Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Clin Med II > Gastrointestinal Disorders > Flashcards

Gastrointestinal Disorders Flashcards

1
Q

Medications that can cause direct esophageal mucosal injury

A 
Antibiotics
Anti-inflammatory 
Biphosphonates
KCl
Iron
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Medication-induced esophagitis clinical presentation

A

Sudden onset, retrosternal pain or heartburn, odynophagia, dysphagia
Pain may be so severe that swallowing saliva is difficult
Onset of the sxs - within a few hours to 1 month after ingestion of the culprit medication
Often have a history of swallowing a pill without water, commonly at bedtime
Clinical diagnosis may be made by history alone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Medication-induces esophagitis diagnosis

A

EGD with severe symptoms, or persistent for greater than one week.

EGD with biopsy can establish the diagnosis and r/o other etiologies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Medication-induced esophagitis treatment

A

Discontinue causative medication (if continued try to switch to liquid)
Most will heal within 7-10 days

After healing can resume med with plenty of water

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Eosinophilic esophagitis

A

Chronic, immune-mediated inflammatory disorder or the esophagus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Eosinophilic esophagitis clinical features

A

Food impaction and dysphagia
> 15 eosinophils on histological exam
Exclusion of other disorder (GERD)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Eosinophilic esophagitis (EoE) risk factors

A

Hx of asthma, allergic rhinitis, eczema, environmental allergies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Causes of eosinophilic infiltration

A

*Think about things that would cause inflammatory response.

GERD, EoEparasites, fungi, IBD, Hodgkin’s disease, Scleroderma, drug injury, allergic vasculitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

EoE vs GERD

A

They often coexist, but are not related

Typically EoE patients will be put on PPI but will not have resolution of symptoms.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

EoE clinical presentation

A

Dysphagia, heartburn, chest pain
Prone to food trapping
Patients typically with hx of atopy (asthma, eczema, food allergy)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

EoE diagnosis

A

Eosinophils of EGD with biopsy
EGD shows cat esophagus (multiple concentric rings) with white plaques or specks
CBC for peripheral eosinophilia
Barium study not required

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

EoE treatment

A
  1. Dietary therapy (Elimination diet)
  2. Pharmacologic therapy
  3. Dilation of esophageal structures

Should be referred to an allergist for food allergy testing.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Elimination diet

A

Elimination of the most common allergenic foods to decrease allergen exposure.

Food is reintroduced one at a time to look for reoccurrence of symptoms.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

EoE pharmacotherapy: Fluticasone

A 
Swallowed fluticasone (glucocorticoid) via MDI
Initial treatment for 6-8 weeks
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

EoE pharmacotherapy: Budesonide

A

Alternative to fluticasone, but is not a first line drug treatment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

EoE pharmacotherapy: PPI

A

Acid suppression can treat coexisting GERD so it may be worth trying for improvement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

EoE treatment: Dilation

A

Some patients (adults) with rings or strictures may require dilation if failed trial of fluticasone.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

EoE prognosis

A

Unclear due to lack of studies
No reports of increased risk of malignancy
Symptoms frequently recur from childhood into adulthood.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

GI disorders common signs and symptoms

A 
Dysphagia
Nausea and vomiting
Diarrhea or constipation
Abdominal pain
Acute GI bleeding
Occult GI bleeding
Jaundice
Abnormal liver chemistries
Ascites
Malnutrition
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Dysphagia

A

Difficulty swallowing or sensation of obstruction to the passage of food anywhere from the mouth to the stomach.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Odynophagia

A

Pain on swallowing

Can coexist with dysphagia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Globus

A

Constant sensation of a lump of fullness in the throat without difficulty swallowing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Aphagia

A

Inability to swallow
Can result in food bolus getting impacted in the esophagus; can result from pharyngeal muscle paralysis (due to neurologic issue)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Xerostomia

A

Dryness of the mouth from decreased salivation

Causes difficulty initiating swallow due to poor lubrication of food bolus.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What are the two types of dysphagia?

