Gastro #1 Flashcards
dysphagia vs odynophagia
dysphagia- difficulty swallowing
odynophagia- painful swallowing (indicates inf process)
most common diagnostic modalities for esophageal disroders
barium swallowing (esophagram)
esophagogastroudodenoscopy (EGD/OGD)
Esophageal manometry
24h pH monitoring
GERD facts + what is it due to
1st identifiable cause for epigastric pain (10-20% of people in the West)
due to excessive relaxation of lower esophageal sphincter (LES)
risk factors for GERD
obesity, old age, hiatus hernia, family hx, meds (Ca2+ channel blockers)
investigations for GERD if chest pain? (4)
- EKG to exclude heart
- Clinical dx using proton pump inhibitors
- gastroscopy
- espphageal manometry
S&S of GERD
heart burn, chest pain, dysphagia, odynophagia
chest pain, chronic cough, wheezes (THIS COULD BE HEART CONDITION)
GERD treatment
proton pump inhibitors (PPIs), H2-antaognists
avoid certain foods and weight loss (and raise head in bed)
Big complication from GERD
Barrett’s esophagus + esophageal adenocarcinoma
can also have esophagitis, ulcer, bleeding, esophageal stricutre disease
what is barrels epophagus and what is it due to
Metaplasia of normal squamous esophageal epithelium to abnormal columnar epithelium
Due to long standing GERD
what does barrett’s esophagus predispose to?
adenocarcinoma
Esophageal Motor Disroders (3)
- Achalasia
- Scleroderma
- Diffuse Esophageal spasm
What is Achalasia and what is it due to
Failure of smooth muscle relaxation at LES (incomplete relaxation of the lower esophageal sphincter)
increased LES pressure
progressive loss of peristaltic function
due to malignancy, idiopathic or chagas disease
investigations for achalasia and best test (4)
Chest x ray Barium studies (birds beak at end of esophagus)- best initial test endoscopy manometry- most accurate test
most accurate test for scleroderma
manometry
Tx for scleroderma
Agressive GERD therapy with PPIs
Diffuse Esophageal Spasm (chest pain)- what is it and symptoms
Disorder in neural conduction of resulting in esophageal spasm.
Presents as intermittent pain that has no relation with swallowing
test to differential diffuse esophageal spasm
EKG and cardiac enzymes to rule out cardiac diseases
diffuse esophageal spasm investigation finding
barium x-ray: corkscrew pattern
treatment for DIffuse Esophageal Spasm
Clacium channel blockers
Esophageal Diverticula def and 3 types
Outpouchings of one or more layers of the esophageal tract
- Pharyngoesophageal diverticulum
- Mid esophageal
- Just prox to LES
Pharyngoesophageal (Zenker’s) Divertiuculum (Esophageal Diverticula)
Most common! - Posterior outpouching
collects food which will rot causing severe HALITOSIS(bad breath) RED
Peptic Structure - What be + investigations
Presents as dysphagia alongside a long history of reflux symptoms, but reflux symptoms may disappear as stricture develops.
- Endocopy
- barium study
two conditions that can cause chest pain
GERD and diffuse esophageal Spasm
Esophagitis def + mc causation
Can be due to infection (viral or fungal) or irritation (chemical or pills) - MOST COMMONLY Candida
Infection is rare in immunocompetent persons
HALLMARK symptom of esophagitis RED
odynophagia
Esophageal carcinoma mc type world wide and western world
world- Squamous cell carcinoma in upper 2/3 esophagus
western- adenocarcinoma in distal 1/3 of esophagus
Risk factors for Squamous Cell Carcinoma (Esophageal carcinoma –> upper 2/3rds of esopahgus (6 s’s)
Smoking Spirits (alcohol) Seeds Scalding (hot liquid) Strictures Sack (diverticula)
Risk factors for adenocarcinoma
barret’s esophagus (MOST IMPORTANT)
Obesity
Gerd
Caucasians
red risk factors for adenocarcinoma of esophagus
Long standing GERD
Distal 1/3
most important investigation for esophageal carcinoma
Endoscopic biopsy (EGD with biopsy)
Dysphagia + weight loss = ?
esophageal pathology
Dysphasia + weifht loss + heme +ve stool/Anemia = ?
cancer
Major sign of esophageal perfortation
Boerhaave’s syndrome - repeated, froceful vomiting
Esophageal perforation conditions BOTH associated with forceful emesis(vomiting)
Boerhave’s syndrome (transmural esophageal perfortation)
MAllory-Weiis tear (Non-transmural esophageal tear - partial thickness)
Hiatal Hernia - Sliding hiatus hernia type 1
90% of esophageal hernias
Herniation of both the stomach and the gastroesophageal (GE) junction into thorax
Paraesophageal hiatus hernia (type 2)
Herniation of all or part of the stomach through the esophageal hiatus into the thorax with an !!!!! undisplaced GE junction !!!!!!!
what is a type 3 (mixed hiatus hernia) and type 4 hernia
type 3- Combo of typw 2 + 3
Type 4- Herniation of the stimach and organs into the thorax
