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G2F > Esophagus and stomach CIS > Flashcards

Esophagus and stomach CIS Flashcards

1
Q

bad taste in mouth

A

water brash

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2
Q

gurgling of stomach

A

borborygmi

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3
Q

bad breath

A

halitosis

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4
Q

GERD

A
  • solids and liquids- intermittent, not progressive

- can have esophageal dysphagia when accompanied by weak peristalsis- motility disorder- ineffective esophageal motility

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5
Q

GERD- complications

A

-esophagitis, stricture, BE, adenocarcinoma

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6
Q

GERD- Dx

A
  • ambulatory 24 to 48 hr esophageal pH recording

- EGD if alarm sx

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7
Q

GERD- treatment

A

trial of acid suppression and lifestyle modification- first line!

  • dec Etoh and caffeine
  • small low fat meals
  • assess psychosocial situation
  • PPI- first line
  • H pylori eradication if indicated
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8
Q

GERD- red flags

A
  • weight loss
  • persistent vomiting
  • constant/severe pain
  • dysphagia
  • hematemesis
  • melena
  • anemia
  • *needs endoscopy (or ABD imaging)!!!
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9
Q

GERD- when else do we need endoscopy

A
  • failed response to 4-8 wks of PPI

- when frequent sx relapse after PPI discontinued

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10
Q

esophageal stricture- sx, caused by?

A
  • esophageal dysphagia
  • progressive- solids–> liquids
  • most common is peptic secondary to GERD (can also occur b/c of eosinophilic esophagitis)
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11
Q

esophageal stricture- Dx, Tx

A
  • barium swallow/EGD

- dilation, PPI/H2 blocker

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12
Q

esophageal ring (Schatzki)- sx

A
  • esophageal dysphagia
  • solids; intermittent sx
  • “steakhouse syndrome”
  • > 40 yrs- acquired
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13
Q

esophageal ring- dx, tx

A
  • barium swallow/EGD

- dilation

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14
Q

Barrett esophagus

A
  • specialized columnar metaplasia in distal esophagus- in ppl with GERD!
  • esophageal adenocarcinoma!
  • at risk- obese white males > 40
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15
Q

BE- Dx

A
  • EGD with Bx

- screening EGD in pts with chronic (10 yrs) GERD!

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16
Q

BE- Tx

A
  • surveillance endoscopy
  • endoscopic ablation
  • surgical resection
  • PPI!
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17
Q

esophageal cancer

A
  • adenocarcinoma

- SCC

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18
Q

adenocarcinoma

A
  • M>W
  • BE
  • distal 1/3 of esophagus
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19
Q

SCC

A
  • > 45, M
  • middle 1/3 of esophagus
  • smoking, alcohol, HPV
  • chemical/thermal injury
  • esophageal disorders- Achalasia
  • radiation
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20
Q

Scleroderma- sx

A
  • esophageal dysphagia- mainly solids
  • motility disorder- absent peristalsis, weakness of LES
  • 30-50 age, F
  • microangiopathy and fibrosis of skin and visceral organs!!!
  • may present with chronic heartburn and raynaud phenomenon
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21
Q

Scleroderma- ab’s

A
  • ANA (in 90%)
  • Topoisomerase I ab’s (anti-Scl-70)- 30% with diffuse dz!!
  • Anticentromere ab’s- 45% with limited dz!!
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22
Q

Diffuse Scleroderma

A
  • diffuse- proximal extremities and trunk
  • early and progressive internal organ involvement
  • worse prognosis
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23
Q

Limited Scleroderma

A
  • fingers, toes, face, distal extremities
  • Raynaud’s
  • CREST syndrome- calcinosis cutis, raynaud’s, esophageal dysmotility, sclerodactyly, telangiectasia
  • indolent course
  • good prognosis
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24
Q

Zenker’s diverticulum- what is it? sx?

A
  • oropharyngeal > esophageal
  • false diverticula- b/w the cricopharyngeus m and inferior pharyngeal constrictor m’s- in Killian’s triangle!!
  • sx- dysphagia, regurgitation, choking, aspiration, voice changes, halitosis, weight loss
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25
Q

Zenker’s diverticulum- Dx, Tx

A
  • Barium swallow

- surgery

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26
Q

Test for achalasia

A

-esophageal manometry

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27
Q

seen with Sjogren’s syndrome?

A

B cell non-Hodgkin lymphoma

28
Q

Test for GERD

A

esophageal pH

29
Q

Sjogren’s syndrome- sx

A
  • rheumatologic
  • F, mid 50’s, postmenopausal
  • Sicca sx- dry eyes/mouth- oropharyngeal dysphagia
30
Q

Achalasia- imaging

A
  • bird’s beak

- sigmod esophagus

31
Q

Achalasia- causes

A
  • primary- loss of ganglion cells within myenteric plexus!!

- secondary- chagas disease (trypanosoma cruzi- kissing bug vector)

32
Q

Achalasia- Dx

A

-barium swallow xray and esophageal manometry!!!

33
Q

Achalasia- Tx

A

-LES pressure can be reduced by nitrates and CCB therapy, pneumatic balloon dilatation, botox injection, or surgical myotomy

34
Q

Achalasia- Manometry

A
  • incomplete LES relaxation
  • inc LES tone
  • aperistalsis
35
Q

Esophageal webs- sx

A
  • esophageal dysphagia
  • intermittent!
  • Plummer-Vinson syndrome- iron def anemia, cheilitis, glossitis, koilonychia (spoon nails)- middle aged women!
36
Q

esophageal webs- Dx, Tx

A
  • barium swallow/EGD

- dilatation

37
Q

Plummer-Vinson syndrome

A
  • upper esophagea lwebs
  • oropharyngeal dysphagia- intermittent, solids!
  • iron def anemia- weakness, fatigue
  • angular cheilitis
  • glossitis
  • koilonychia (spoon nails)
  • pallo
38
Q

Assoc with scleroderma?

