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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
How to confirm the dx of Achalasia?
Esophageal manometry which basically measures contractions of esophagus when you swallow
26
What is the treatment for Achalasia?
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
27
_________ disease can cause achalasia
Chaga's disease
28
What is diffuse esophageal spasm?
A condition characterized by uncoordinated contractions of the esophagus, which may cause difficulty swallowing (dysphagia) or regurgitation.
29
What is jackhammer esophagus?
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
What do patients with jackhammer esophagus present with?
CP and dysphagia
31
What is the treatment for jackhammer esophagus that is not completely effective?
Nitrates & CCBs
32
What is an esophageal stricture?
Loss of diameter of the lumen area where <15 mm causes dysphagia (either intermittent or dysphagia to large pieces of food)
33
Treatment for a stricture?
1. esophageal dilation 2. Control GERD 3. PPIs (over H2)
34
Is this a ring or web? | circumferential mucosa or muscle in the distal esophagus
ring
35
Is this a ring or web? | occupy only part of the esophageal lumen, always mucosal, usually proximal
web
36
What is the best imaging for webs?
Barium radiography
37
What is the tx for a web?
Mechanical disruption
38
What is the triad of Plummer-Vinson syndrome?
¤ Proximal esophageal webs ¤ Iron deficiency anemia | ¤ Dysphagia
39
Treatment for Plummer-Vinson syndrome
iron supplementation and mechanical widening of the esophagus
40
Patients with Plummer-Vinson syndrome are at higher risk for what?
squamous cell cancer of the esophagus and pharynx
41
What is a Schatzki’s Ring?
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
What is the most common cause of intermittent solid food | dysphagia and food impaction?
Schatzki’s Ring
43
What is the best test to dx Schatzki’s Ring?
Barium swallow
44
What is the tx for Schatzki’s Ring?
PPIs
45
What disease process commonly presents with rapidly progressive solid food dysphagia and weight loss
esophageal cancer
46
Squamous cell esophogeal carcinoma is from what?
``` ̈ ETOH and tobacco abuse ̈ Prior esophageal injury (caustic, radiation) ̈ Associated with HPV ̈ Associated with achalasia ̈ Obesity ̈ GERD and Barrett’s esophagus ̈ Scleroderma ```
47
Adeno esophogeal carcinoma is from what?
̈ Obesity ̈ GERD and Barrett’s esophagus ̈ Scleroderma
48
How do we dx esophageal cancer?
CT and endoscopic U/S to evaluate depth of invasion
49
Treatment for esophageal cancer?
- Radiation (early stage) | - chemo/radiation (later stage)
50
Sac protruding from the esophageal wall
Esophageal diverticuli
51
This disease results from incomplete relaxation of the UES
Zenker's Diverticulum
52
What are some symptoms of Zenker's Diverticulum?
Dysphagia, regurg of undigested food, halitosis, cough, aspiration pneumonia
53
How to dx Zenker's?
barium swallow
54
Tx of Zenker's?
Treatment with open surgical resection
55
What is pill induced dysphagia?
Ingestant of irritant med or swallowing a pill without water or while supine causes severe retrosternal CP, odynophagia, dysphagia
56
How to dx pill induced dysphagia?
Endoscopy visualization of ulceration
57
How to tx pill induced dysphagia?
Remove offender (NSAID, K+, Bactrim, Tetracyclines)
58
An immunocompromised patient presents with odynophagia (painful swallowing). What are the three mc offending pathogens?
- Candidia - Herpes simplex - CMV
59
How to dx infectious esophagitis?
endoscopy w/ biopsy
60
A patient presents with episodic dysphagic/food impaction and has a hx of allergies what type of dx is this?
eosinophilic esophagitis?
61
What would labs for eosinophilic esophagitis show?
eosinophilia or elevated IgG
62
What does edoscopy with biopsy for eosinophilic esophagitis show?
¤ White exudates or papules ¤ Red furrows ¤ Corrugated concentric rings ¤ Strictures
63
Treatment for eosinophilic esophagitis?
¤ PPIs ¤ Avoidance of known allergen ¤ Inhaled corticosteroids ¤ Referral to an allergist
64
This is a sudden onset mucosal tear from vomiting/retching that is usually from alcoholism?
Mallory-Weiss Syndrome
65
How do you eval a mallory weiss tear?
upper endoscopy
66
How do you treat Mallory-Weiss Syndrome?
¤ Fluid resuscitation ¤ Blood transfusion ¤ Endoscopic hemostatic therapy in active bleeding ¤ Epinephrine injection, cautery, or mechanical compression
67
This is a sudden or insidious onset of varicose veins in the esophagus that is typically from portal hypertension/cirrhosis
Esophageal varices
68
A patient who presents with hematemesis and melena or hematochezia may have what condition?
Esophageal varices
69
How to treat Esophageal varices?
¤ Acute resuscitation ¤ Emergent endoscopy ¤ Pharmacologic therapy
70
What medication prevents rebleeding in esophogeal varices?
B-blockers
71
What is a surgical way you can treat esophogeal varices?
band ligation

Ex3GI CM (15 decks)

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