Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Gastroenterology > Esophagus Disorders > Flashcards

Esophagus Disorders Flashcards

1
Q

Progressive solid food dysphagia

Patients enhance esophageal emptying by lifting the neck or throwing shoulders back

Regurgitation of undigested food

A

Achalasia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Aperistalsis in distal 2/3 of esophagus

Failure/incomplete relaxation of
the LES

Denervation of the esophagus

A

Achalasia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the cause of primary achalasia?

A

Result from a defect in inhibitory vagal innervation

Unknown if infectious, autoimmune, or environment is the source

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the cause of secondary achalasia?

A

Chagas disease
Cancer
Lymphoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How is achalasia diagnosed?

A

Barium esophagram
Endoscopy
Usually confirmed by manometry

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

If you see the characteristic “Bird’s beak” tapering of the esophagus on a Barium esophagram, what diagnosis is it?

A

Achalasia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are some treatment options for achalasia?

A

Calcium channel blockers
Botulism toxin injection - Inject the LES (temporary relief (1-6 months))
Pneumatic dilation of LES
Surgical esophagomyotomy of LES

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Characterized by uncoordinated, nonpropulsive contractions of the
esophagus - Uncoordinated motility

Simultaneous distal esophageal contractions with normal peristalsis (Lower esophageal sphincter normal)

A

Diffuse Esophageal Spasm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

3-5% of patients with diffuse esophageal spasms are likely to progress to what disorder?

A

achalasia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are some signs/symtpoms of esophageal spasms?

A

Progressive dysphagia
Odynophagia
Intermittent substernal pain
Worsen after ingesting cold fluids, large meals, or emotional stress

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the diagnostic measures for esophageal spasms?

A

Barium esophagram
Esophageal manometry

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

If you see a “corkscrew” appearance” tapering of the esophagus on a Barium esophagram, what diagnosis is it?

A

esophageal spasms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are some treatment options for esophageal spasms?

A

Small meals
Avoiding cold foods
Antacids
Calcium channel blockers
NTG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Inflammation of the esophagus

Three types

A

Esophagitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Any patient who has trouble swallowing and hurts in their chest, what needs to be ruled out?

A

rule out a foreign body

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the three types of esophagitis?

A

Infectious esophagitis

Pill-induced esophagitis

Caustic esophageal injury esophagitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Infectious esophagitis will mainly be seen in what patient demographic?

A

Mainly in immunosuppressed patients

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the common pathogens that cause infectious esophagitis?

A

Candida albicans
HSV
CMV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

This endoscopic finding on EGD suggests what diagnosis?

Diffuse linear yellow-white plaques adherent to mucosa

A

Candida albicans

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

This endoscopic finding on EGD suggests what diagnosis?

Multiple small, deep ulcerations

A

HSV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are some common agents that result in pill-induced esophagitis?

A

NSAIDs
KCl
Bisphosphonates
Iron
Vitamin C
Antibiotics (Doxycycline most common)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is the evaluation/treatment of caustic esophageal injury esophagitis?

A

Admit to ICU

ENT/GI consult

Circulatory status along with airway patency and oropharyngeal mucosa should be priority

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Swallowing medication causes inflammation

Occurs most commonly if swallowed without water or while supine

Self limited – no intervention

A

Pill-Induced Esophagitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Accidental (children) or intentional (suicide)

Less likely to have serious gastric injury of no major symptoms

A

Esophageal Injury Esophagitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Chronic immune/antigen mediated disease

Causing esophageal dysfunction and eosinophil-predominant inflammation

Most common in Caucasian men

Characterized by concentric esophageal rings

Seen in patients with established GERD

A

Eosinophilic Esophagitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What is the treatment for eosinophilic esophagitis?

A

Treat dysphagia with EGD/dilation
PPI
Topical glucocorticoids (swallowed fluticasone)
Food allergy evaluation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Heartburn is the cardinal symptom

Firstly, rule out cardiac origin

Very common: 20% of adults have weekly symptoms of this (10%
have daily symptoms)

50% develop reflux esophagitis

A

Gastroesophageal Reflux Disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What are some alarm symptoms of gastroesophageal reflux disease?

A

difficulty or pain with swallowing - Odynophagia is NOT common in GERD and warrants further investigation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What are some contributing factors of GERD?

