Gastro TBL Flashcards
Strep pyo infection leads to
Presentation
Pharyngitis
Fever, exudative pharyngitis, LAD
Vagus nerve
Gastric pacemaker
Neurohormonal gastric control
Proximal gastric relaxation
Migrating motor complexes (propulsive)
Acid secretion (stimulate pareital/G cells, inhibit D cells)
BER, slow waves of weak contractions
Gastrin
CCK
Secretin
GLP
Peptide YY
Neurohormonal gastric control
Gastric motility, acid sec
Inhibits gastric motility, acid sec
Inhibits gastric motility, acid sec
Inhibits gastric motility, acid sec
Inc insulin/dec glucagon
Dec intestinal motility
Gastrocolic reflex pathway
Mediated through
Gastric distension by stretch receptors
SNS fibers to celiac ganglion and MP
LES Relaxation factors
Obesity/pregnancy
Tobacco/alcohol
Meds (theophylline, nitrates, anti-chol, CCB)
Food- chocolate, peppermint, onions, garlic, carb beverages
Destruction of hypopharyngeal mucosa/submucosa via infection
Herniation bw pharyngeal constrictor/cricopharyngeus muscle
Dz and presentation
Infect Esoph (HSV/CMV/Candida)- dysphagia, odynophagia
Zenker- regurg undigested food, dysphagia (solids/liquids), halitosis
Oropharyngeal dysphagia due to reduced lingual control
Ineffective peristalsis due to a congenital defect in pharyngeal muscles
Dz and presentation
Stroke/MN disease- dysphagia to liquids/solids, tracheobronchial aspiration
Newborn RD, functional dysphagia later
Luminal obstruction from concentric narrowing of the lower esophagus
dz ad presentation
Peptic stricture- delayed dysphagia to solids
retrosternal discomfort
Orophayngeal dysphagia sx
Esophageal sx
Structural (obstru) presentation
Functional (motility)
Neck, immediate, aspiration
Chest, delayed, food impaction
Intermittent, solids>liquids
Constant, solids=liquids
Oropharyngeal vs esophageal
strcture
Functional
S/F- modified barium swallow
S- upper endoscopy
F- esophogram
Absence of peristalsis in distal esophagus with weak LES contraction
Discoordination of esophageal peristalsis w simulataneous contraction of multiple muscle groups
Dz and presentation
Scleroderma- collagen dep/fibrosis, GERD, dysphagia (L, then S)
Diffuse esophageal spasm- acute dysphagia, chest pain after meals, cold foods
Inflam rxn @ distal esophagus w CT stricture at squamocolumnar jxn
Neoplastic obstruction of the esophageal lumen
Weak/discoordinated distal esophageal contraction w hypertonic LES
Dz and presentation
Reflux esophagitis w peptic stricture- GERD/dysphagia (S)
Esophageal cancer- long time GERD, dysphagia (S)
Achalasia- autoimmune/chagas, lose inhibitory, dysphagia (L then S)
Eosinophilic esophagitis
Candidal
Erosive
Biopsy findings
Mucosal edema, trachealization
Diffuse, linear, adherent yellow plaques
Mucosal erythema/friability
erosions
Herniation of esophageal squamocolumnar jxn
Intestinal metaplasia of gastric mucosa
Malignant transformation of distal columnar epithelium
Malignant transformation of distal squamous epithelium
Dz and presentation
Hiatal hernia- gerd
autoimmune gastritis- asx, dyspepsia
adenocarcinoma- severe GERD, dysphagia (S)
SCC- alcohol/T/dysphagia (S)
Mx dyspepsia
Alarm symptoms
Age >55, alarm sx
Young pt, no alarm sx
Vomitting, wl, melena, dysphagia
Esophagogastroduodenoscopy
Stop NSAIDs, PPI x 8wks
Test H Pylori
Antacids
H2 receptor antagonists
PPI
reduce acid time
last
15-30 min, 90 min
1-2hrs, 9 hrs
1-2 days, 2-3 days
Quadruple therapy for H pylori
Bismuth/Metro/Tetra/ PPI
Inactivation of e cadherin
Integration of HPV into genome
Integration of EBV into genome
Mutate p53 tumor suppressor
Overexp of her2/neu oncogene
Cancer association
Gastric adenocarcinoma (linits plastica)
H/N cancer (oropharynx), cervical/penile/anal
H/N Cancer (nasopharynx), burkitt lymphoma
Colon/pancreatic cancer
Esophageal/gastric adenocarcinoma
Breast/ovary/endometrial
