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Clin med GI > Esophagus, stomach, duodenum > Flashcards

Esophagus, stomach, duodenum Flashcards

1
Q

What is the most common cause of esophagitis

A

GERD

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2
Q

What is esophagitis

A

inflammation or injury to esophageal mucosa

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3
Q

What is the most common cause of infection of the esophagus

A

Fungus

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4
Q

What is Eosiniphilic esophagitis (EoE)

A

Chronic immune antigen-related esophageal disease

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5
Q

What is the common presentation of esophagitis

A

retrosternal chest pain
heart burn
odynophagia / dysphagia

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6
Q

What can help differentiate the subtypes of esophagitis

A

endoscopy and bx

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7
Q

What is CMV esophagitis

A

several large, shallow, superficial ulcerations

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8
Q

What is HSV esophagitis

A

multiple small, deep ulcerations

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9
Q

What does EoE esophagitis look like

A

white exudates/papules, red furrows, corrugated concentric rings and strictures

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10
Q

What medication must be avoided with esophagitis

A

NSAIDs

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11
Q

What are some complications of esophagitis

A

bleeding
stricture
barretts esophagus
perforation
laryngitis
aspiration pneumonia

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12
Q

What is gastritis

A

Inflammation of gastric mucosa caused by infection, drugs, stress, atrophic gastritis

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13
Q

How do you diagnose gastritis

A

endoscopy

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14
Q

How do you differentiate between erosive and non-erosive gastritis

A

based of the severity of mucosal injury

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15
Q

What causes gastric atrophy

A

result of long standing gastritis
(loss of intrinsic factors)

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16
Q

What is the clinical presentation of non-erosive gastritis

A

mostly asx but may c/o with dyspepsia

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17
Q

What is the treatment of non-erosive gastritis

A

Eradication of H.pylori

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18
Q

What is the most common pathogen that causes gastritis

A

H.Pylori

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19
Q

What is the most common/gold standard to diagnose H.pylori

A

Urea breath test

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20
Q

What is the treatment of H.Pylori

A

PPI plus 2 antibiotics

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21
Q

What does H.Pylori typically cause

A

Gastritis
PUD
Gastric adenosine-carcinoma
gastric lymphoma

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22
Q

What does H.Pylori put you at an increased risk for

A

Stomach cancer
*class 1 carcinogen

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23
Q

How does H.Pylori cause gastritis

A

Increased gastrin production which results in increased acid production predisposing to pre pyloric and duodenal ulcer

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24
Q

What is the best treatment for H.Pylori

A

PPI + Metronidazole + tetracycline + Bismuth subsalicylate x 14 days

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25
Q

If ulcers are present, how long does a PPI need to be used in tx of H.Pylori

A

4 week minimum

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26
Q

What is erosive gastritis

A

damage to mucosal defenses

*usually acute with bleeding

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27
Q

What are common causes of Erosive gastritis

A

NSAIDs
Alcohol
Stress

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28
Q

What is the first sign of erosive gastritis

A

Hematemesis or melena for 2-5 days of inciting event

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29
Q

What is GERD

A

Incompetence of LES allowing reflux of gastric contents into the esophagus = burning pain

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30
Q

What is the typical sx of GERD

A

heartburn 30-60min postprandial

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31
Q

What increases the risk for GERD

A

Weight gain
fatty food
caffeinated/carbonated drinks
alcohol
tobacco smoking
drugs/meds

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32
Q

Which drugs will worsen GERD

A

Anticholinergics
antihistamines
TCSa
CCBs
progesterone
nitrates

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33
Q

What are the components of Gerd

A

Impaired LES function
hiatal hernia
irritant effects of reflux (pH>4)
abnormal esophageal clearance

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34
Q

What conditions can weaken LES

A

hiatal hernia
pregnancy

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35
Q

What condition affect transit from stomach to the small intestine

A

diabetes
PUD
connective tissue disorders

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36
Q

What is the common clinical presentation of GERD

A

heartburn
regurgitation
dysphagia

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37
Q

What is heartburn

A

retrosternal burning discomfort located in the epigastric area.

