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Foundations III GI (Cholley) > Esophagus & stomach > Flashcards

Esophagus & stomach Flashcards

1
Q

What causes esophagitis?

A

Candida

CMV, HSV

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2
Q

What is the presentation of esophagitis?

A

Odynophagia or dysphagia**

Fever, lymphadenopathy

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3
Q

How do you dx esophagitis?

A

Endoscopy

Definitive = cytology/culture

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4
Q

How do you treat esophagitis?

A

Candida: Fluconazole or ketoconazole

HSV: Acyclovir

CMV: IV ganciclovir or foscarnet

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5
Q

What is the presentation of medical induced esophagitis?

A

Severe retrosternal CP

Odynophagia, dysphagia

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6
Q

How does corrosive esophagitis (due to ingestion of causative agent) present?

A

Ulceration, necrosis, perforation

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7
Q

What are complications of corrosive esophagitis?

A

Fibrosis
Stricture
Increased risk of SCC

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8
Q

How does neurogenic esophageal dysmotility present?

A

Trouble swallowing liquids & solids

Can lead to aspiration pneumo

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9
Q

How does Zenker’s diverticulum (an esophageal dysmotility) present?

A

Pouch in posterior hypopharynx above UES

Undigested food & liquid is regurgitated

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10
Q

How does esophageal stenosis (an esophageal dysmotility) present?

A

Webs, rings, malignancy

Trouble swallowing solids

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11
Q

What is the presentation of Schatzki’s ring?

A

Occurs at GE junction

Dysphagia to solids

+/- impaction of bolus

Abrupt sub-sternal discomfort

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12
Q

What are esophageal webs?

A

Mucosal fold protrudes into lumen

Intermittent dysphagia to solids

Sx seen in iron deficiency & middle-aged women (plummer vinson syndrome)

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13
Q

Describe achalasia

A

Decreased peristalsis, ineffective relaxation of LES

Dysphagia to solids & liquids

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14
Q

Describe esophageal spasm

A

Dysphagia or intermittent CP

+/- a/w eating, drinking cold liquids

Can mimic MI

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15
Q

Describe scleroderma of the LES

A

Decreased sphincter tone & peristalsis –> reflux

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16
Q

How do you dx achalasia?

A

Parrot beak on esophagram

Dilated esophagus tapering to distal obstruction

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17
Q

How do you dx diffuse esophageal spasm?

A

Barium esophagram: corkscrew

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18
Q

How do you treat esophageal spasm?

A

SM relaxants

NTG before meals & bed
Isosorbide before meals
Nifedipine before meals

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19
Q

What is an ADE of SM relaxants?

A

Hypotension

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20
Q

What does “CREST” stand for in scleroderma?

A 
Calcinosis
Raynauds 
Esophageal dysmotility 
Sclerodactyly 
Telangiectasis
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21
Q

How do you dx dysphagia in general?

A

Barium swallow

Endoscopy: to DIRECTLY see abnormalities & bx

Esophageal manometry

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22
Q

How do you treat esophageal dysmotility?

A

Strictures: if benign –> dilation, if CA –> resect

Diverticula, achalasia, stenonis: endoscopic dilation, resection, myotomy

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23
Q

Describe: Mallory-Weiss Tear

A

Causes 10% of upper GIB

Linear tear in esophageal mucosa

Usually at GE junction

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24
Q

What is the pathophys behind Mallory-Weiss tears?

