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GI II Final DF > Esophagus and Stomach DSA > Flashcards

Esophagus and Stomach DSA Flashcards

1
Q

causes of nausea and vomiting

A

visceral afferent stimulation
vestibular disorders
CNS disorders
Irritation of chemoreceptor trigger zone

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2
Q

visceral afferent stimulation causes of nausea and vomiting

A
  • infections
  • mechanical obstruction
  • dysmotility (gastroparesis, scelroderma)
  • peritoneal irritation (viruses, food poisoning, appendicitis)
  • hepatobillary or pancreatic disorders
  • topical GI irritants (antibiotics, alcohol, NSAIDs)
  • postoperative
  • other
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3
Q

vestibular disorders and N/V

A

labryinthitis, meniere syndrome, motion sickness

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4
Q

CNS disorders and N/V

A

increased intracranial pressure (tumors, hemmor)
migraine
infections (meningitits)
psychogenic (anticipatory vomiting, anorexia, bulemia)

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5
Q

irritaiton of chemoreceptor trigger zone and N/V

A

antitumor chemo
medications and drugs
radiation therapy
systemic disorders

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6
Q

medications and drugs with irritation of chemoreceptor trigger zone and N/V

A 
opiods
anticonvulsants
antiparkinsonism drugs
beta blockers, antiarrhythmics, digoxin
nictotine
OCs
cholinesterase inhibitors 
diabetes meds like metformin
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7
Q

systemic disorders associated with irritation of chemoreceptor trigger zone and N/V

A 
diabetic ketoacidosis
uremia
adrenocortical crisis
parathyroid disease
hypothyroidism
pregnancy
paraneoplastic syndrome
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8
Q

causes of oropharyngeal dysphagia

A 
neuro disorders
muscular and rheumatologic disorders
metanbolic disorders
infectious disease
structural disorders
motitility disorders
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9
Q

oropharyngeal dysphagia and some neuro disorders that cause it

A 
Guillain-Barre syndrome
parkinsons
huntington
dementia
MS
ALS
brain trauma
mass lesion
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10
Q

muscular and rheumatologic disorders with oropharyngeal dysphagia

A

sjogren syndrome

myopathies

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11
Q

metabolic disorders with oropharyngeal dysphagia

A

amyloidosis
cushing
wilson
med side effects: anticholinergics, phenothiazines

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12
Q

infectious disease and oropharyngeal dysphagia

A 
polio
diptheria
botulism
lyme disease
syphilis
mucositis (candida, herpes)
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13
Q

structural disordes with oropharyngeal dysphagia

A 
zenker diverticulum
esophageal webs
tumor
postsurgical change
pill induced injury
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14
Q

esophageal dysphagia clue: intermittent dysphagia, not progressive

A

schatzki ring

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15
Q

esophageal dysphagia clue: chronic heartburn, progressive dysphagia

A

peptic stricture

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16
Q

esophageal dysphagia clue: progressive dysphagia, age over 50

A

esophageal cancer

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17
Q

esophageal dysphagia clue: yhoung adult, small caliber lumen, proximal stricture, corrugated rings, or white papules

A

eosinophilic esophagitis

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18
Q

what kind of dysphagia is achalasia

A

progressive

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19
Q

esophageal dysphagia clue: intermittient, not progressive, may have chest pain

A

diffuse esophageal spasm

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20
Q

esophageal dysphagia clue: chronic heartburn, raynaud phenomenon

A

scleroderma

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21
Q

esophageal dysphagia clue: intermittent, not progressive, commonly associated with GERD

A

ineffective esophageal motility

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22
Q

endoscopy is the study of choice for evaluating what

A

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

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23
Q

what is oropharyngeal dysphagia best evaluated by

A

rapid sequence videoesophagography

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24
Q

what can a barium esophagography help differentiate

A

btwn mechainical lesion and motility disorder

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25
Q

what should be obtained first in pts with suspected motility disorder

A

barium esophagoscopy

26
Q

in pts with high suspicion of mechanical lesion of esophagus what is done first
but..

A

endoscopic evaluation although barium study is more sensitive for detecting subtle esophageal narrowing due to rings, achalasia, and porximal esophageal lesions

27
Q

what are the uses of esophageal manometry

A

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

28
Q

what are esophageal pH recording and impedence testing used for

A

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
29
Q

typical symptom of GERD

what occurs in 1/3 of these pts

A

heartburn most often 30-60 mintues after meals and upon reclining
-antacids or baking soda helps

-dysphagia in 1/3 of pts

30
Q

atypical or extraesophageal manifestations of GERD

A 
asthma
chronic cough
chronic laryngitis
sore throat
non cardiac chest pain
sleep disturcbances
31
Q

should barium esophagography be used to diagnose GERD

A

no

32
Q

differential diagnosis of GERD

A

esophageal motility disorders
peptic ulcer
angina pectoris
functional disorder

33
Q

reflux erosive esophagitits may be confused with

A

pill induced damage
eosinophiic esophagitis
infections

34
Q

complications of GERD

A

barrett esophagus–>possible adenocarcinoma

peptic stricture

35
Q

what is mandatory in all cases to differnetiate a peptic stricutre from a stricture by esophageal carcionoma

A

endoscopy with biopsy

36
Q

how to treat peptic stricutre

A

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

37
Q

extraesophageal reflux manifestations

-trial of what to figure out if GERD is contributing factor

A

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

38
Q

unresponsive disease

A

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

39
Q

most common pathogens with infectious esophagitis in immunosuppressed pts

A

candida albicans
herpes simplex
CMV

40
Q

what infection in those with uncontrolled diabetes

A

candidda

41
Q

is oral thrush a reliable indicator of casue of esophageal infection

A

no

not in all pts that have candidal esophagitis

42
Q

pts with esophgaeal CMV infection may have infection at other sites such as

A

colon and retina

43
Q

diagnosis for esophageal candititis

A

endoscopy with biopsy and brushing preferred

44
Q

endoscopic signs of candidal esophagitis

A

diffuse linear, yellow-white plaques adherent to the mucosa

45
Q

CMV esophagitis is charactereized by

A

one to several large, shallow, superficial ulcerations

-herpes esophagitis results in multiple small, deep ulcerations

46
Q

-herpes esophagitis results in

A

multiple small, deep ulcerations

47
Q

treatment length of oral candititis

A

21 days

48
Q

treatment for esophageal candititis

A

flucanozle
then itraconazole if fluc not working or vaoriconazole
caspofungin for refractory infection (IV)

49
Q

the most common meds that may inure esophagus

A 
NSAIDs
potassium chloride pills
quinidine
zalcitabine
zidovudine
alendronate
risedronate
emepronium bromide
iron
vitamin 
c
antibiotics
50
Q

symptoms of pill induced esophagitis

A

odynophagia, dysphagia, severe retrosternal chest pain

several hours after taking a pill

51
Q

what might endoscopy shows for pill induced esophagitits

A

one to several discrete ulcers that may be shallow or deep

52
Q

special exam for mallory weiss

A

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

53
Q

eosinophilia of the esophagus is most commonly caused by what conditions

A 
eosinophilic esophagitis
GERD
PPI responsive eosinophilia
celiac disease
chron disease
pephigus (rarely)
54
Q

what is required to establish diagnosis of eosinophilic esophagitis

-what would endoscopy show

A

endoscopy with esophageal biopsy and histologic evaluation

endoscopy: white exudates or pa[pules, red furrows, corrugated concentric rings and strictures

55
Q

what is the best way to visualize esophageal webs and rings

A

barium esophagogram with full esophageal distention

56
Q

location of schatzkis rings and almost always associated with what

A

distal esophagus at squamocolumnar junction

associated with hiatal hernia

57
Q

treatmetn of rings and webs

A

passage of bougie dilator or endoscopic electrosurgical incision

58
Q

best way to diagnose zenker diverticulum

A

video esophagography

59
Q

diagnosis of esophageal varices

A

upper endoscopy

60
Q

number of factors that increased risk of bleed from esophageal varices

A
  • size of varices
  • presence at endoscopy of red wale markings (longitud dilated venules on varix surface)
  • severity of liver disease
  • active alcohol abuse

GI II Final DF (9 decks)

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