Esophagus and stomach CIS Flashcards
bad taste in mouth
water brash
gurgling of stomach
borborygmi
bad breath
halitosis
GERD
- solids and liquids- intermittent, not progressive
- can have esophageal dysphagia when accompanied by weak peristalsis- motility disorder- ineffective esophageal motility
GERD- complications
-esophagitis, stricture, BE, adenocarcinoma
GERD- Dx
- ambulatory 24 to 48 hr esophageal pH recording
- EGD if alarm sx
GERD- treatment
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
GERD- red flags
- weight loss
- persistent vomiting
- constant/severe pain
- dysphagia
- hematemesis
- melena
- anemia
- *needs endoscopy (or ABD imaging)!!!
GERD- when else do we need endoscopy
- failed response to 4-8 wks of PPI
- when frequent sx relapse after PPI discontinued
esophageal stricture- sx, caused by?
- esophageal dysphagia
- progressive- solids–> liquids
- most common is peptic secondary to GERD (can also occur b/c of eosinophilic esophagitis)
esophageal stricture- Dx, Tx
- barium swallow/EGD
- dilation, PPI/H2 blocker
esophageal ring (Schatzki)- sx
- esophageal dysphagia
- solids; intermittent sx
- “steakhouse syndrome”
- > 40 yrs- acquired
esophageal ring- dx, tx
- barium swallow/EGD
- dilation
Barrett esophagus
- specialized columnar metaplasia in distal esophagus- in ppl with GERD!
- esophageal adenocarcinoma!
- at risk- obese white males > 40
BE- Dx
- EGD with Bx
- screening EGD in pts with chronic (10 yrs) GERD!
BE- Tx
- surveillance endoscopy
- endoscopic ablation
- surgical resection
- PPI!
esophageal cancer
- adenocarcinoma
- SCC
adenocarcinoma
- M>W
- BE
- distal 1/3 of esophagus
SCC
- > 45, M
- middle 1/3 of esophagus
- smoking, alcohol, HPV
- chemical/thermal injury
- esophageal disorders- Achalasia
- radiation
Scleroderma- sx
- 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
Scleroderma- ab’s
- ANA (in 90%)
- Topoisomerase I ab’s (anti-Scl-70)- 30% with diffuse dz!!
- Anticentromere ab’s- 45% with limited dz!!
Diffuse Scleroderma
- diffuse- proximal extremities and trunk
- early and progressive internal organ involvement
- worse prognosis
Limited Scleroderma
- fingers, toes, face, distal extremities
- Raynaud’s
- CREST syndrome- calcinosis cutis, raynaud’s, esophageal dysmotility, sclerodactyly, telangiectasia
- indolent course
- good prognosis
Zenker’s diverticulum- what is it? sx?
- 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
Zenker’s diverticulum- Dx, Tx
- Barium swallow
- surgery
Test for achalasia
-esophageal manometry
seen with Sjogren’s syndrome?
B cell non-Hodgkin lymphoma
Test for GERD
esophageal pH
Sjogren’s syndrome- sx
- rheumatologic
- F, mid 50’s, postmenopausal
- Sicca sx- dry eyes/mouth- oropharyngeal dysphagia
Achalasia- imaging
- bird’s beak
- sigmod esophagus
Achalasia- causes
- primary- loss of ganglion cells within myenteric plexus!!
- secondary- chagas disease (trypanosoma cruzi- kissing bug vector)
Achalasia- Dx
-barium swallow xray and esophageal manometry!!!
Achalasia- Tx
-LES pressure can be reduced by nitrates and CCB therapy, pneumatic balloon dilatation, botox injection, or surgical myotomy
Achalasia- Manometry
- incomplete LES relaxation
- inc LES tone
- aperistalsis
Esophageal webs- sx
- esophageal dysphagia
- intermittent!
- Plummer-Vinson syndrome- iron def anemia, cheilitis, glossitis, koilonychia (spoon nails)- middle aged women!
esophageal webs- Dx, Tx
- barium swallow/EGD
- dilatation
Plummer-Vinson syndrome
- upper esophagea lwebs
- oropharyngeal dysphagia- intermittent, solids!
- iron def anemia- weakness, fatigue
- angular cheilitis
- glossitis
- koilonychia (spoon nails)
- pallo
Assoc with scleroderma?
GAVE
Candidiasis- occurs in who?
- uncontrolled diabetes
- immunosuppressed
Eosinophilic Esophagitis- sx
- M, allergies, atopic conditions
- dysphagia and esophageal food impactions!!!
Eosinophilic Esophagitis- Dx
EGD!
-multiple circular esophageal rings creating a corrugated appearance (“feline esophagus”/ looks like trachea), edema
Eosinophilic Esophagitis- Biopsy
- squamous epit eosinophil-predominant infl
- >15-20 eosinophils per high-power field
Eosinophilic Esophagitis- complications
-esophageal stricture, narrow-caliber esophagus, food impaction, esophageal perforation!!
Eosinophilic Esophagitis- Tx
- 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!!
Esophagitis- causes
- dysphagia and odynaphagia!!- mainly solids
- pill- doxycycline, quinidine, phenytoin!!
- infectious
- eosinophilic
diffuse esophageal spasm (DES)- sx
(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”
diffuse esophageal spasm- Dx
-manometry, EGD
Nutcracker esophagus
(hypertensive peristalsis)
- greater amplitude and duration but normal coordinated contraction!!
- LES relaxes normally, but has an elevated pressure at baseline!!
mechanical obstruction vs motility disorder
- mechanical- solid foods worse than liquids
- motility- solids and liquids
Esophageal Perforation- sx
- trauma
- forceful vomiting- rupture at gastroesophageal jxn- Boorhaave’s syndrome- pleuritic retrosternal pain- pneumomediastinum, subcutaneous emphysema
Esophageal perforation- dx
- CT of chest- detects mediastinal air
- confirmed by contrast swallow, usually gastrografin followed by thin barium
esophageal perforation- tx
-NGT suction, NPO parenteral antibx and surgery
Mallory-weiss tear
- vomiting
- nontransmural tear at GE jxn
- causes upper GI bleeding
mallory- weiss tear- dx, tx
- history, EGD
- bleeding usually abates spontaneously!
- protracted bleeding may respond to local epinephrine!! or cauterization therapy, endoscopic clipping, or angiographic embolization
Esophageal varices- sx, dx, tx
- 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
stress ulcers- caused by?
-curling ulcer- burns
H pylori- assoc with
MALToma
ulcer risk
smoking + H pylori
peptic ulcer dz- causes
-NSAID, H pylori, EtOH
peptic ulcer dz- dx, tx
- EGD +/- H pylori
- H2 blocker, PPI, eradicate H pylori!!
Gastric ulcer disease- caused by? sx?
- H pylori (75% of time)
- lesser curvature of antrum of stomach
- burning epigastric pain
- worsens within 30 min of eatin
duodenal ulcer- caused by? sx?
- 95% secondary to H pylori
- gnawing pain
- 1-3 hrs after eating
- relieved by food/eating
- NSAIDs/steroids- risk factors
Helicobacter pylori- is what? causes what?
- 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
H pylori- testing
- Stool ag immunoassay!!
- Carbon 13/14 urea breath test!!
- pt should be off PPI or antibiotics for 7-14 days prior to testing!!
H pylori- histologic exam
-EGD with biopsy (warthin-starry stain) or rapid CLO
H pylori- serology
H pylori abs, IgA
Zollinger-Ellison Syndrme
- 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!!