A

Incompetent LES
Hiatal hernia
Irritant effects of reflux
Abnormal esophageal clearance
Delayed gastric emptying

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What are some exacerbating factors of GERD?

A

Foods
Bending or recumbency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What is the clinical presentation of GERD?

A

Heartburn
Regurgitation
Nausea
Throat irritation
Atypical symptoms - asthma, cough (persistent, dry), laryngitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Most effective agents available for GERD

A

Proton Pump Inhibitors (PPIs)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What are the treatment goals of GERD?

A

Provide symptomatic relief
Heal esophagitis
Prevent complications

34
Q

What are some treatment options for GERD?

A

Proton Pump Inhibitors (PPIs)
H2 Antagonists
Antacids

Complicated patient - Gets EGD right away

Surgical treatment – Nissen Fundoplication

35
Q

What are some alarm symptoms for GERD?

A

GI bleeding/anemia
Dysphagia/odynophagia
Unintentional weight loss
h/o heavy NSAID use

36
Q

What are some invasive testing for GERD (either for complicated or unresponsive GERD)?

A

Upper endoscopy
Barium swallow
Esophageal pH monitoring

37
Q

What is a complication we worry about with GERD?

A

Barrett’s Esophagitis

38
Q

Squamous epithelium at distal esophagus replaced by metaplastic columnar epithelium

A

Barrett’s Esophagitis

39
Q

Why are we concerned about Barrett’s Esophagitis?

A

Can lead to adenocarcinoma - presence of dysplasia increases the risk of progression to carcinoma

40
Q

What is the treatment for Barrett’s esophagitis and why?

A

Treatment: long term PPI

PPIs are the only agents that heal ulcers and erosions - may reduce the risk of cancer (keeps risk of changing from metaplastic to dysplasia down)

41
Q

Recommend EGD for Barrett’s screening in patients with what factors?

A

chronic GERD symptoms
Male
White
Hiatal hernia
Age 50+ years

42
Q

What are the Barrett’s esophagitis screening guidelines?

A

If low grade dysplasia is found, repeat endoscopy in 6 months

If high grade dysplasia is found, repeat EGD with biopsy

EGD every 3-5 years with known Barrett’s esophagitis

43
Q

What are some complications of GERD?

A

Barrett’s Esophagitis
Stricture

44
Q

What is a common cause of GERD in neonates/infants?

A

Usually due to immature lower esophageal sphincter

45
Q

Gastric regurgitation occurs in up to how many infants, but pathological GERD affects only 1 in 300 infants

A

two thirds

46
Q

When should you intervene in neonates/infants who had GERD?

A

Regurgitation but still having weight gain 🡪 monitor (unless concerning symptoms)

Regurgitation with poor weight gain 🡪 intervene

47
Q

What are the complications of GERD in neonates/infants?

A

Failure to thrive

Respiratory - aspiration pneumonia, chronic cough, wheezing

48
Q

Mucosal tear at the GE junction

Usually caused by prolonged vomiting/retching (50% of cases)

Binge drinking can be a predisposing factor

Accounts for 5% of upper GI bleeds

Benign, self-limiting (typically)

A

Mallory-Weiss Tear

49
Q

What is the treatment for a Mallory-Weiss tear?

A

Most heal uneventfully within 24-48 hours

Severe bleeds: IV fluid resuscitation, blood transfusion, endoscopic hemostatic therapy

50
Q

Any ring-like structure along the length of the esophagus

Uncommon - Less than 10% of people

May be an incidental finding

Covered by squamous epithelium

A

Esophageal Webs and Rings

51
Q

Esophageal webs and rings are covered by what type of cell?

A

Covered by squamous epithelium

52
Q

Which type of esophageal ring/web is described below?

Connective tissue effect

Triad: IDA, dysphagia, webs

Treat IDA = web resolves

If problematic, perform EGD for endoscopic dilation

A

Plummer Vinson Syndrome

53
Q

Plummer Vinson Syndrome is associated with what?

A

Iron Deficiency Anemia

54
Q

Which type of esophageal ring/web is described below?

Distal esophagus - Most common ring in distal esophagus

Thin, web-like constriction near the border of LES

Common, smooth, benign, circumferential structures

Common cause of intermittent solid food dysphagia

Chronic GERD may cause a role - although pathogenesis is controversial

A

Schatzki’s Ring

55
Q

Schatzki’s Ring is associated with what?