May radiate upwards and typically occur postprandial

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38
Q

If GERD does not respond to empiric treatment or has longstanding symptoms, how do you work them up

A

Endoscopy with cytology and/or bx is test of choice

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39
Q

What are some complications of GERD

A

Barretts esophagus
esophagitis
chronic aspiration
peptic strictures
esophageal ulcers

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40
Q

What is the number one treatment for GERD

A

lifestyle modification

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41
Q

What are things to avoid with GERD

A

Eating within 3 hours of bedtime
strong stimulants for acid secrete
Certain meds
specific foods
smoking

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42
Q

What are some drug therapy that can be done for GERD

A

Antacids
H2 blockers
PPIs

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43
Q

What are some antireflux procedures that can be done for GERD

A

Laparoscopic fundoplication
bariatric surgery
esophageal strictures

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44
Q

what is the only complication of GERD with malignant potential

A

barretts esophagus

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45
Q

Who is Barretts esophagus typically seen in

A

middle age white males

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46
Q

what cellular changes are seen with Barretts esophagus

A

conversion of normal esophageal squamous epithelium into metaplastic columnar epithelium

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47
Q

What is the clinical presentation for Barretts esophagus

A

chronic history of GERD with no other specific exam finding

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48
Q

What are the screening guidelines for Barretts esophagus in men

A

> 5 years of chronic GERD with 2 additional risk factors

> 50yo, hx smoking, white ethnicity, central obesity, +fh BE

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49
Q

What will be seen on endoscopy with Barretts esophagus

A

columnas metaplasia (salmon pink tongues of mucosal tissues)

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50
Q

What will be seen on bx from Barretts esophagus

A

goblet cells

51
Q

What is used for routine surveillance of Barretts esophagus

A

hi-def white light endoscopy

52
Q

When is an esophagectomy done for Barretts esophagus

A

is intramucosal cancer is present

53
Q

What type of cancer can Barretts cause

A

adenocarcinoma

54
Q

What is another name for a gastrinoma

A

Zollinger-Ellison syndrome (Z-E)

55
Q

Where are gastrinomas found

A

in the pancreas of duodenal wall

56
Q

How do you diagnose a gastrinoma

A

Measure serum gastrin levels

57
Q

What is a gastrinoma

A

Type of pancreatic endocrine tumor arising from islets cells and gastrin producing cells in the duodenum

58
Q

What syndrome is highly associated with Z-E syndrome

59
Q

What is the initial treatment of gastrinomas

60
Q

What serum gastrin level is indicative of a gastrinoma

A

> 1000pg/mL
&
gastric acid secretion >5mEq/hr

61
Q

What PE findings may be seen with esophageal motility disorders

A

prolonged swallowing time

62
Q

What are common symptoms of esophageal motility disorder

A

dysphagia
chest pain/pressure
heartburn

63
Q

What types of evaluations can be done for esophageal motility disorders

A

upper endoscopy
barium swallow
esophageal manometry
acid-reflux tests

64
Q

What are some common causes of esophageal motility disorder

A

secondary neurogenic
Diffuse esophageal spasm
achalasia

65
Q

What is diffuse esophageal spasm (DES)

A

Spectrum of motility disorders characterized by non-propulsive contractions, hyper dynamic contractions, or elevated LES pressure

66
Q

How can you treat DES

A

nitrates
CCB
botulinum toxin
surgical myotomy
antireflux therapy

67
Q

What are some symptoms of DES

A

Substernal chest pain
pain that wakes from sleep
temp extremes aggravate
severe pain w/o dysphagia

68
Q

What test will provide most specific descriptions of spasms in DES

A

Esophageal manometry

69
Q

What is achalasia

A

Neurogenic esophageal disorder characterized by impaired esophageal peristalsis and lack of LES relaxation during swallowing

70
Q

What are the symptoms of achalasia

A

slowly progressive dysphage and regurge of undigested food

71
Q

What is the cause of achalasia

A

loss of ganglion cells in myenteric plexus of the esophagus = denervation of esophageal muscle

72
Q

What is the primary symptom of achalasia

A

dysphagia of both solids and liquids

73
Q

What is the preferred dx tests for achalasia

A

esophageal manometry

74
Q

What would be seen on a barium swallow with achalasia

A

very dilated esophagus with a narrowed - beaklike stricture at LES

75
Q

What needs to be ruled out in the dx of achalasia

A

Systemic sclerosis
GE junction cancer

76
Q

What is the treatment for achalasia

A

No therapy will restore peristalsis

balloon dilation of LES and surgical/endoscopic myotome

77
Q

What is an esophageal diverticula

A

Outpouching of mucosa through the muscular layer of the esophagus

78
Q

How do you diagnose esophageal diverticula

A

barium swallow

79
Q

What is the most common esophageal diverticula

80
Q

What is zenkers diverticula

A

Posterior out pouching of mucosa & submucosa thru cricopharyngeal muscle

81
Q

What are the different types of esophageal diverticula

A

Zenkers
mid-esophageal
api-phrenic

82
Q

What are characteristic symptoms of zenkers diverticula

A

pouching fills with food and will empty when leaning forward

83
Q

What is the treatment of senders diverticula

A

none unless very large or symptomatic… then resection will be done

84
Q

What are some intrinsic esophageal obstructions

A

esophageal tumors
esophageal rings
esophageal webs
strictures from GERD

85
Q

What are some extrinsic esophageal obstructions

A

enlarged left atrium
aortic aneurysm
suubsternal thyroid
cervical bony exostosis
thoracic tumor