A

GAVE

39
Q

Candidiasis- occurs in who?

A
  • uncontrolled diabetes

- immunosuppressed

40
Q

Eosinophilic Esophagitis- sx

A
  • M, allergies, atopic conditions

- dysphagia and esophageal food impactions!!!

41
Q

Eosinophilic Esophagitis- Dx

A

EGD!

-multiple circular esophageal rings creating a corrugated appearance (“feline esophagus”/ looks like trachea), edema

42
Q

Eosinophilic Esophagitis- Biopsy

A
  • squamous epit eosinophil-predominant infl

- >15-20 eosinophils per high-power field

43
Q

Eosinophilic Esophagitis- complications

A

-esophageal stricture, narrow-caliber esophagus, food impaction, esophageal perforation!!

44
Q

Eosinophilic Esophagitis- Tx

A
  • PPI, elimination diets, swallow topical glucocorticoids, allergist referral
  • food allergy elimination- milk, wheat, soy, nuts, seafood- followed by systematic reintroduction
  • esophageal dilation- relieves dysphagia
  • risk of esophageal perforation!!
45
Q

Esophagitis- causes

A
  • dysphagia and odynaphagia!!- mainly solids
  • pill- doxycycline, quinidine, phenytoin!!
  • infectious
  • eosinophilic
46
Q

diffuse esophageal spasm (DES)- sx

A

(uncoordinated esophageal contraction

  • esophageal dysphagia
  • solids and liquids- intermittent!
  • “corkscrew esophagus”
  • LES fxn normal; disordered motility of esophageal body
  • dysphagia and chest pain
  • “rosary bead esophagus”
47
Q

diffuse esophageal spasm- Dx

A

-manometry, EGD

48
Q

Nutcracker esophagus

A

(hypertensive peristalsis)

  • greater amplitude and duration but normal coordinated contraction!!
  • LES relaxes normally, but has an elevated pressure at baseline!!
49
Q

mechanical obstruction vs motility disorder

A
  • mechanical- solid foods worse than liquids

- motility- solids and liquids

50
Q

Esophageal Perforation- sx

A
  • trauma
  • forceful vomiting- rupture at gastroesophageal jxn- Boorhaave’s syndrome- pleuritic retrosternal pain- pneumomediastinum, subcutaneous emphysema
51
Q

Esophageal perforation- dx

A
  • CT of chest- detects mediastinal air

- confirmed by contrast swallow, usually gastrografin followed by thin barium

52
Q

esophageal perforation- tx

A

-NGT suction, NPO parenteral antibx and surgery

53
Q

Mallory-weiss tear

A
  • vomiting
  • nontransmural tear at GE jxn
  • causes upper GI bleeding
54
Q

mallory- weiss tear- dx, tx

A
  • history, EGD
  • bleeding usually abates spontaneously!
  • protracted bleeding may respond to local epinephrine!! or cauterization therapy, endoscopic clipping, or angiographic embolization
55
Q

Esophageal varices- sx, dx, tx

A
  • dilated submucosal v’s
  • asymptomatic or hematemesis- if rupture- emergency!!
  • liver dz work up
  • Dx- EGD
  • Tx- banding, sclerotherapy, balloon tamponade, variceal ligation, B blocker to dec portal HTN
56
Q

stress ulcers- caused by?

A

-curling ulcer- burns

57
Q

H pylori- assoc with

A

MALToma

58
Q

ulcer risk

A

smoking + H pylori

59
Q

peptic ulcer dz- causes

A

-NSAID, H pylori, EtOH

60
Q

peptic ulcer dz- dx, tx

A
  • EGD +/- H pylori

- H2 blocker, PPI, eradicate H pylori!!

61
Q

Gastric ulcer disease- caused by? sx?

A
  • H pylori (75% of time)
  • lesser curvature of antrum of stomach
  • burning epigastric pain
  • worsens within 30 min of eatin
62
Q

duodenal ulcer- caused by? sx?

A
  • 95% secondary to H pylori
  • gnawing pain
  • 1-3 hrs after eating
  • relieved by food/eating
  • NSAIDs/steroids- risk factors
63
Q

Helicobacter pylori- is what? causes what?

A
  • curved gram neg rods that produce urease (microaerophilic spiral gram neg bacilli with flagella)
  • chronic gastritis- antrum- inc gastrin- inc Hcl prod by parietal cells- inc risk of duodenal ulcer
  • MALToma assoc
  • poverty, birth outside US
  • person to person (fecal/oral)
  • CagA- toxin
64
Q

H pylori- testing

A
  • Stool ag immunoassay!!
  • Carbon 13/14 urea breath test!!
  • pt should be off PPI or antibiotics for 7-14 days prior to testing!!
65
Q

H pylori- histologic exam

A

-EGD with biopsy (warthin-starry stain) or rapid CLO

66
Q

H pylori- serology

A

H pylori abs, IgA

67
Q

Zollinger-Ellison Syndrme

A
  • PUD that isnt responding to tx, is severe, atypical, recurrent
  • gastrin secreting tumor (gastrinoma)- pancreas, proximal duodenal, LN’s
  • 25% apart of MEN1
  • hypertrophic gastric mucosa
  • 2/3 are malignant- metastasize to liver!!
  • fasting gastrin–> rule out MEN1!!

G2F (17 decks)

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