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PANCE 2.0 > GI #5 > Flashcards

GI #5 Flashcards

1
Q

What is achalasia?

A

-Loss of peristalsis and failure of relaxation of the LES

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2
Q

What is the pathophysiology of Achalasia?

A

Idiopathic degeneration of Auerbach’s plexus leads to increased LES pressure and impaired LES relaxation

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3
Q

Symptoms of achalasia

A
  • Dysphagia to both solids and liquids at the same time
  • Weight loss
  • Malnutrition
  • Regurgitation of undigested food
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4
Q

What is the MOST accurate diagnostic for achalasia?

A

Manometry: increased LES pressure and lack of peristalsis

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5
Q

What is seen on a barium esophageal for achalasia?

A

-Bird’s beak appearance of LES (narrowing of LES) with proximal esophageal dilation and loss of peristalsis distally

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6
Q

What is performed in a patient with achalasia prior to initiating treatment to rule out esophageal SCC?

A

Endoscopy

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7
Q

How to manage a patient with achalasia?

A
  • Decrease LES pressure: Botulinum toxin, Nitrates, Surgery
  • Pneumatic dilation of LES
  • Esophagomyomectomy (definitive)
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8
Q

What is a Zenker’s Diverticulum?

A

Pharyngoesophageal pouch (false diverticulum) that only involves the mucosa and possibly submucosa

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9
Q

Zenker’s Diverticulum MC occurs in

A

Males in 70’s

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10
Q

What is the pathophysiology of Zenker’s Diverticulum?

A

Weakness at junction of Killian’s Triangle (between fibers of cricopharyngeal muscle and lower inferior pharyngeal constrictor muscle)

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11
Q

Symptoms of a Zenker Diverticulum

A
  • Dysphagia
  • Regurgitation of undigested food
  • Neck mass
  • Choking sensation
  • Halitosis (due to food retention in pouch)
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12
Q

What is the initial test of choice for a Zenker Diverticulum?

A

-Barium Esophagram with video fluoroscopy (collection of dye behind esophagus at pharyngoesophageal junction)

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13
Q

However, an ________ is usually performed for surgical evaluation for a Zenker

A

Upper endoscopy

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14
Q

Management for a Zenker Diverticulum

A

Observation if small and asymptomatic

Diverticulectomy if large or symptomatic

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15
Q

Explain distal (diffuse) esophageal spasms

A

-Severe, non-peristaltic esophageal contractions (uncoordinated contractions)

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16
Q

Symptoms of diffuse esophageal spasms

A
  • Stabbing, chest pain worse with hot or cold liquids

- Dysphagia to both solids and liquids

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17
Q

Definitive diagnostic for diffuse esophageal spasm

A

Manometry: increased simultaneous or premature contractions

18
Q

What is seen on esophagram with diffuse esophageal spasm

A

Corkscrew esophagus: severe, non-peristaltic contractions

19
Q

First-line treatment for diffuse esophageal spasms

A

-Anti-Spasmodics (CCB, Nitrates, TCAs)

20
Q

What are other treatment options for diffuse esophageal spasms?

A

-Botulinum toxin, Pneumatic dilation

21
Q

What is hyper contractile (jackhammer) esophagus

A

-Increased pressure during peristalsis

22
Q

What is another name for Jackhammer Esophagus?

A

-Nutcracker Esophagus

23
Q

Symptoms of jackhammer Esophagus

A
  • Dysphagia to both solids and liquids

- Chest pain, retrosternal

24
Q

Definitive diagnostic for jackhammer esophagus

A

Manometry: increased pressure during peristalsis

25
Q

What tests are usually normal in jackhammer esophagus?

A

Upper endoscopy and esophagram

26
Q

Treatment for hyper contractile esophagus

A

-CCB, Nitrates, Botulinum injection, TCA

27
Q

What is the difference in presentation between diffuse esophageal spasm and hypercontractile esophagus?

A
  • Diffuse: severe, non-peristaltic contractions

- Hypercontractile: increased pressure during peristalsis

28
Q

Boerhaave Syndrome (esophageal perforation) is a

A

Full thickness rupture most commonly affecting the left posterolateral wall of the lower esophagus

29
Q

What is the MC cause of Boerhaave Syndrome?

A

-Iatrogenic perforation during endoscopy

30
Q

But other causes of Boerhaave Syndrome include

A

-Repeated, forceful vomiting (Bulimia, alcoholism)

31
Q

Symptoms of Boerhaave Syndrome

A
  • Chest pain worse with breathing and swallowing
  • Vomiting
  • Hematemesis
  • Crepitus on auscultation
  • Hamman’s Sign: crackling accompanying every heart beat in left lateral decubitus position
32
Q

What is Hamman’s Sign?

A

Crackling associated with every heart beat in left lateral decubitus position

33
Q

What is the diagnostic test of choice for Boerhaave Syndrome?

A

Contrast esophagram: Gastrografin swallow preferred

34
Q

What does a CXR show in Boerhaave Syndrome?

A

Pseudomediastinum

35
Q

Treatment for Boerhaave Syndrome?

A

Small and stable: IVF, NPO, H2 receptor blockers, ABX

Large or severe: surgical repair

36
Q

What is a Mallory-Weiss Syndrome/Tear?

A

-Longitudinal superficial mucosal laceration at GEJ or gastric cardia

37
Q

What is the cause of a Mallory-Weiss Tear?

A

Sudden rise in intraabdominal pressure or gastric prolapse into the esophagus (persistent retching or vomiting after ETOH binge)

38
Q

Symptoms of a Mallory-Weiss Tear

A
  • Upper GI bleeding: hematemesis, melena, hematochezia, syncope
  • Abdominal pain, back pain
39
Q

What is the test of choice for a Mallory-Weiss Tear?

A

Upper endoscopy: shows superficial longitudinal mucosal erosions

40
Q

Treatment for Mallory-Weiss Tears (not actively bleeding vs severe bleeding)

A

Not actively bleeding: supportive, acid suppression with PPI

Severe bleeding: thermal coagulation, hemoclips, endoscopic band ligation, balloon tamponade

PANCE 2.0 (62 decks)

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