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Clin Med- GI > Esophagus lecture > Flashcards

Esophagus lecture Flashcards

1
Q

Difficulty initiating swallow reflex

Usually neuromuscular disorder causing weakness or lack of coordination

ie… CVA, parkinsons

A

Oropharyngeal dysphagia

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2
Q

Arises in body of esophagus, LES, or cardia

Usually due to mechanical problem or motility disturbance

ie.. stricture, tumor, radiation, scleroderma

A

Esophageal dysphagia

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3
Q

Sharp substernal pain on swallowing

*usually reflects severe erosive disease

A

Odynophagia

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4
Q

3-4 cm long segment of smooth muscle at distal end of esophagus

*prevents reflux of stomach contents back into esophagus

A

Lower esophageal sphincter (LES)

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5
Q

Occurs when LES is weak or relaxes inappropriately

A

GERD

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6
Q

Severity of GERD depends on?

A
  1. acidity
  2. duration
  3. amount

…of refluxed fluid in esophagus

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7
Q

Occurs when the LES, upper part of stomach moves up into chest through a small opening in the diaphragm (the diaphragmatic hiatus)

*can lead to GERD

*can be detected on XRay

A

Hiatal hernia

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8
Q
  • Abx (tetracycline)
  • Bisphosphonates
  • Iron
  • NSAIDs
  • Anticholinergics
  • CCBs
  • Narcotics
  • Benzos

….do what to GERD?

A

Worsen GERD

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9
Q

MC disorder of esophagus
Mostly mild dz but 50% will develop esophagitis
Common in N. America and Europe
MC in caucasians

Common in pregnancy due to increased hormones and increased intrabdominal pressure

A

GERD

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10
Q

Presentation:
Heartburn
Odynophagia
Dysphagia
Belching
Nausea
Anorexia/wt loss

atypical sxs: sore throat, dental carries, chronic cough, asthma, recurrent pneumonia

A

GERD

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11
Q

MC sx of GERD?

A

Heartburn 30-60 mins after meal

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12
Q

Symptoms of GERD are temporarily relieved by…

A

Antacids

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13
Q

Sxs of GERD are aggravated by…

A

Recumbent position

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14
Q

Diagnostic of choice for GERD?

A

Upper endoscopy with biopsy

(esophagogastroduodenoscopy, EGD)

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15
Q

Age >50
Wt loss
Melena
Difficulty/pain swallowing
Heavy ETOH/ tobacco
Non responsive to tx
PPIs

…should pursue what?

A

Upper endoscopy with biopsy

(Esophagogastroduodenoscopy, EGD)

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16
Q

Metaplastic changes which stratified squamous epithelium change to intestinal columnar epithelium

*increases risk for developing adenocarcinoma!

A

Barrett’s esophagus

(a complication of GERD)

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17
Q

Where do changes orginally occur in Barrett’s and how do they spread?

A

Originate at gastroesophageal junction

Extend proximally

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18
Q

in Barrett’s, how frequently do you repeat endoscopy with bx?

A

every 2 years

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19
Q

What percentage of pts who undergo endoscopy for GERD have Barrett’s?

A

5-15 %

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20
Q

In Barrett’s, if high grade dysplasia risk increases to 25%, what must you consider?

A

Surgical resection or ablative therapy

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21
Q

Avoid chocolate, peppermint, ETOH, coffee and fatty foods

Avoid acidic foods: red wine, OJ

Decrease portion size
Lose weight
avoid eating 2-3 hours before bed
elevate head of bed
quit tobacco (causes hyposalivation)

A

Non pharm tx for GERD

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22
Q

“-tidine” drugs

A

H2 blockers

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23
Q

“-prazole” drugs

A

PPIs

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24
Q

Motility disorder

usually associated with CP and/or dysphagia

Nutcracker esophagus (increased pressure >180 mmHg during peristalsis)

Rx: Nitrates, CCBs (Diltiazem)

A

Esophageal spasm

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25
Q

Increased pressure >180 mmHg during peristalsis

A

Nutcracker esophagus

26
Q

Esophageal manometry shows:

aperistalsis (no relaxation of LES)

A

Achalasia

27
Q

Esophageal manometry shows:

hypercontractile, esp at LES

A

Nutcracker esophagus

28
Q

HSV
Varicella Zoster
CMV
Candidia

A

Can all cause infectious esophagitis

29
Q

Intraluminal mucosal tear of distal esophagus or gastric cardia

*a linear mucosal tear in esophagus, generally at gastroesophageal junction

*caused by increase in intra-abdominal pressure

A

Mallory-Weiss Syndrome

30
Q

Occurs with foreceful vomiting or retching, causing hematemesis

accounts for 5-10% of upper GI bleeds

***generally occcurs with alcohol use but should always be suspected in an upper GI bleed

A

Mallory-Weiss Syndrome

31
Q

How do you dx a Mallory-Weiss tear?

