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Ex3GI CM > Esophagus- Dobbs > Flashcards

Esophagus- Dobbs Flashcards

1
Q

What is the pathophys behind GERD?

A

Incompetent Lower Esophageal Sphincter that is not as tight as we want it to be so allows for backup of contents into esophagus from stomach

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2
Q

Signs and symptoms of gerd?

A

Heartburn that is worse after eating and positional (worse when lying down)

  • Acid reflux
  • difficulty swallowing
  • chronic cough (silent gerd)
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3
Q

What are two alarm symptoms/

A

Dysphagia and changes in stool

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4
Q

Would we expect any + physical exam findings in GERD?

A

No

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5
Q

Will GERD have normal lab values?

A

Yes

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6
Q

What test is the gold standard, definitive dx for GERD when an atypical case?

A

Ambulatory esophageal pH monitoring

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7
Q

In atypical case of GERD, what studies would we order?

A

barium swallow (for dysphagia) and upper endoscopy (this is only in atypical or complicated cases-alarm symptoms)

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8
Q

What is a trial we could do for people with GERD?

A

PPI trial, doesn’t rule out GERD

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9
Q

What is good innervention (tx) for GERD?

A

weight loss, head elevated above the bed, avoid late night meals

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10
Q

This has shown to be not recommended to improve GERD

A

Tobacco/alcohol cessation

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11
Q

This test is NOT RECOMMENDED for GERD dx?

A

H. pylori testing

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12
Q

Tx for GERD? One example med

A

PPI- x 8 weeks, no longer
*Don’t use long-term
“azoles” omeprazole

Take 30 min prior to food

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13
Q

Tx for GERD? One example med not PPI

A

H2 blockers

famotidine, ranitidine

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14
Q

If pt with suspected GERD don’t respond to tx, what is the next step?

A
  • Ambulatory esophageal reflux monitoring

- Upper endoscopy (if alarm symptoms)

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15
Q

When a patient has GERD for 5 years plus, you should think of this potentially harmful condition?

A

Barret’s Esophagus

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16
Q

How would you confirm Barret’s

A

endoscopy

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17
Q

Chronic GERD patients should be screened for what every 3-5 years?

A

Barret’s Esophagus

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18
Q

This is a complication of GERD that causes gradual and progressive dysphagia with solid foods over months to years

A

Peptic stricture

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19
Q

What imaging should we get on someone with an esophogeal stricture and why?

A

Endoscopy with biopsy to exclude malignant causes of stricture

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20
Q

How to treat a peptic stricture?

A

Dilation over single sessions and long-term PPIs

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21
Q

This is a condition due to poorly relaxing LES so everything above it dilates and results in lack of peristalsis

A

Achalasia

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22
Q

What is the biggest indicator of achalasia?

A

Regurgitation of undigested food- also will be progressive dysphagia for solids and liquids

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23
Q

Regurgitation of undigested food should make you think of what disease?

A

Achalasia

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24
Q

How do you diagnose Achalasia?

A

Barium swallow

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25
Q

How to confirm the dx of Achalasia?

A

Esophageal manometry which basically measures contractions of esophagus when you swallow

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26
Q

What is the treatment for Achalasia?

A
  1. Pneumatic dilation (balloon to break lower esophagus open)
  2. Surgical myotomy (cut the LES)
  3. Botulinium toxin
  4. CCB or nitrates for poor surgical candidates
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27
Q

_________ disease can cause achalasia

A

Chaga’s disease

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28
Q

What is diffuse esophageal spasm?

A

A condition characterized by uncoordinated contractions of the esophagus, which may cause difficulty swallowing (dysphagia) or regurgitation.

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29
Q

What is jackhammer esophagus?

A

High amplitude abnormal contractions (“spasm”) of the esophageal muscle. These contractions are of much higher force than normal and also are discoordinated compared to normal contraction. CAN ALSO HAVE SOME NORMAL PERISTALSIS

30
Q

What do patients with jackhammer esophagus present with?

A

CP and dysphagia

31
Q

What is the treatment for jackhammer esophagus that is not completely effective?

A

Nitrates & CCBs

32
Q

What is an esophageal stricture?

A

Loss of diameter of the lumen area where <15 mm causes dysphagia (either intermittent or dysphagia to large pieces of food)

33
Q

Treatment for a stricture?

A
  1. esophageal dilation
  2. Control GERD
  3. PPIs (over H2)
34
Q

Is this a ring or web?

circumferential mucosa or muscle in the distal esophagus

A

ring

35
Q

Is this a ring or web?

occupy only part of the esophageal lumen, always mucosal, usually proximal

A

web

36
Q

What is the best imaging for webs?

A

Barium radiography

37
Q

What is the tx for a web?