A

GERD

56
Q

Outpouchings in the esophageal wall

A

Esophageal Diverticula

57
Q

What are the two types of esophageal diverticula?

A

Zenker’s diverticulum - Pharyngeal mucosa protrusion at the pharyngoesophageal junction

Esophageal diverticulum - Mid or distal esophagus, secondary to motility disorders or strictures

58
Q

Pharyngeal mucosa protrusion at the pharyngoesophageal junction

A

Zenker’s diverticulum

59
Q

False diverticulum/outpouching

Harbors undigested food

A

Zenker’s Diverticulum

60
Q

What are some signs/symptoms of Zenker’s Diverticulum?

A

Regurgitation of saliva and food particles consumed several days previously (especially in AM)

Uncoordinated swallow/occlusive episode

Dysphagia

Halitosis

Choking/gurgling

Cough

aspiration

Neck protrusion

61
Q

How is Zenker’s Diverticulum diagnosed?

A

Barium esophagram
EGD
contrast CT neck

62
Q

What is the treatment for Zenker’s Diverticulum?

A

Surgery if symptomatic

63
Q

What are some complications of Zenker’s Diverticulum?

A

Aspiration pneumonia
Bronchiectasis

64
Q

Enlarged venous collateral channels that dilate as a result of portal HTN

Dilated sub-mucosal veins in lower esophagus

Can be a life-threatening emergency

A

Esophageal Varices

65
Q

What amount of patients with varices will bleed?

A

1/3

66
Q

Highest mortality and morbidity of any upper GI bleed

Mortality rate of 30%

A

Esophageal Varices

67
Q

Esophageal Varices is associated with what?

A

History of portal hypertension/cirrhotic liver disease (Present in 50% of patients with cirrhosis)

68
Q

What are some causes of esophageal varices?

A

Alcoholism
Viral hepatitis

69
Q

What are the treatment options for esophageal varices?

A

Fluid resuscitation

Blood transfusion/FFP transfusion if needed

Antibiotics

Octreotide (reduces portal pressure)

Emergency endoscopy within 2-12 hours (Variceal banding, Sclerotherapy)

Surgical intervention

70
Q

What measures can help prevent rebleeding of esophageal varices?

A

ALCOHOL CESSATION
Band ligation
Beta blockers
TIPS surgery
Liver transplantation

71
Q

Esophageal rupture/perforation

Secondary to severe retching/vomiting causing increase in
intraoresophageal pressure combined with negative intrathoracic pressure

Emergent surgical consult

A

Beorhaave’s Syndrome

72
Q

What are some signs/symptoms of Beorhaave’s Syndrome?

A

Hematemesis with SEVERE retrosternal “tearing” pain

Subcutaneous emphysema/crepitation

73
Q

In Beorhaave’s Syndrome, what finding would you expect to see on a CXR?

A

Mediastinal widening

74
Q

What imaging do you order for suspected Beorhaave’s Syndrome?

A

CXR
CT chest (confirms rupture of lower esophagus)

75
Q

What is the most common type of esophageal cancer worldwide?

A

Squamous cell carcinoma most common worldwide (90%)

76
Q

What is the most common type of esophageal cancer in the US?

A

Adenocarcinoma 80% (associated with GERD and Barrett’s esophagitis)

77
Q

Which type of esophageal cancer is described below?

Typically found in lower 1/3 of esophagus

Associated with GERD and Barrett’s esophagitis

A

Adenocarcinoma

78
Q

Which type of esophageal cancer is described below?

Typically found in upper 2/3 of esophagus

Associated with tobacco and alcohol

A

Squamous cell carcinoma

79
Q

What are some signs/symptoms of esophageal cancer?

A

Progressive solid food dysphagia - Dysphagia for solids only (90%) – tolerating soft/liquid foods

Odynophagia

Anorexia/weight loss

Voice changes/hoarseness

Anemia

Signs of metastatic disease

80
Q

What methods are used to diagnose esophageal cancer?

A

Barium esophagogram - May only identify large lesions

Upper endoscopy with biopsy for diagnosis

81
Q

What is the overall 5 year survival rate of esophageal cancer?

A

<15%

82
Q

Why does esophageal cancer carry such a poor prognosis?

A

Over 60% of patients are not candidates for surgery - Present with advanced disease, have significant comorbidities

Gastroenterology (9 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions