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esophegeal motility disorders Flashcards

1
Q

what is the most common motility disorder due to degeneration of myenteric plexus and failure of relaxation of LES

A

achalasia

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2
Q

what are causes of achalasia

A

idiopathic
adenocarcinoma of proximal stomach
chagas disease (parasite enter body)

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3
Q

a patient with achalasia presents with what

A

triad of dysphagia (liquids/solids) regurg and wt loss
halitosis bcz of food stuck
retrosternal chest pain

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4
Q

what are complications of achalasia

A

aspiration –> pneumonia or bronchitis

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5
Q

how do u diagnose if u suspect a pt with achalasia

A

MANOMETRY (gold standard) : absence of peristalsis , absence of LES relaxation w swallowing , inc LES tone

BARIUM SWALLOW (bird beak sign) - tapering of distal esophagus and dilate proximal lower esophagus

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6
Q

in achalasia what can lead to high risk of malignancy

A

in achalasia there is food stuck so constant irritation can cause mutation in epithelial cells high risk of squamous cell carcinoma

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7
Q

how can you manage the symptoms pf achalasia

A

medical: nitroglycerin, sildenafil (PDEI), nifedipine (CCB) –> dec LES tone
inject LES with botulinum (botox)

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8
Q

what is systemic sclerosis

A

smooth layer of the esophagus is replaced by fibrous tissue

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9
Q

a patient comes in with chronic heartburn and has a history of scleroderma

A

systemic sclerosis

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10
Q

what would show in manometry a patient with systemic sclerosis and how would u tx

A

low LES pressure
aperistalsis
esophageal hypomobility

tx PPI for reflux

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11
Q

what is loss of normal peristaltic coordination of sm, simultaneous contraction of segments of esophageal body mainly in distal end

A

diffuse esophageal spasm

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12
Q

a patient comes in with substernal chest pain, sudden onset, not related to exertion, precipitaed by drinking cold liquids

A

diffuse esophageal spasm

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13
Q

in DES dysohagia happens to what

A

to solids and liquids but no regurg (unlike ACHALASIA)

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14
Q

what is the diagnosis of DES

A

barrium swallow–> cork screw appearance

manometry (GOLD STANDARD) : spontaneous activity , repetitive waves, prolong high amplitude contractions, LES tone is normal

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15
Q

tx of DES

A

nitrates + CCB
(reduce ca influx and contractility)

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16
Q

what is type 1 hiatal hernia

A

type 1 is sliding hernia associated w GERD

sliding of GE junction into the chest thru esophageal hiatus in diaphragm

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17
Q

what is type 2 hiatal hernia

A

paraesophageal hernia
isolated sliding of the stomach into thorax wout GE junction

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18
Q

type 3 hiatal hernia

A

combo of both sliding and para esophageal hernia

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19
Q

type 4 hiatal hernia

A

herniation of other organs ex, colon , spleen, omentum

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20
Q

what is diagnosis of hiatal hernias

A

GOLD STANDARD - contrast upper gi swallow: confirm advanced hiatal hernia

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21
Q

there is a high risk of incarceration and ischemia in what type of hiatal hernia

22
Q

what do u see in benign esophageal stricture

A

congenital webs or acquired from and injury : chronic reflex, infection, inflam

23
Q

what are symptoms of esoohageal stricture

A

asymptomatic if small
if obstructive –> progressive dysphagia first to solids then liquids ( unlike motility disorders )

24
Q

what are causes of esoohageal stricture

A

long standing gerd
radiotherapy
ingestion of corrosives
prolong NGT

25
tx of esophageal stricture
endoscopic dilation + PPI (if cause is gerd)
26
esophageal webs or rings are two types what are they
plummer vinson syndrome Schatzki ring
27
plummer vinson syndrome is a triad of what
cervical esohageal web dysphagia IDA
28
where is the web located in plummer vinson syndrome
proximal upper esophagus
29
what are other symptoms related to plummer vinson syndrome
glossitis ngular chelitis koilonychia splenomegaly enlarge thyroid
30
plummer vinson syndrome may transform to what type of cancer
squamous cell carcinoma
31
what is schatzki ring
scarring or tightening of distal lower esophagus from acid reflux associated w hiatal hernia
32
what is zenker diverticulum
false diverticulum , outpouching of posterior pharyngeal constrictor muscles
33
what does a pt w zenker diverticulum present w
dysphagia halitosis regurg gurgling mass in neck aspiration pneumonia
34
diff btwn squamous cell carcinoma and adenocarcinoma in location
SCC: upper and middle third of esoph ADENO: lower third of esophagus
35
what are risk factors of SCC
SMOKING alcohol high diet intake of nitrosamines (salted fish) achalasia china asia iran
36
risk factors adenocarcinoma
barrets esophagus after GERD
37
risk factors shared by both SCC and adenocarcinoma
progressive dysphagia wt loss chest pain age > 50
38
what is more srs btwn two cancers
SCC - usually present more advanced disease, greater wt loss, history of smoking and alcohol (survival is 20% in 5yrs)
39
diagnosis of esophageal carcinoma
barium swallow : stricture with filling defect ct scan: detect metastases (mostly to liver and lungs)
40
what is GERD
reflux of stomach contents into esophagus bcz of incompetent LES
41
symptoms of gerd
heartburn regurg dysohagia dyspepsia after heavy meals described as burning or discomfort in epigastrium
42
how is pain relieved in gerd
by anatcids aggravated by lying supine or leaning forward frequent consumption of alcohol
43
drug of choice for all gerd pts
PPI
44
how can u diagnose gerd
a trial of PPI for 2 weeks with pt response usually suffiecient unless red flags
45
when do you have to do upper endoscopy in gerd pts
if there are red flags, age >55 , not respond to tx, monitor complications (barrets) signs of esophagitis hiatal hernia intestinal metaplasia
46
what is a late complication of Gerd
barrets esophagus
47
what causes barrets esophagus metaplasia of what part
columnar intestinal metaplasia of squamous epithelium w goblet cells
48
what does esophagus look like in barrets esophagus
salmon pink velvety mucosa
49
what does barrets esophagus start as and ends as
metaplasia low grade dysplasia high grade dysplasia invasive
50
endoscopic surveillance of different levels in barrets esophagus
metaplasia: rescope every 2-3yrs low grade dysplasia: repeat endoscopy w biopsy every 1 cm within 6 months while on high dose ppi

gi survival (6 decks)

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