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GI 2 Final > Esophagus and Stomach - McGowan > Flashcards

Esophagus and Stomach - McGowan Flashcards

1
Q

A uncontrolled diabetic, post viral, or post vagotomy pt who presents with nausea and vomiting, early satiety over months. possible cause of the N/V

A

gastroparesis

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2
Q

Older pt with history of extensive surgery who presents with nausea and bilious emesis and no BM. All else seems normal. Possible cause of her N/V

A

adhesion

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3
Q

Dysphagia with solids and liquids think what kind of obstruction?

A

Motility disorder. Mechanical obstruction has dysphagia worse with solids than liquids

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4
Q 
for each of the following mechanical obstructions causing dysphagia, indicate the clues associated with it's distinction
A. Schatzki ring
B. Peptic stricture
C. Esophageal cancer
D. Eosinophilic esophagitis
A

A. intermittent dysphagia esp with solids; not progressive (“steakhouse syndrome” Dx: barium swallow/EGD. Tx: Dilation
B. Chronic heartburn; progressive dysphagia
C. Progressive dysphagia; over age 50
D. Young adults; small caliber lumen, proximal stricture, corrugated rings, or white papules

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5
Q

for each of the following motility disorder causing dysphagia, indicate the clues associated with it’s distinction
A. Achalasia
B. Scleroderma
C. Ineffective esophageal motility

A

A. Progressive dysphagia
B. Chronic heartburn; Raynaud phenomenon
C. Intermittent; not progressive; commonly associated with GERD

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6
Q

what is water brash

A

regurgitation of an excessive accumulation of saliva from the lower part of the esophagus often with some acid material from the stomach. Associated with GERD

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7
Q

Pts with persistent heartburn, dysphagia, odynophagia, or structural/mechanical abnormalities seen on barium esophagography, what is the study of of choice?

A

Upper endoscopy

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8
Q

what is the best imaging study for orophyngeal dyspphagia

A

Videoesophagraphy

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9
Q

What is the bariumm esophagography best used for?

A

pt with dysphagia and suspected to have a motility disorder

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10
Q

Best test for Acid reflux

A

Esophageal pH recording and impedance testing

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11
Q

Pt with worsening dysphagia, pain in chest with swallowing, weight loss, what is the best imaging study?

A

Esophagoduodenoscopy (EGD)

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12
Q

what are the signs and symptoms of GERD?

A
  • heartburn 30-60mins after meals and upon reclining
  • pain relieved from antacid
  • regurgitation
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13
Q

What are the extraesophgeal manifestation of GERD?

A
  • asthma
  • chronic cough, laryngitis
  • sore throat
  • noncardiac chest pain (pyrosis: heart burn)
  • sleep disturbances
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14
Q

Pt with GERD are usually first treated empirically with PPI, but if pt does not get relief with PPI, what special exams can be done to further evaluate?

A
  1. Upper endoscopy: look for tissue damage, strictures, metaplasia adenocarcinoma
  2. Barium esophagography (used prior to endoscopy to look for strictures)
  3. Esophageal pH or combined esophageal pH-impedance testing
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15
Q

Pt presents with gradual development of solid food dysphagia progressive over months to years, usually seen at the GE junction. Most likely _

A

Peptic stricture. Due to long time GERD. Diagnosed with barium swallow/EGD

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16
Q

How is peptic stricture treated?

A

dilation with graduated polyvinyl catheter over several session until diameter is 13-17mm; FU tx with PPI

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17
Q

In a patient with long term GERD, what changes are seen on biopsy of the lower esophagus

A

Orange, gastric type epithelium that extends upward from stomach into distal tubular esophagus in a tongue like or circumferential fashion. These are Squamous epithelium of esophagus replaced by metaplastic columnar epithelium with Goblet cells

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18
Q

what complications are associated with GERD?

A
  • esophagitis
  • strictures
  • Barrett’s
  • adenocarcinoma
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19
Q

How is GERD treated?

A
  • First line: trial of acid suppression and lifestyle modification
  • H.pylori eradication if indicated
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20
Q

what are the red flags that which require endoscopy or ABD imaging?