A

Oropharyngeal and esophageal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Oropharyngeal dysphagia

A

Difficulty with food from mouth to esophagus. Disorders typically affect the function of oropharynx, larynx, and upper esophageal sphincter.

Most commonly a neurological or muscle disorder.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Esophageal dysphagia types

A

Mechanical (structural): Something blocking the esophagus such as a tumor, stricture, or scar

Motility (propulsive): Food not being move forward properly such as with esophageal contractions or sphincter function.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Key questions to ask when evaluating dysphagia

A
  1. Is it actually dysphagia?
  2. At what level is the obstacle?
  3. Is dysphagia for solids, liquids, or both?
  4. Is it intermittent or progressive?
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Key questions to ask when evaluating dysphagia

A
  1. Is it actually dysphagia?
  2. At what level is the obstacle?
  3. Is dysphagia for solids, liquids, or both?
  4. Is it intermittent or progressive?
  5. Do you have associated symptoms?
  6. Do you have any other medical problems?
  7. Any hx of radiation?
  8. What medications are you taking now?
  9. Hx of prior surgery?
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Infectious esophagitis risk factors

A 
HIV/AIDS
Leukemia/lymphoma 
Solid organ transplant
Uncontrolled diabetes mellitus (DM)
Chronic systemic steroid use
(Immune compromised patients)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What is the most common cause of fungal esophagitis in HIV patients?

A

Candidiasis caused by candida albicans

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Fungal esophagitis clinical presentation

A

Dysphagia most common
Patients will often have oral thrush.
Oropharyngeal candidiasis in association with symptoms of esophagitis, such as pain or difficulty swallowing, is predictive of esophageal candidiasis
Odynophagia, fever, nausea, vomiting less common
Severity of these symptoms correlates with the degree of immunologic impairment.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Most common types of viral esophagitis?

A

HSV and CMV

34
Q

Viral esophagitis clinical presentation: CMV

A

Odynophagia and chest pain most common
Dysphagia uncommon
May also have low grade fever, nausea and vomiting
Can have involvement of the colon and retina

35
Q

Viral esophagitis clinical presentation: HSV

A

Both dysphagia and odynophagia most common as well as fever and continuous chest pain
Can also have herpes labialis (oral lesions)

36
Q

Bacterial esophagitis clinical presentation

A

Odynophagia, dysphagia, substernal chest pain
Painful or difficult swallowing may result in dehydration and weight loss
VS may reveal fever and orthostatic hypotension

This is rare in severely immune compromised patients.

37
Q

Bacterial esophagitis clinical presentation

A

Odynophagia, dysphagia, substernal chest pain
Painful or difficult swallowing may result in dehydration and weight loss
VS may reveal fever and orthostatic hypotension

This is rare in severely immune compromised patients.

38
Q

Infectious esophagitis diagnosis

A

WBC, CD4 count, EGD w/ biopsy

39
Q

Typical organisms with CD4 < 200

A

HSV, VZV

40
Q

Typical organisms with CD4 100-200

A

Candida, HSV

41
Q

Typical organisms with CD4 of 50-100

A

Candida, CMV, HSV

42
Q

Typical organisms with CD4 of 50-100

A

Candida, CMV, HSV

43
Q

EGD: Candidiasis

A

Multiple adherent, white or yellow lesions, “cottage cheese” plaques
Brushings or biopsy reveal yeast or budding hyphae

44
Q

EGD: HSV

A

Small, superficial ulcers

Cytology shows giant cells and ground-glass nuclei

45
Q

EGD: CMV

A

Large, well-demarcated, deep ulcers are visualized on gross examination
Immunohistochemical staining for CMV antigens are diagnostic

46
Q

EGD: VZV

A

Multiple vesicles and confluent ulcers

Immunohistochemistry or culture

47
Q

Esophagitis treatment: Candidiasis

A

Systemic antifungal agents - oral or intravenous (IV)

