Esophagus and Stomach DSA Flashcards
causes of nausea and vomiting
visceral afferent stimulation
vestibular disorders
CNS disorders
Irritation of chemoreceptor trigger zone
visceral afferent stimulation causes of nausea and vomiting
- infections
- mechanical obstruction
- dysmotility (gastroparesis, scelroderma)
- peritoneal irritation (viruses, food poisoning, appendicitis)
- hepatobillary or pancreatic disorders
- topical GI irritants (antibiotics, alcohol, NSAIDs)
- postoperative
- other
vestibular disorders and N/V
labryinthitis, meniere syndrome, motion sickness
CNS disorders and N/V
increased intracranial pressure (tumors, hemmor)
migraine
infections (meningitits)
psychogenic (anticipatory vomiting, anorexia, bulemia)
irritaiton of chemoreceptor trigger zone and N/V
antitumor chemo
medications and drugs
radiation therapy
systemic disorders
medications and drugs with irritation of chemoreceptor trigger zone and N/V
opiods anticonvulsants antiparkinsonism drugs beta blockers, antiarrhythmics, digoxin nictotine OCs cholinesterase inhibitors diabetes meds like metformin
systemic disorders associated with irritation of chemoreceptor trigger zone and N/V
diabetic ketoacidosis uremia adrenocortical crisis parathyroid disease hypothyroidism pregnancy paraneoplastic syndrome
causes of oropharyngeal dysphagia
neuro disorders muscular and rheumatologic disorders metanbolic disorders infectious disease structural disorders motitility disorders
oropharyngeal dysphagia and some neuro disorders that cause it
Guillain-Barre syndrome parkinsons huntington dementia MS ALS brain trauma mass lesion
muscular and rheumatologic disorders with oropharyngeal dysphagia
sjogren syndrome
myopathies
metabolic disorders with oropharyngeal dysphagia
amyloidosis
cushing
wilson
med side effects: anticholinergics, phenothiazines
infectious disease and oropharyngeal dysphagia
polio diptheria botulism lyme disease syphilis mucositis (candida, herpes)
structural disordes with oropharyngeal dysphagia
zenker diverticulum esophageal webs tumor postsurgical change pill induced injury
esophageal dysphagia clue: intermittent dysphagia, not progressive
schatzki ring
esophageal dysphagia clue: chronic heartburn, progressive dysphagia
peptic stricture
esophageal dysphagia clue: progressive dysphagia, age over 50
esophageal cancer
esophageal dysphagia clue: yhoung adult, small caliber lumen, proximal stricture, corrugated rings, or white papules
eosinophilic esophagitis
what kind of dysphagia is achalasia
progressive
esophageal dysphagia clue: intermittient, not progressive, may have chest pain
diffuse esophageal spasm
esophageal dysphagia clue: chronic heartburn, raynaud phenomenon
scleroderma
esophageal dysphagia clue: intermittent, not progressive, commonly associated with GERD
ineffective esophageal motility
endoscopy is the study of choice for evaluating what
persistent heartburn, dysphagia, odynophagia, and structral abnornalities detected on barium esophagography
-allows biopsy of mucosal abnormalitites and of normal mucosa (evaluate for eosinophilic esophagitis) and dilation of strictures
what is oropharyngeal dysphagia best evaluated by
rapid sequence videoesophagography
what can a barium esophagography help differentiate
btwn mechainical lesion and motility disorder
what should be obtained first in pts with suspected motility disorder
barium esophagoscopy
in pts with high suspicion of mechanical lesion of esophagus what is done first
but..
endoscopic evaluation although barium study is more sensitive for detecting subtle esophageal narrowing due to rings, achalasia, and porximal esophageal lesions
what are the uses of esophageal manometry
1) determine location of LES for placement of electrode pH probe
2) to establish etiology of dysphagia in pts in whom pts with mechanical obstruction cannot be found, especially if achalasia suspected
3) for preoperative assessment of pts being considereed for antireflux surgery to exclude alt diagnosis or possibly to assess peristaltic fnct in esophageal body
what are esophageal pH recording and impedence testing used for
moniter pH of espohagus to provide info about amt of esophageal acid reflux and temporal correlations btwn symptoms and reflux
- provide info on amt of esophageal acid reflux but not nonacid refulx, use multichannel intraluminal impedance too to assess nonacid liquid reflux
- useful in pts with atypical reflux symptoms or persistent symptoms despite therapy with PPI to diagnose hypersensitivity, funct symptoms, and symptoms caused by nonacid reflux
typical symptom of GERD
what occurs in 1/3 of these pts
heartburn most often 30-60 mintues after meals and upon reclining
-antacids or baking soda helps
-dysphagia in 1/3 of pts
atypical or extraesophageal manifestations of GERD
asthma chronic cough chronic laryngitis sore throat non cardiac chest pain sleep disturcbances
should barium esophagography be used to diagnose GERD
no
differential diagnosis of GERD
esophageal motility disorders
peptic ulcer
angina pectoris
functional disorder
reflux erosive esophagitits may be confused with
pill induced damage
eosinophiic esophagitis
infections
complications of GERD
barrett esophagus–>possible adenocarcinoma
peptic stricture
what is mandatory in all cases to differnetiate a peptic stricutre from a stricture by esophageal carcionoma
endoscopy with biopsy
how to treat peptic stricutre
dilation with graduated polyvinyl catheters passed over a wire
balloons passed fluorscopically or thorugh an endoscope
luminal diameter of 13-17mm is usually sufficient to relieve dysphagia
-long term therapy with a proton pump inhibitor is required to decrease likelihood of stricture recurrence
extraesophageal reflux manifestations
-trial of what to figure out if GERD is contributing factor
asthma, hoarseness, cough, sleep distrucbance
may be contributing factor not sole factor
-trial of TID PPI administered for 2-3 months in pts with extraesophageal GERD or typical GERD symptoms
-improvement of extraesophageal symptoms suggests that GERD is causative factor
-esophageal imedance pH testing may be used in pts who don’t get better after 3 months PPIs
unresponsive disease
pts who don’t respond to 2x daily PPI should undergo endoscopy for detection of severe inadequately treated reflux esophagitis and for other gastroespohageal lesions that may mimic GERD
-presence of active erosive espophagitis usually is indicative of inadequate acid suppression and can be treated with higher dose PPI
most common pathogens with infectious esophagitis in immunosuppressed pts
candida albicans
herpes simplex
CMV
what infection in those with uncontrolled diabetes
candidda
is oral thrush a reliable indicator of casue of esophageal infection
no
not in all pts that have candidal esophagitis
pts with esophgaeal CMV infection may have infection at other sites such as
colon and retina
diagnosis for esophageal candititis
endoscopy with biopsy and brushing preferred
endoscopic signs of candidal esophagitis
diffuse linear, yellow-white plaques adherent to the mucosa
CMV esophagitis is charactereized by
one to several large, shallow, superficial ulcerations
-herpes esophagitis results in multiple small, deep ulcerations
-herpes esophagitis results in
multiple small, deep ulcerations
treatment length of oral candititis
21 days
treatment for esophageal candititis
flucanozle
then itraconazole if fluc not working or vaoriconazole
caspofungin for refractory infection (IV)
the most common meds that may inure esophagus
NSAIDs potassium chloride pills quinidine zalcitabine zidovudine alendronate risedronate emepronium bromide iron vitamin c antibiotics
symptoms of pill induced esophagitis
odynophagia, dysphagia, severe retrosternal chest pain
several hours after taking a pill
what might endoscopy shows for pill induced esophagitits
one to several discrete ulcers that may be shallow or deep
special exam for mallory weiss
upper endoscopy
diagnosis established by .5-4 cm linear mucosal tears usualy at GE junction or more commonly just below the junction in the gastric mucosa
eosinophilia of the esophagus is most commonly caused by what conditions
eosinophilic esophagitis GERD PPI responsive eosinophilia celiac disease chron disease pephigus (rarely)
what is required to establish diagnosis of eosinophilic esophagitis
-what would endoscopy show
endoscopy with esophageal biopsy and histologic evaluation
endoscopy: white exudates or pa[pules, red furrows, corrugated concentric rings and strictures
what is the best way to visualize esophageal webs and rings
barium esophagogram with full esophageal distention
location of schatzkis rings and almost always associated with what
distal esophagus at squamocolumnar junction
associated with hiatal hernia
treatmetn of rings and webs
passage of bougie dilator or endoscopic electrosurgical incision
best way to diagnose zenker diverticulum
video esophagography
diagnosis of esophageal varices
upper endoscopy
number of factors that increased risk of bleed from esophageal varices
- size of varices
- presence at endoscopy of red wale markings (longitud dilated venules on varix surface)
- severity of liver disease
- active alcohol abuse