A

Occurs w/ forceful vomiting/retching

Leads to hematemesis

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25
What are RFs of Mallory-Weiss tears?
Alcohol | Hyperemesis gravidarum
26
How do you dx Mallory-Weiss tears?
Endoscopy
27
How do you treat Mallory-Weiss tears?
Epi injection to stop bleeding Thermal coagulation Surgery if severe
28
What causes esophageal varices?
Portal HTN from cirrhosis due to alcohol abuse or chronic hepatitis Budd-Chiari syndrome (thrombosis of portal vein)
29
What are RFs of esophageal varices?
NSAIDs exarcerbate bleeding
30
How do esophageal varices present?
Painless upper GI bleed If large bleed --> hypovolemic shock, orthostasis Usually asx until they bleed & become life-threatening!
31
How do you dx esophageal varices?
Endoscopy
32
How do you treat esophageal varices?
Hemodynamic support Emergent EGD: Band ligation, sclerotherapy
33
How do you prevent esophageal varices in pts w/ cirrhosis?
B-blockers No alcohol Band ligation
34
What causes GERD?
Abnormality of LES Prolonged exposure to gastric acid Abx, bisphosphonates, iron, NSAIDs, anticholinergics, CCBs, narcotics, benzos
35
How does GERD present?
Heartburn = MC sx - worse after meals, lying down, bending over, or in PM - some relief w/ antacids - regurgitation, dysphagia Hoarseness, halitosis, cough, hiccups, sore throat, laryngitis, nausea, CP
36
What are the "ALARM Sx" of GERD, which indicate a different dx?
``` Anemia Loss of weight Anorexia Recent onset Melena or hematemesis Swallowing difficulty ```
37
How do you dx GERD?
Clinically! Trial of PPI x 4-8wks Consider endoscopy to confirm
38
What diagnostic procedures can you use for more severe GERD?
Barium swallow Esophageal manometry Ambulatory 24hr pH monitor (gold standard for surgical planning)
39
How do you treat GERD?
Lifestyle modification H2 blockers: only relieve sx PPIs prior to eating: heals mucosa (meds end in "prazole or prozole")
40
How do you treat GERD if refractive to PPI therapy?
Nissen fundoplication
41
What are complications of GERD?
``` Aspiration pneumo Acid laryngitis Asthma Strictures Barrett esophagus & adenocarcinoma ```
42
Describe Barret esophagus
Replacement of squamous epithelium w/ columnar epithelium A/w adenocarcinoma
43
What is the most frequent benign tumor of the esophagus & how does it present?
Leiomyoma Usually asx May cause dysphagia
44
How do you dx leiomyomas?
Discovered incidentally
45
How do you treat leiomyomas?
Excision
46
What are characteristics of SCC?
Mid esophagus Smokers, Etoh users Asians, African Americans
47
What are characteristics of adenocarcinomas?
``` Distal 1/3 of esophagus MC type in US Smokers Chronic reflex Obesity Caucasian males ```
48
What are RFs of esophageal CA?
Smoking Chronic alcohol - SCC Caustic agents HPV
49
How does esophageal CA present?
Progressive dysphagia w/ solid foods Wt loss, heartburn, vomiting, regurg, aspiration, hoarseness
50
How do you dx esophageal CA?
Barium esophagogram (best initial test): apple core lesion Endoscopy w/ bx (definitive dx)
51
How do you stage esophageal CA?
CT chest/abd Endoscopic U/S w/ FNA bx of LNs PET-CT +/- bronchoscopy
52
How do you treat esophageal CA?
Resection | Radiation, chemo
53
Where does esophageal CA tend to metastasize?
Stomach & colon
54
What causes gastritis?
``` Autoimmune d/o NSAIDS = #1 H. pylori = #2 Stress Alcohol ```
55
How does gastritis present?
Dyspepsia | Abd pain
56
How do you dx gastritis?
Endoscopy w/ bx Urea breath test Stool antigen (H.pylori) Serology for H.pylori (IgA or IgM vs. IgG)
57
How do you treat gastritis?
If NSAID induced --> PPI --> endoscopy If H. pylori --> tx x 14 days
58
Tx for H.pylori: What meds do you use if you are concerned for macrolide resistance?
Bismuth + tetracycline + Metronidazole + PPI
59
What is gastritis a/w?
PUD Gastric adenocarcinoma B cell gastric lymphoma
60
What causes PUD?
Break in mucosa from injury, NSAIDs, stress, alcohol H. pylori = #1
61
What is the presentation of PUD?
Abd pain (burning, gnawing, may radiate to back) Dyspepsia: belching, bloating, distention, heartburn, regurg
62
What is the difference btwn gastric & duodenal ulcers?
Gastric: worsens after eating Duodenal: improves after eating
63
How do you dx PUD?
Endoscopy* Barium swallow H. pylori testing
64
How do you treat PUD?
If H.pylori: tx x 2-4wks Gastric: PPI x 12 wks Duodenal: PPI x 4-8wks
65
What can you use for prophylactic tx for pts w/ hx of ulcers?
Misoprostol Sucralfate 1 hr before meals PPI
66
What are complications of PUD?
Obstruction (due to scars) GI bleed Ulcer perforation Penetration/fistulizaton
67
What causes gastroparesis (delayed gastric emptying/motility)?
Idiopathic DM Diseases of SM Neuro dysfunction
68
What is the presentation of gastroparesis?
Nausea Excessive fullness after meals Bloating, wt loss, abd pain
69
How do you dx gastroparesis?
Endoscopy Scintigraphic gastric emptying
70
How do you treat gastroparesis?
Smaller meals Prokinetic meds: cisapride, metoclopramid
71
How do hiatal/diaphragmatic hernias present?
Asx GERD Chest discomfort
72
How do you dx hiatal/diaphragmatic hernias?
Barium esophagogram | Endoscopy
73
How do you treat hiatal/diaphragmatic hernias?
Acid reduction | Surgical repair
74
What are characteristics of a gastrinoma?
Gastrin secreting tumor --> hypergastrinemia --> PUD AKA Zollinger-Ellison syndrome
75
How do gastrinomas present?
Abd pain, diarrhea, GI bleed
76
How do you dx gastrinomas?
Fasting serum gastrin > 150 Secretin test (confirms): Gastrin rises > 200 Endoscopy/CT/MRI
77
How do you treat gastrinomas?
PPI Removal of tumor Screen for MEN1
78
What are RFs of gastric adenocarcinomas?
Smoking H. pylori Genetic
79
How do adenocarcinomas present?
Dyspepsia, wt loss, GIB, anemia Abd mass Signs of metastasis: Virchow node, sister Mary Joseph nodule
80
How do you dx adenocarcinomas?
Endoscopy CBC: iron deficiency CT
81
How do you treat adenocarcinomas?
Surgery +/- chemo & radiation
82
What are the 2 types of gastric lymphoma?
MALT | B cell lymphoma
83
What increases risk of gastric lymphoma?
H.pylori increases 6-fold

Foundations III GI (Cholley) (10 decks)

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