Oral fluconazole is treatment of choice

Refractory disease or azole resistant Candida:
Amphotericin B IV or Echinocandins (anidulafungin, caspofungin, micafungin) IV

HIV patients should be on HAART (may not improve without it)

48
Q

Esophagitis treatment: HSV or VSV

A

First line therapy - acyclovir IV or orally

Can also use ganciclovir, famciclovir, valacyclovir or foscarnet (Foscavir)

49
Q

Esophagitis treatment: CMV

A

Antiviral – IV ganciclovir (can cause neutropenia; use if patient is not pancytopenic)

Alternative - foscarnet IV (can cause renal failure, hypocalcemia, and hypomagnesemia)
~30% of patients relapse

*Typically these patients are more immune compromised and require IV treatment.

50
Q

Motility disorders

A

Patients usually have problems swallowing both liquids and solids from the onset

Can be peristalsis problem, sphincter problem, or both

Can involve both striated and smooth muscle of esophagus

Can be primary or secondary (associated with another disorder)

51
Q

Striated muscle motility disorder

A

Oropharyngeal dysphagia (problem with transfer of food bolus from mouth to esophagus). Voluntary muscle that initiates swallowing.

Causes – neurologic disease, trauma
Most common is stroke (CVA)
Other causes – myasthenia gravis, Parkinson’s, MS (multiple sclerosis), ALS (amyotrophic lateral sclerosis)

52
Q

Smooth muscle motility disorder

A

Involuntary muscle involved in swallowing.

Ex: achalasia (most common), diffuse esophageal spasm (DES), nutcracker esophagus, scleroderma (systemic sclerosis)

53
Q

Motility disorder clinical presentation

A

Dysphagia and chest pain in absence of obstruction

Diagnosis is based on imaging or motility testing

54
Q

Achalasia

A

Combination of a LES that does not relax and a noncontractile, aperistaltic distal esophagus.

Cause is idiopathic

55
Q

Achalasia clinical presentation

A

Pt presents with gradual, progressive dysphagia, chest pain, food regurgitation, and mild weight loss

Chest pain: retrosternal heartburn-like pain, associated with regurgitation and lasting <30 minutes OR episodic, spasm-like chest tightness that may radiate to the back, often at night

Regurgitate may be saliva and undigested food or may be acidic due to fermentation and acidification of undigested food in the esophagus

56
Q

Achalasia: Chagas disease

A

Protozoan disease commonly seen in Mexico, central, and south America.

57
Q

Pseudoachalasia

A

esophageal cancer, lung cancer, or metastatic disease may present with achalasia due to the effects of direct mechanical compression on the esophagus by a tumor mass or due to malignant invasion of the neural plexus (EGD).

58
Q

Achalasia: Diagnosis

A

Esophagogastroduodenoscopy (EGD) : R/O other disorders, eg, cancer, i.e. pseudoachalasia
No mucosal abnormalities

Barium swallow (barium esophagography): “Bird beak” appearing distal esophagus with proximal dilatation

Manometry (required for diagnosis)
Shows lack of peristalsis and increased LES tone (poorly relaxing), elevated LES post-swallow residual pressures
These findings are NOT found in GERD

59
Q

Achalasia: Treatment

A

Goal is to reduce the pressure gradient represented by the LES.

Preferred treatment is an endoscopic dilation of the LES.

Pharmacologic agents – nitrates, calcium channel blockers; not generally used

Surgical – myotomy (cut the LES muscle so that it stays open)
Botulinum toxin injection via EGD.

60
Q

Achalasia treatment risks

A

Patients who have received treatment for achalasia are at increased risk for GERD and its complications – any symptoms are controlled with usual GERD treatments

High risk of developing squamous cell CA due to chronic GERD symptoms. Attempt to control with PPI

61
Q

2 major varients of esophageal spasm

A
  1. Diffuse esophageal spasm

2. Hypertensive peristalsis

62
Q

Diffuse esophageal spasm

A

Simultaneous, uncoordinated or spastic peristaltic contractions in the distal esophagus.

