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PANCE 2.0 > GI #4 > Flashcards

GI #4 Flashcards

1
Q

Infectious esophagitis MC occurs in those with _______, but can occur in healthy individuals as well

A

Immunocompromised states (HIV, post-transplant, malignancy, chemotherapy)

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2
Q

MCC of infectious esophagitis

A

Candida

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3
Q

Clinical manifestations of infectious esophagitis (triad of symptoms)

A
  • Odynophagia
  • Dysphagia
  • Retrosternal chest pain
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4
Q

On endoscopy for Candida infectious esophagitis, what is expected to be seen?

A

-linear yellow-white plaques

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5
Q

First-line treatment for Candida infectious esophagitis

A
  • PO Fluconazole

- 2nd line options: Voriconazole, Caspofungin

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6
Q

On endoscopy for CMV infectious esophagitis, what is expected to be seen?

A

-Large, superficial shallow ulcers

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7
Q

What is the first-line treatment for CMV infectious esophagitis?

A

Ganciclovir

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8
Q

What is expected to be seen on endoscopy for HSV esophagitis?

A

small, deep ulcers

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9
Q

What is the first-line treatment for HSV esophagitis?

A

Acyclovir

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10
Q

Eosinophilic esophagitis is MC seen in…

A

Children and associated with atopic disease (asthma, eczema, etc.)

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11
Q

Symptoms of eosinophilic esophagitis

A

Dysphagia (solids), Odynophagia, Reflux or feeding problems in kids

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12
Q

What is seen on endoscopy for eosinophilic esophagitis?

A

-Normal or multiple corrugated rings, white exudates

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13
Q

Management for eosinophilic esophagitis

A
  • Remove foods that incite allergic response
  • PPIs may be needed in some
  • Inhaled topical corticosteroids WITHOUT a spacer to allow penetration
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14
Q

What medications MC cause pill-induced esophagitis?

A
  • NSAIDs
  • Bisphosphonates
  • BB, CCB
  • Iron Pills
  • Vitamin C
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15
Q

How do you manage pill-induced esophagitis?

A
  • Take pills with at least 4 ounces of water

- Avoid laying down 30-60 minutes after pill ingestion

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16
Q

What is caustic (corrosive) esophagitis from?

A

-Ingestion of corrosive substances: alkali (drain cleaner, bleach) or acids

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17
Q

Management of caustic (corrosive) esophagitis

A
  • Supportive
  • Pain medications
  • IVF
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18
Q

MC type of hiatal hernia

A

Sliding (Type I): GE junction slides into mediastinum (increases reflux)

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19
Q

MC type of hiatal hernia

A

Sliding (Type I): GE junction slides into mediastinum (increases reflux)Wh

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20
Q

A paraesophageal hiatal hernia (rolling hernia), occurs when

A

the fundus of the stomach protrudes through diaphragm with the GE junction remaining in anatomic location

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21
Q

Symptoms of a hiatal hernia

A
  • Postprandial fullness (prolonged persistence of food in stomach)
  • May be asymptomatic
  • May have intermittent epigastric pain
  • Nausea, vomiting
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22
Q

Treatment for sliding hernia

A

-Management of GERD + PPI + Weight loss

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23
Q

Treatment for paraesophageal hernia

A

-Surgical repair if complications (volvulus, strangulation, bleeding)

24
Q

What is an esophageal atresia?

A

Complete absence or closure of a portion of the esophagus (associated with tracheoesophageal fistula, polyhydramnios)

25
Q

Symptoms of esophageal atresia

A

-Presents immediately after birth with excessive oral secretions that lead to choking, drooling, inability to feed, respiratory distress, and coughing

26
Q

How to diagnose esophageal atresia?