A
  • wt loss
  • Persistent vomiting
  • Constant or severe pain
  • Dysphagia
  • Hematemesis
  • Melena
  • Anemia
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21
Q

A. Scleroderma is a cause of esophageal dysphagia mainly with 1 (solids or liquids).
B. Is it a mechanical or motility disorder?
C. What are the hallmark findings?

A

A. Solids
B. Motility
C. thickening and hardening of skin, microangiopathy and fibrosis of skin and visceral organs, may have chronic heartburn and Raynauds. Will be positive for one ore more of the following: ANA, Scl-70, Anticentromere

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22
Q

Zenker’s diverticulum is a false diverticulum that herniates posteriorly between what structures?

A

Cricopharyngeus muscle and the inferior pharyngeal constrictor muscles. This is the area of natural weakness in the Killian’s triangle

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23
Q

what are the symptoms of zenker’s diverticulum?

A
  • Dysphagia, regurg, choking, aspiration, voice changes, halitosis, wt loss
24
Q

how is zenker’s diverticulum diagnosed and treated?

A

Dx: Barium swallow
Tx: surgery

25
Q

What are the sicca symptoms of Sjogrens?

A
  • Dry eyes, dry mouth –> oropharyngeal dyspphagia.
  • vaginal dryness
  • tracheo-bronchial dryness
  • increased risk of oral infection
  • dental caries
  • parotid or other major salivary gland enlargement
26
Q

what neoplasm does Sjogren have a strong association with?

A
  • B cell non-hodgkin lymphoma
27
Q

what bug is associated with chagas disease –> achalasia

A

Trypanosoma cruzi

28
Q

For Achalasia:
A. motility or mechanical disorder?
B. acute or progressive?
C. Dyspagia with solids, liquids or both?
D. what are likely to see/not see in path?
E. How is achalasia diagnosed?
F. how is it treated?

A

A. Motility
B. Progressive
C. Both
D. loss of ganglion cells with myenteric plexus
E. Barium swallow xray and/or esophageal manometry (definitive)
F. Reduce LES pressure with nitrates and CCB therapy, pneumatic balloon dilatation, botox, or surgical myotomy

29
Q

What triad of clinical findings are seen in achalasia with manometry?

A
  1. Incomplete LES relaxation
  2. Increased LES tone/ elevated esophageal resting pressure
  3. Loss of peristalsis (aperistalsis)
30
Q

For Esophageal web (plummer vinson):
A. Is dysphagia due to solids liquids or both
B. Motility or structural problem?
C. Are symptoms persistent or inermittant?
D. How is diagnosed?
E. How is it treated?

A 
A. solids
B. Structural
C. intermittent 
D. Barium swallow/EGD
E. dilatation
31
Q

what is plummer-vinson syndrome?

A

Combo of:

  • symptomatic proximal esophageal webs
  • Iron-def anemia
  • angular chelitis
  • Glossitis
  • Koilonychia (spoon nails)
  • Commonly seen in middle-aged women
32
Q

middle aged woman with fatigue, hx of scleroderma, anemia (iron def and B12 def). Endoscopy shows watermelon lesions. what is most likely?

A

Gastric antral vascular ectasia

33
Q

In pts with esoinophilic esophagitis (EOE), what are you likely to see with EGD?

A
  • Loss of vascular markings (edema), multiple circular esophageal rings creating a corrugated appearance (Feline esophagus) also been said to look like a trachea, longitudinally orientated furrows and punctuated exudate
34
Q

18 yr male with dysphagia, hx of seasonal allergies and asthma, presents with esophageal food impaction. Eosinophilic esophagitis (EOE) is suspected. what are you likely to see on biopsy?

A

Squamous epithelium esosinophil-predominant inflammation. The diagnosis requires biopsy with histologic findings of > 15-20 eosinophils per high power field.

35
Q

How is EOE treated?

A

PPI, elimination diets, swallow topical glucocorticoids, allergist referral

36
Q

how do symptoms of EOE differ in adults vs kids?

A

Both have dysphagia and esosinophila. In addition:

Adults: pyrosis, poor response to meds, regurg

Kids: vomiting, difficulty feeding, failure to thrive,

37
Q

what are some common drugs leading to drug-induced esophagitis?

