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G2F > Esophagus and stomach DSA > Flashcards

Esophagus and stomach DSA Flashcards

1
Q

oropharyngeal dysphagia- causes

A
  • neurologic disorders
  • muscular and rheumatologic disorders
  • metabolic disorders
  • infectious disease
  • structural disorders
  • motility disorders
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2
Q

esophageal dysphagia- mechanical obstruction- causes

A

(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


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3
Q

esophageal dysphagia- motility disorder- causes

A
  • achalasia- progressive
  • diffuse esophageal spasm- intermittent, not progressive
  • scleroderma- chronic heartburn; Raynaud phenomenon
  • ineffective esophageal motility- assoc with GERD
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4
Q

Upper Endoscopy- used for?

A

-heartburn, dysphagia, odynophagia, structural abnormalities detected on barium esophagography

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5
Q

video esophagography- used for?

A

-oropharyngeal dysphagia

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6
Q

Barium esophagography- used for

A
  • 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
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7
Q

esophageal manometry- used for

A
  • 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
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8
Q

Esophageal pH recording- used for

A

-amount of esophageal acid reflux

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9
Q

GERD- sx and signs

A
  • heartburn- typical!!!
  • 30-60 min after meals, reclining
  • regurgitation
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10
Q

GERD- diff diagnosis

A
  • esophageal motility disorders
  • peptic ulcer
  • angina pectoris
  • fxnal disorders
  • pill-induced damage, eosinophilic esophagitis, infectons
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11
Q

GERD- complications

A
  • BE

- peptic stricture

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12
Q

GERD- Barrett Esophagus

A
  • from chronic GERD, obesity

- biopsies- confirm diagosis

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13
Q

Barrett Esophagus- complication

A
  • esophageal adenocarcinoma- do endoscopic surveillance yearly!
  • endoscopic therapy- for high-grade dysplasia
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14
Q

Peptic Stricture

A
  • gradual development of solid food dysphagia

- endoscopy with biopsy!!- differentiate from stricture by esophageal carcinoma

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15
Q

Extraesophageal reflux manifestations

A

(asthma, hoarseness, cough, sleep disturbances)

-if suspected extraesophageal GERD syndromes- trial of PPI- but doesnt not prove a causative connection

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16
Q

GERD- unresponsive disease

A
  • 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!
17
Q

Infectious esophagitis- essentials of diagnosis

A
  • immunosuppressed pt
  • odynophagia, dysphagia, chest pain
  • endoscopy with biopsy- diagnosis
18
Q

Infectious esophagitis- caused by

A

-Candida albicans (esp in uncontrolled diabetes), herpes simplex, CMV

19
Q

Infectious esophagitis- endoscopic signs

A
  • candida- diffuse, linear, yellow-white plaques adherent to mucosa
  • CMV- one to several large, shallow, superficial ulcerations
  • herpes- mult, small deep ulcerations
20
Q

Pill-induced esophagitis

A
  • injury most common if pills swallowed w/o water or supine

- sx- retrosternal chest pain, odynophagia, dysphagia

21
Q

Benign esophageal lesions

A
  • Mallory-Weiss Syndrome
  • Eosinophilic esophagitis
  • esophageal webs and rings
  • zenker diverticulum
  • esophageal varices
22
Q

Mallory-Weiss syndrome- essentials of diagnosis

A

(mucosal laceration of gastroesophageal jxn)

  • hematemesis
  • prior history of vomiting, retching (alcoholism)
  • endoscopy esta diagnosis
23
Q

Eosinophilic esophagitis

A
  • Food/environmental ag’s stim an infl response
  • history of allergies/atopic conditions (asthma, eczema)
  • endoscopy with biopsy- diagnosis
  • endoscopy- corrugated concentric rings
24
Q

Zenker diverticuluum

A
  • protrusion of pharyngeal mucosa at the pharyngoesophageal jxn
  • loss of elasticity of UES
25
Q

esophageal varices- essentials of diagnosis

A
  • develop secondary to portal HTN
  • found in 50% of pts with cirrhosis
  • 1/3 will develop upper GI bleeding
  • diagnosis- upper endoscopy
26
Q

Achalasia- essentials of diagnosis

A

-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!!!


27
Q

Achalasia- diff diagnosis

A
  • Chagas disease (in pts from Central/South America)

- tumors- “pseudoachalasia”

28
Q

Erosive and Hemorrhagic Gastritis (Gastropathy)- essentials of diagnosis

A
  • 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
29
Q

Erosive and Hemorrhagic Gastritis- causes?

A
  • stress gastritis
  • NSAID gastritis
  • alcoholic
  • portal HTN
30
Q

Nonerosive, nonspecific gastritis- causes?

A

-H pylori gastritis

31
Q

noninvasive tests for H pylori

A
  • fecal ag

- ura breath test

32
Q

endoscopic tests for H pylori

A
  • not indicated to diagnose H pylori infection
  • used for pts with suspected MALTomas
  • confirm infection in pts with a neg rapid urease test
33
Q

Peptic ulcer Disease- essentials of diagnosis

A
  • 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
34
Q

peptic ulcer disease- 2 causes

A
  • NSAIDs

- chronic H pylori infection

35
Q

peptic ulcer disease- sx

A
  • epigastric pain (dyspepsia)- hallmark!!

- “hunger-like” pain

36
Q

Zollinger-Ellison Syndrome (gastrinoma)- essentials of diagnosis

A
  • peptic ulcer dz
  • gastric acid hypersecretion
  • diarrhea common, relieved by nasogastric suction
  • most are sporadic, 25% with MEN 1
37
Q

Zollinger-Ellison Syndrome- lab findings

A
  • inc fasting serum gastrin concentration!!

- gastric pH > 3- implies hypochlorhydria- excludes gastrinoma

G2F (17 decks)

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