A
  • Inability to pass NG tube further than 10-15 cm (coiling in esophagus)
  • Fluoroscopy: water-soluble contrast may help visualize it
27
Q

How to treat esophageal atresia

A

-Surgical ligation of fistula

28
Q

GERD is due to an

A

Incompetent lower esophageal sphincter

29
Q

What is the pathophysiology of GERD

A

-Transient relaxation of LES (incompetency) –> gastric acid reflux –> esophageal mucosal injury

30
Q

Typical Symptoms of GERD

A
  • Heartburn (Pyrosis): increased with supine position
  • Sour taste in mouth
  • Cough
  • Sore Throat
  • Regurgitation
31
Q

Alarm Symptoms of GERD

A
  • Dysphagia
  • Odynophagia
  • Weight loss
  • Bleeding
32
Q

4 main complications from GERD may present with alarm symptoms

A
  • Esophagitis
  • Stricture
  • Barrett’s Esophagus
  • Esophageal Adenocarcinoma
33
Q

Although GERD is a clinical diagnosis based on history if presenting with classic, typical symptoms, what is the GOLD standard if confirmation is needed?

A

-24-hour ambulatory pH monitoring

34
Q

What does an esophageal manometry show if the patient has GERD?

A

Decreased LES pressure

35
Q

If the patient has persistent symptoms or alarm symptoms, what diagnostic should be done?

A

Endoscopy

36
Q

Management for early or Stage 1 GERD

A

-Lifestyle modifications: elevate head of bed, avoid laying down for 3 hours after eating, smoking cessation, decreased alcohol intake, avoid chocolate/peppermint/caffeine/spicy foods, weight loss

37
Q

Management for Stage 2 GERD ( < 2 episodes per week)

A

Antacids and H2 receptor antagonists

38
Q

Management for Stage 3 GERD ( 2 or more episodes per week)

A

PPI

39
Q

If the GERD is medication-refractory, what is the treatment?

A

Nissen fundoplication

40
Q

Name some H2 receptor antagonists

A
  • Famotidine (Pepcid)
  • Cemetidine (Tagamet)
  • Nizatidine
41
Q

Name some PPI

A
  • Omeprazole
  • Pantoprazole
  • Rabeprazole
42
Q

Mechanism of action of PPI

A

-block gastric acid secretion by irreversibly binding to and inhibiting the hydrogen-potassium ATPase pump that resides on the luminal surface of the parietal cell membrane

43
Q

What is Barrett’s Esophagus?

A

-Esophageal squamous epithelium replaced by precancerous metaplastic columnar cells from cardia of stomach (complication of long-standing GERD)

44
Q

How to diagnose Barrett’s Esophagus

A

-Upper endoscopy with biopsy

45
Q

Recommendations for treatment based on findings of upper endoscopy with Barrett’s Esophagus…

A
  • Barrett’s Esophagus only (metaplasia): PPI and rescope every 3-5 years
  • Low-grade dysplasia: PPI and rescope every 6-12 months
  • High-grade dysplasia: Ablation with endoscopy, radio frequency ablation
46
Q

What type of esophageal neoplasms is the MC in the US?

A

Adenocarcinoma

47
Q

Adenocarcinoma of the esophagus is common in ______ and is MC in what area of the esophagus?

A

Caucasian males

-Distal esophagus, esophagogastric junction

48
Q

What type of esophageal neoplasm is the MCC worldwide?

A

Squamous cell

49
Q

Squamous cell esophageal cancer is MC in _____ and is most common in what area of the esophagus

A
  • African-Americans

- Mid to upper third of esophagus

50
Q

Risk factors for Adenocarcinoma of the esophagus

A
  • Barrett’s Esophagus
  • Smoking
  • High body mass index
51
Q

Risk factors for Squamous Cell Carcinoma of the Esophagus

A
  • Smoking
  • Alcohol
  • Poor Nutritional status
  • Drinking beverages at high temperatures
  • HPV infection
  • Achlasia
52
Q

What are two protective factors for esophageal neoplasms?

A

-Aspirin or NSAIDs

53
Q

What are some symptoms of esophageal neoplasms?

A
  • Progressive dysphagia (solid food progressing to fluids)
  • Odynophagia
  • Weight loss, anorexia
  • Iron deficiency anemia (chronic blood loss)
  • Hoarseness (recurrent laryngeal nerve)
  • Horner’s Syndrome
54
Q

What is the diagnostic study of choice for Esophageal neoplasms?

A

-Upper endoscopy with biopsy

55
Q

What is the preferred method for pretreatment staging for esophageal neoplasms?

A

Endoscopic US

56
Q

Treatment for esophageal neoplasms

A
  • Esophageal resection with chemotherapy

- Palliative stenting to improve dysphagia

PANCE 2.0 (62 decks)

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