A

Mechanical disruption

38
Q

What is the triad of Plummer-Vinson syndrome?

A

¤ Proximal esophageal webs ¤ Iron deficiency anemia

¤ Dysphagia

39
Q

Treatment for Plummer-Vinson syndrome

A

iron supplementation and mechanical widening of the esophagus

40
Q

Patients with Plummer-Vinson syndrome are at higher risk for what?

A

squamous cell cancer of the esophagus and pharynx

41
Q

What is a Schatzki’s Ring?

A

A Schatzki ring is a circular band of mucosal tissue that can form at the end of the food pipe (esophagus) closest to the stomach. The ring of tissue causes the food pipe, or esophagus, to narrow.

*Located near LES

42
Q

What is the most common cause of intermittent solid food

dysphagia and food impaction?

A

Schatzki’s Ring

43
Q

What is the best test to dx Schatzki’s Ring?

A

Barium swallow

44
Q

What is the tx for Schatzki’s Ring?

A

PPIs

45
Q

What disease process commonly presents with rapidly progressive solid food dysphagia and weight loss

A

esophageal cancer

46
Q

Squamous cell esophogeal carcinoma is from what?

A 
̈ ETOH and tobacco abuse
 ̈ Prior esophageal injury
(caustic, radiation)
 ̈ Associated with HPV
 ̈ Associated with achalasia
 ̈ Obesity
 ̈ GERD and Barrett’s
esophagus
 ̈ Scleroderma
47
Q

Adeno esophogeal carcinoma is from what?

A

̈ Obesity
̈ GERD and Barrett’s
esophagus
̈ Scleroderma

48
Q

How do we dx esophageal cancer?

A

CT and endoscopic U/S to evaluate depth of invasion

49
Q

Treatment for esophageal cancer?

A
  • Radiation (early stage)

- chemo/radiation (later stage)

50
Q

Sac protruding from the esophageal wall

A

Esophageal diverticuli

51
Q

This disease results from incomplete relaxation of the UES

A

Zenker’s Diverticulum

52
Q

What are some symptoms of Zenker’s Diverticulum?

A

Dysphagia, regurg of undigested food, halitosis, cough, aspiration pneumonia

53
Q

How to dx Zenker’s?

A

barium swallow

54
Q

Tx of Zenker’s?

A

Treatment with open surgical resection

55
Q

What is pill induced dysphagia?

A

Ingestant of irritant med or swallowing a pill without water or while supine causes severe retrosternal CP, odynophagia, dysphagia

56
Q

How to dx pill induced dysphagia?

A

Endoscopy visualization of ulceration

57
Q

How to tx pill induced dysphagia?

A

Remove offender (NSAID, K+, Bactrim, Tetracyclines)

58
Q

An immunocompromised patient presents with odynophagia (painful swallowing). What are the three mc offending pathogens?

A
  • Candidia
  • Herpes simplex
  • CMV
59
Q

How to dx infectious esophagitis?

A

endoscopy w/ biopsy

60
Q

A patient presents with episodic dysphagic/food impaction and has a hx of allergies what type of dx is this?

A

eosinophilic esophagitis?

61
Q

What would labs for eosinophilic esophagitis show?

A

eosinophilia or elevated IgG

62
Q

What does edoscopy with biopsy for eosinophilic esophagitis show?

A

¤ White exudates or papules ¤ Red furrows
¤ Corrugated concentric rings
¤ Strictures

63
Q

Treatment for eosinophilic esophagitis?

A

¤ PPIs
¤ Avoidance of known allergen
¤ Inhaled corticosteroids
¤ Referral to an allergist

64
Q

This is a sudden onset mucosal tear from vomiting/retching that is usually from alcoholism?

A

Mallory-Weiss Syndrome

65
Q

How do you eval a mallory weiss tear?

A

upper endoscopy

66
Q

How do you treat Mallory-Weiss Syndrome?

A

¤ Fluid resuscitation
¤ Blood transfusion
¤ Endoscopic hemostatic therapy in active bleeding
¤ Epinephrine injection, cautery, or mechanical compression

67
Q

This is a sudden or insidious onset of varicose veins in the esophagus that is typically from portal hypertension/cirrhosis

A

Esophageal varices

68
Q

A patient who presents with hematemesis and melena or hematochezia may have what condition?

A

Esophageal varices

69
Q

How to treat Esophageal varices?

A

¤ Acute resuscitation
¤ Emergent endoscopy
¤ Pharmacologic therapy

70
Q

What medication prevents rebleeding in esophogeal varices?

A

B-blockers

71
Q

What is a surgical way you can treat esophogeal varices?

A

band ligation

Ex3GI CM (15 decks)

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