Patients present with dysphagia, regurgitation, chest pain.

63
Q

Diffuse esophageal spasm diagnosis

A

Best diagnosed with manometry and barium swallow

EGD is typically normal.

64
Q

Nutcracker esophagus (hypertensive peristalsis)

A

Peristaltic contractions proceed in a coordinated manner but the amplitude is excessive (>180mmHg) and of long duration (>6 seconds).

Patients typically present with chest pain

65
Q

Nutcracker esophagus diagnosis

A

Best diagnosed with high-resolution manometry

Barium swallow and EGD typically normal.

66
Q

Scleroderma

A

Autoimmune/connective tissue disorder. Can cause severe pain and dysphagia.

Patients have problems with contractility (atonic esophagus) combined with LES remaining open resulting in chronic acid reflux and scarring.

67
Q

Scleroderma (& spastic disorder of the esophagus) treatment

A

Often treated with acid blockers - PPIs, nitrates, calcium channel blockers

Often difficult to treat

68
Q

What is the test of choice for esophageal dysphagia

A 
Upper endoscopy (EGD) 
Allows for direct visualization of the oropharynx, esophagus, stomach, and proximal duodenum.
69
Q

Barium swallow test

A

Alternate test
Useful if subtle strictures suspected
Pre-EGD to road map a tight/complicated stricture
Reveals structural esophageal abnormalities (e.g., tumors, webs, rings)
Motility disorders (e.g. achalasia, diffuse spasm, scleroderma) have typical findings but manometry required for definitive dx

70
Q

Esophageal manometry

A

When no structural or obstructive process found on upper endoscopy or barium swallow (esophagram)
Thin catheter is passed through nose, down esophagus, and past the LES
Pressure measurements taken for the entire length of the esophagus (plus UES and LES) – both at rest and during a swallow

71
Q

Common etiologies of mechanical disorders

A 
Diverticula
Schatzki rings
Esophageal webs
Strictures from inflammatory changes
Esophagitis
72
Q

Esophageal disorder: Diverticula

A

Pockets in esophageal wall in which food becomes trapped, making it hard to swallow.

They are classified by their location within the esophagus.

73
Q

Zenker’s diverticula

A

Outpouching of the posterior oropharynx just proximal to the upper esophageal sphincter.

74
Q

Esophageal Rings

A

Pathogenesis is not entirely known. Both can occur from chronic damage from GERD and congenital or developmental origin.

75
Q

Esophageal strictures

A

Any type of chronic inflammation that can can lead to narrowing or tightening of the esophagus.

76
Q

Peptic strictures

A

Typically related to prolonged reflux esophagitis.

Usually occurs in the distal esophagus just proximal to the squamocolumnar junction.

77
Q

Peptic stricture treatment

A

Aggressive acid control with high dose PPI.

Dilation is often required and is done via endoscopy. Less common surgery

78
Q

Schatzki rings or “steakhouse syndrome”

A

Another type of stricture that often occurs in the distal esophagus. Due to GERD, pill esophagitis, and most commonly hiatal hernias.

Can be associated with intermittent solid food dysphagia

79
Q

Schatzki ring treatment

A

For mild disease patient should chew food carefully.

Endoscopic dilation for more severe and possibly even surgery.

Treat with PPI if reflux symptoms are prominent.

80
Q

Plummer-Vinson Syndrome

A

Syndrome characterized by a triad of anemia, upper esophageal webs, and dysphagia. Most commonly seen in middle-aged women.

This is rare but does put the patient at risk for developing squamous cell CA.

81
Q

Esophageal strictures diagnostics

A

Labs are generally not helpful (unless CBC for plummer-vinson)

EGD for visualization as well as dilation therapy.

Barium swallow can be useful .

82
Q

Risk factors for medication-induced esophagitis

A

Supine patients
Swallowing pills with insufficient wter
Taking prior to bed
Increased esophageal transit time due to anatomic abnormalities.

Clin Med II (7 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions