Esophagus and stomach DSA Flashcards
oropharyngeal dysphagia- causes
- neurologic disorders
- muscular and rheumatologic disorders
- metabolic disorders
- infectious disease
- structural disorders
- motility disorders
esophageal dysphagia- mechanical obstruction- causes
(solid foods worse than liquids)
-Schatzki ring- intermittent dysphagia; not progressive
-Peptic structure- chronic heartburn; progressive
-Esophageal cancer- progressive
-Eosinophilic esophagitis- rings or white papules
esophageal dysphagia- motility disorder- causes
- achalasia- progressive
- diffuse esophageal spasm- intermittent, not progressive
- scleroderma- chronic heartburn; Raynaud phenomenon
- ineffective esophageal motility- assoc with GERD
Upper Endoscopy- used for?
-heartburn, dysphagia, odynophagia, structural abnormalities detected on barium esophagography
video esophagography- used for?
-oropharyngeal dysphagia
Barium esophagography- used for
- differentiate b/w mechanical and motility causes of esophageal dysphagia
- should be used first in pts with esophageal dysphagia and high suspicion of motility disorder
esophageal manometry- used for
- determine location of LES to allow placement of a pH prob
- esta the etiology of dysphagia where a mechanical obstruction cant be found
- preoperative assessment of pts being considered for antireflux surgery
Esophageal pH recording- used for
-amount of esophageal acid reflux
GERD- sx and signs
- heartburn- typical!!!
- 30-60 min after meals, reclining
- regurgitation
GERD- diff diagnosis
- esophageal motility disorders
- peptic ulcer
- angina pectoris
- fxnal disorders
- pill-induced damage, eosinophilic esophagitis, infectons
GERD- complications
- BE
- peptic stricture
GERD- Barrett Esophagus
- from chronic GERD, obesity
- biopsies- confirm diagosis
Barrett Esophagus- complication
- esophageal adenocarcinoma- do endoscopic surveillance yearly!
- endoscopic therapy- for high-grade dysplasia
Peptic Stricture
- gradual development of solid food dysphagia
- endoscopy with biopsy!!- differentiate from stricture by esophageal carcinoma
Extraesophageal reflux manifestations
(asthma, hoarseness, cough, sleep disturbances)
-if suspected extraesophageal GERD syndromes- trial of PPI- but doesnt not prove a causative connection
GERD- unresponsive disease
- if dont respond to PPI- should undergo endoscopy for detection of reflux esophagitis or other lesions that may mimic GERD
- if active erosive esophagitis- treat with higher PPI doses
- other causes- gastrinoma (Zollinger-Ellison syndrome), pill-induced esophagitis, resistance to PPIs, medical noncompliance
- pH study!
Infectious esophagitis- essentials of diagnosis
- immunosuppressed pt
- odynophagia, dysphagia, chest pain
- endoscopy with biopsy- diagnosis
Infectious esophagitis- caused by
-Candida albicans (esp in uncontrolled diabetes), herpes simplex, CMV
Infectious esophagitis- endoscopic signs
- candida- diffuse, linear, yellow-white plaques adherent to mucosa
- CMV- one to several large, shallow, superficial ulcerations
- herpes- mult, small deep ulcerations
Pill-induced esophagitis
- injury most common if pills swallowed w/o water or supine
- sx- retrosternal chest pain, odynophagia, dysphagia
Benign esophageal lesions
- Mallory-Weiss Syndrome
- Eosinophilic esophagitis
- esophageal webs and rings
- zenker diverticulum
- esophageal varices
Mallory-Weiss syndrome- essentials of diagnosis
(mucosal laceration of gastroesophageal jxn)
- hematemesis
- prior history of vomiting, retching (alcoholism)
- endoscopy esta diagnosis
Eosinophilic esophagitis
- Food/environmental ag’s stim an infl response
- history of allergies/atopic conditions (asthma, eczema)
- endoscopy with biopsy- diagnosis
- endoscopy- corrugated concentric rings
Zenker diverticuluum
- protrusion of pharyngeal mucosa at the pharyngoesophageal jxn
- loss of elasticity of UES
esophageal varices- essentials of diagnosis
- develop secondary to portal HTN
- found in 50% of pts with cirrhosis
- 1/3 will develop upper GI bleeding
- diagnosis- upper endoscopy
Achalasia- essentials of diagnosis
-progressive dysphagia for solids/liquids
-regurgitation of undigested food
-barium esophagogram- “bird’s beak”, sigmoid esophagus (dilated)
-esophageal manometry- confirms diagnosis- complete absence of normal peristalsis and incomplete LES relaxation!!!
Achalasia- diff diagnosis
- Chagas disease (in pts from Central/South America)
- tumors- “pseudoachalasia”
Erosive and Hemorrhagic Gastritis (Gastropathy)- essentials of diagnosis
- seen in alcoholic or critically ill pts, or pts taking NSAIDs
- often asymptomatic, may cause epigastric pain, N/V
- may cause hematemesis; usually insignificant bleeding
- upper endoscopy
Erosive and Hemorrhagic Gastritis- causes?
- stress gastritis
- NSAID gastritis
- alcoholic
- portal HTN
Nonerosive, nonspecific gastritis- causes?
-H pylori gastritis
noninvasive tests for H pylori
- fecal ag
- ura breath test
endoscopic tests for H pylori
- not indicated to diagnose H pylori infection
- used for pts with suspected MALTomas
- confirm infection in pts with a neg rapid urease test
Peptic ulcer Disease- essentials of diagnosis
- hx of dyspepsia
- ulcer sx- characterized by rhythmicity and periodicity
- NSAID-induced ulcers are mostly asymptomatic
- upper endoscopy with gastric biopsy for H pylori- diagnostic
- exclude gastric malignancy
peptic ulcer disease- 2 causes
- NSAIDs
- chronic H pylori infection
peptic ulcer disease- sx
- epigastric pain (dyspepsia)- hallmark!!
- “hunger-like” pain
Zollinger-Ellison Syndrome (gastrinoma)- essentials of diagnosis
- peptic ulcer dz
- gastric acid hypersecretion
- diarrhea common, relieved by nasogastric suction
- most are sporadic, 25% with MEN 1
Zollinger-Ellison Syndrome- lab findings
- inc fasting serum gastrin concentration!!
- gastric pH > 3- implies hypochlorhydria- excludes gastrinoma