86
Q

What is the treatment for a complete obstruction

A

emergen endoscopy to clear blockage

87
Q

What is a Schatzki ring

A

lower esophageal ring

88
Q

What is a presentation for schatzki ring

A

intermittent dysphagia for solids
*worse with meat and dry bread

89
Q

When does a schatzki ring typically present

90
Q

How do you diagnose a schatzki ring

A

Endoscopy or barium swallow

91
Q

What is the treatment for lower esophageal rings

A

Wide lume = chew food thoroughly

Narrow lumen = dilation by endoscopy

92
Q

What is Plummer-vinson syndrome

A

esophageal web

93
Q

What is an esophageal web

A

thin mucosal membrane that grows across the lumen

94
Q

What causes esophageal webs

A

untreated, severe iron deficiency anemia

95
Q

What is mallory-Weiss syndrome

A

Non-penetrating mucosal laceration of the distal esophagus and proximal stomach caused by vomiting, retching, or hiccuping

96
Q

How is mallory-weiss syndrome diagnosed

A

*typically clinical
can have a diagnostic/therapeutic endoscopy done

97
Q

If intervention is needed, what procedures can be done for mallory-weiss

A

Clip placement
injection of ethanol / epi
electrocautery

98
Q

What are esophageal varices

A

Dilated veins in the distal esophagus or proximal stomach caused by elevated pressure in portal venous system

99
Q

How do you treat esophageal varices

100
Q

What is the treatment for esophageal varices

A

Endoscopic banding
IV octreotide

*may need TIPS

101
Q

What can cause esophageal varices

A

When portal pressure > IVC pressure

102
Q

Where are the most dangerous collaterals from portal HTN

A

Distal esophagus and gastric fundus

103
Q

When can variceal rupture occur

A

pressure gradient >12mmHg

104
Q

How do those with esophageal varices typically present

A

sudden, painless, upper GI bleeding (often massive)

105
Q

What does mortality depend of with esophageal varices

A

The severity of the liver disease

106
Q

What are the first things that are done for treatment of ruptures esophageal varices

A

Airway management
Transfusion
prophylactic abx (ceftriaxone)

107
Q

What is the primary treatment of esophageal varices

A

endoscopic banding

108
Q

What is a concurrent treatment for esophageal varices

A

IV octreotide

109
Q

What is PUD

A

Erosion of GI mucosa (usually stomach) penetrating muscularis mucosa

110
Q

What generally causes PUD

A

H Pylori vs NSAIDs

111
Q

What are the symptoms for PUD

A

burning epigastric pain that is often relieved by food

112
Q

What are the symptoms of a duodenal ulcer

A

pain is absent when awakening and appears mid-morning

relieved with food and then will reoccur 2-3 hours after meal

113
Q

If a patient is woken up at night in pain, what type of ulcer do they probably have

114
Q

How do you diagnose PUD

115
Q

What is the most common concern with PUD

A

hemorrhage

116
Q

What are the common complications of PUD

A

hemorrhage
perforation
recurrence

117
Q

If PUD causes a perforation, where is it most commonly

A

anterior wall of the duodenum

118
Q

What are the ssx of a free preformation with PUD

A

sudden, intense, continuous epigastric pain that spread rapidly

prominent in ROQ that refers to 1 or both shoulders

119
Q

What will be seen in CT/XR with a perforation in PUD

A

free air under diaphragm or peritoneal cavity

120
Q

What can cause a gastric outlet obstruction

A

scarring, spasms, or inflammation

121
Q

What are the ssx of a gastric outlet obstruction

A

recurrent, large volume vomiting, usually at the end of the day

122
Q

What is the duodenal ulcer surgery of choice

A

parietal cell vagotomy

123
Q

What are some surgical complications from PUD

A

Anemia (Fe)
Dumping syndrome
mechanical problems

Clin med GI (9 decks)

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