A

Endoscopy

32
Q

Control bleeding endoscopically via coag techniques

most bleeding resolves spontaneously
*typically benign, self limiting

A

Mallory Weiss Syndrome

33
Q

If Mallory-Weiss pt is…

  • Hemodynamically unstable
  • Has an extreme in age
  • Has underlying medical issue
A

ADMIT

34
Q

Dilated submucosal veins develop in pts with portal HTN

*blood flow thru liver is diminished so blood flow increases thru microscopic blood vessels within esophageal wall, which causes the vessels to dilate

A

Esophageal varices

35
Q

MC cause of portal HTN?

A

Cirrhosis

(other causes= Portal vein thrombosis, Budd Chiari Syndrome, Infiltrative liver dz)

36
Q

Mortality rate for first time esophagaeal varcies rupture

A

40-70%

37
Q
A
38
Q

Varices here are most likely to rupture bc they are superficial

A

GE junction

39
Q

Hematemesis (>50% stop bleeding spontaneously)
Melena
Weakness/fatigue
Tachycardia
Hypotension, syncope
Abd pain
Jaundice

A

Esophageal varices

40
Q

MUST STOP BLEEDING ASAP!

tx:
ligation with rubber band
sclerotherapy
balloon tamponade

(most stop spontaneously but ~75% mortality rate for those who continue to bleed)

A

Esophageal varices

41
Q

The underlying cause in adults is portal HTN, MC caused by cirrhosis (either from alcohol abuse or chronic viral hepatitis)

*use of NSAIDs can exacerbate

A

Esophageal varices

42
Q

Beta blockers and nitrates to decrease portal HTN

Shunts

Liver transplant

long term tx for?

A

Esophageal varices

43
Q

Ring of tissue located at jxn of esophagus and stomach, Schatzki’s Ring

*usually congenital
*can be due to chronic GERD, scar tissue

sx: dysphagia (esp with solids)

A

Esophageal ring

44
Q

Similar to esophageal rings but occur in mid to upper esophagus

lead to intermittent dysphagia of solid food

A

Esophageal web

45
Q

Dx of esophageal web or rings

Tx?

A

Dx:
Barium Esophogram
EGD

Tx: mechanical dilation with balloon

46
Q

Loss of peristalsis in distal esophagus and failure of the LES to relax

Food backs up and ferments in esophagus, causing it to distend and dilated

causes include: damage to nerves of esophagus, infection (Chagas), hereditary

A

Achalasia

47
Q

MC symptom= dysphagia

Chest pain

Regurgitation

Difficulty belching

Weight loss

A

Achalasia

48
Q

Dx of Achalasia made with…

A

Chest X ray

Barium swallow

Manometry

Endoscopy

49
Q

Bird’s beak seen on barium swallow X ray

A

Achalasia

50
Q

Pneumatic dilation with balloon inflation can be used in tx of…

(60-90% effective and can last for 10 years)

A

Achalasia

51
Q

After the lower end of the esophagus is found and moved into position, the muscular ring surrounding the LES is cut, allowing it to open more easily.

95% success rate in treating achalasia

A

Myotomy

52
Q

Surgical Procedure to Rx GERD/Hiatal Hernia

Gastric Fundus is wrapped around Lower end of Esophagus

Can be done Laproscopically

Complications: Gas Bloat syndrome (can’t belch), Dysphagia, Dumping Syndrome(Food passes thru stomach too fast)

A

Nissen Fundoplication

53
Q

What is diagnosed more:

Adenocarcinoma or squamou cell carcinoma

(for esophageal cancer)

A

Pretty much equal

54
Q

5 year survival rate for esophageal cancer?

A

10-13%

55
Q

3x more common in males
6x more common in blacks
MC found in middle esophagus

Risks: smoking, ETOH

A

Squamous cell carcinoma

56
Q

7x more common in males
4x more common in whites
MC found in distal esophagus

Risks: Barrett’s esophagus

A

Adenocarcinoma

57
Q

Achalasia (16 fold increase)

Caustic esophageal injury due to lye (ie suicide attempt)

Partial gastrectomy

..increase risk of?

A

Esophageal (squamous cell) carcinoma

58
Q

Obesity is a risk factor for….

A

Adenocarcinoma

59
Q

An esophageal lumen diameter of less than 13 cm indicates…

A

Severe dz! (will have dysphagia)

60
Q

Tracheobronchial fistulas are a late complication of….

A

Esophageal cancer

(fistulas caused by direct invasion thru the esophageal wall and into the main stem bronchus)

life expectancy is less than 4 weeks if this complication develops

61
Q

Budd-Chiari syndrome may cause thrombosis of the portal vein, leading to…

A

Esophageal varices

Clin Med- GI (8 decks)

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