERD symptoms
  • association with prolonged alcohol and tobacco use
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25
Q

esophageal cancer - characteristic symptoms

A

dysphagia first for solids, followed (progressing) for dysphagia for liquids

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26
Q

esophageal cancer - most important clue id diagnosis

A

Progressive dysphagia

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27
Q

esophageal cancer - diagnosis test (only names)

A
  1. Endoscopy
  2. Barium
  3. CT and MRI
  4. PET
28
Q

esophageal cancer - best initial test

A

Barium –> but no radiologic test can diagnosed cancer

29
Q

esophageal cancer - endoscopy

A

indispensible –> only biopsy can diagnose cancer

30
Q

esophageal cancer - CT and MRI

A

not enogu to diagnose esoph cancer –> they are used to determine the extent of spread into the surrounding tissues

31
Q

esophageal cancer - PET

A
  • to determine the contents of anatomic lesions if you are not certain whether they contain cancer.
  • to determine is cancer is resectable (local is, widely metastatic is not)
32
Q

cancer - radiologic test for diagnosis

A

never the most accurate

33
Q

esophageal cancer - treatment

A
  • no resection = no cure
  • chemotherapy and radiation are used in addition to surgical removal
  • stent placement
34
Q

esophageal cancer - stent placement

A

for lesions that cannot be resected surgically just to keep the esophagus open for palliation and ti improve dysphagia

35
Q

esophageal spasm - types

A

the 2 forms of spastic disorders, diffuse esophageal spasm (DES) and nutcracker esophagus are clinically indistinguishable

36
Q

esophageal spasm - presentation

A

both types present with the sudden onset of chest pain that is not related to exertion. Therefore, at first it is impossible to distinguish them from some form of atypical coronary artery spasm or unstable angina

37
Q

esophageal spasm - the case will describe

A

sudden severe chest pain

38
Q

esophageal spasm - ecg

A

normal

39
Q

esophageal spasm - esophagram + endoscopy

A

both normal

40
Q

esophageal spasm - DES vs nutcracker

A

can be distinguished only by the most accurate test: manometry –> different pattern of abnormal contraction in each them

41
Q

esophageal spasm - most accurate test

A

manometry

42
Q

esophageal spastic disorders - treatment

A
  1. CCBs and nitrates –> simlar to Printzmental treatment

2. PPIs can improve the number of cases

43
Q

patient with aids and odynophagea - diagnosis

A 
esophageal candidiasis (90%)
other: CMV hepres
44
Q

Dyshagia with HIV CD4 under 100 - steps

A

empirically start fluconazole (oral): IMPROVMENT?
YES: continue therapy and HAART
NO: perform upper endoscopy with biopsy –>
- large ulcerations –> CMV –> gangiclovir or foscarnet
- small ulcerations –> HSV –> acyclovir
- if candida –> IV amphoteriicn

45
Q

Dyshagia with HIV CD4 under 100 - IV amphotericin

A

if confirmed candida not responding to fluconazole

46
Q

candida - nystatin

A

only oral

47
Q

medications that cause esophagitis in prolonged contact

A
  1. Doxycycline
  2. alendronate
  3. KCL (Potassium chloride)
48
Q

esophagus - rings and webs - some diseases (also both can cause)

A
  1. Schatzki ring
  2. Plummer-Vinson
    both give dysphagia
49
Q

Schatzki ring - definition / association etc

A
  • it is a type of scarring or tightenning (aka peptic stricture) of the DISTAL esophagis
  • often from acid reflex and associated with hiatal hernia
  • intermittent dysphagia
50
Q

Plummer vinson - it is associated with / complications

A

iron def anemia

- rarely transform to squamous cell cancer

51
Q

Plummer vinson - iron def anema

A

it is not caused by blood lodd –> plummer vinson is more proximal

52
Q

esophagis - rings and webs - diagnosis

A

easily detected in barium studies

53
Q

esophagis - rings and webs - treatment

A

Schatzki ring –> pneumatic dialiation

Plummer vinson –> treated with iron replacement at firs –> (lead to resolution of the lesion)

54
Q

zenker Diverticulum - definition

A

outpocketing of the posterior pharyngeal constrictor muscles

55
Q

zenker Diverticulum - symptoms

A

dysphagia, halitosis (Bad breath), regurgitation of food particles
some patients suffer from aspiration pneumonia

56
Q

zenker Diverticulum - diagnostic tests

A

barium studies

57
Q

zenker Diverticulum - nasogastric tube placement

A

NEVER –> it can cause perforation

58
Q

zenker Diverticulum - upper endoscopy

A

NEVER –> it can cause perforation

59
Q

zenker Diverticulum - treatment

A

repaired with surgery

- there is no medical therapy

60
Q

esophageal Scleroderma - these patients present with

A

symptoms of reflux and have a clear history of scleroderma or progressive systemic sclerosis

61
Q

esophageal Scleroderma - manometry

A

decreased LES pressure from an inablity to close

62
Q

esophageal Scleroderma - treamtnet

A

PPI (like any person with reflux)

63
Q

manometry is esophagus - which diseases

A
  1. achalasia
  2. spasm
  3. scleroderma
64
Q

Mallory-Weiss tear presents with

A

upper GI bleeding after prolonged or severe vomiting or retching –> repeated retching is followed by hematemesis or bright red blood, or by black stool
(CAN BE PAINFUL)

65
Q

esophageal disease without dysphagia / microscopic imafe

A

Mallory-Weiss tear

nonpenetrating tear of only mucosa

66
Q

Mallory-Weiss tear - treatment

A

no specific therapy –> it will resolve spontaneously –> if severe –> injection of epinephrine to stop bleeding or the use of electrocautery

67
Q

Boerhaave syndrome?

A

ful penetration of the esophagus (with pneumodiastinum) –> surgical emergency

Gastrointestinal STEP 2 (8 decks)

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