A
  • Doxycycline, quinidine, phenytoin
38
Q

Infectious cause of esophagitis

A
  1. Candida: diffuse, linear, yellow-white plaques adherent to mucosa
  2. CMV (large, shallow, superficial ulcers
  3. Herpes (multiple small, deep ulcers)
39
Q

Corkscrew esophagus, rosary bead esophagus are seen in what

A

diffuse esophageal spasm (DES) - uncoordinated esophageal contraction.
Corkscrew

40
Q 
DES:
A. oropharyngeal or esophageal dysphaiga? 
B. Motility or mechanical disorder?
C. Solids or liquids or both?
D. Progressive or intermittent?
E. What causes the corkscrew esophagus
F. Is LES affected? 
G. HOw is it diagnosed? 
H. how is it treated?
A

A. esophageal
B. Motility
C. Solids and liquids
D. intermittent
E. spastic contraction of circular muscle of esophageal wall
F. LES is normal, disordered motility limited to esphageal body
G. Manometry, EGD

41
Q

_ is a hypertensive peristaltic disorder where swallowing contraction are too powerful and produce greater amplitude and duration of peristalsis but normal coordinated contraction. LES relaxes normally but has elevated pressure

A

Nutcracker esophagus

42
Q

Esophageal perforation that is commonly seen as spontaneous transmural rupture at the gastroesophageal junction and presents as pleuritic retrosternal pain

A

Boerhaave’s syndrome

43
Q

Nontransmural tear at the GE junction and can be due to vomiting, retching, or vigorous coughing. How is this type of tear treated?

A

Described is a mallory-weiss tear. Tx: bleeding usually abates spontaneously. But if protracted, it may respond to local epinephrine or cauterization, endoscopic clipping or angiographic embolization.

44
Q

what is pneumomediastinum and what esophageal disorder is it associated with?

A

It occurs when air leaks into the mediastinum and can be due to esophageal rupture, ie Boerhaave’s syndrome

45
Q

How would a pt with Hiatal hernia present?

A
  • Pt will have history of GERD and complain of reflux and chest pain
  • CXR will be diagnostic
46
Q

A pt with severe burn should be treated prophylactically with PPI to prevent what?

A

Curling ulcer of esophagus

47
Q

Pt with long term H.pylori infection are risk of what neoplasm?

A

MALToma

48
Q

What are the three biggest contributor to developing peptic ulcer disease?

A
  • NSAID
  • H pylori
  • ETOH
49
Q

How is peptic ulcer disease treated?

A

H2 blocker, PPI, and eradicate H pylori if they have it

50
Q 
Gastric ulcer disease:
A. 75% is associated with _
B. typically occurs in which part of the stomach? 
C. What's the common symptom?
D. Does it get relief or pain with meal?
A

A. H. pylori
B. lesser curvature of antrum of stomach
C. Burning epigastric pain
D. 30 min after eating

51
Q

Duodenal ulcer
A. 95% is secondary to _
B. Presents as what kind of pain?
C. is pain relieved or aggravated with meal?

A

A. H pylori
B. Gnawing pain
C. relieved by food/eating, pain starts 1-3 hours after eating

52
Q

What toxin of H pylori is associated with disease progression and gastric cancer?

A

CagA

53
Q

What are the most sensitive and specific test for H pylori?

A
  • Stool H pylori antigen immunoassay

- Carbon 13 or Carbon 14 urea breath test

54
Q

What histological exam can be done to detect H pylori?

A
  • EGD with biopsy and stain with H&E or Warthin-Starry

- Rapid CLO

55
Q

Pt presents with pyrosis and epigastric pain, long history of GERD that isn’t responding to treatment. A tumor is suspected.
A. what kind of tumor?
B. 25% is associated with what autosomal dominant familial syndrome?
C. Is gastric mucosa atrophied or hypertrophied?
D. 2/3 are malignant and 1/3 presents as metastasis to what site commonly?
E. what is a common lab finding?

A 
A. Zollinger- Ellison syndrome- non-beta islet cell-gastrin secreting tumor (Primary gastrinoma)
B. MEN1
C. hypertrophied
D. liver
E. elevated fasting gastrin level

GI 2 Final (11 decks)

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