GI Esophageal + Gastric Disease Flashcards
1
Q
Dyshagia
A
sensation of impaired passage of food or liquids from mouth to stomach
oropharyngeal
esophageal
2
Q
Odynophagia
A
painful swallowing
Typically represents a severe inflammatory process
3
Q
Oropharyngeal dysphagia
A
difficulty transferring food from mouth to the upper esophagus sphincter
typically mucosal disruption
4
Q
Esophageal dysphagia
A
difficulty with the passage of ingested material form the hypopharynx to the stomach
5
Q
Causes of Oropharyngeal dysphagia
A
Neurologic: CVAs (brainstem), Parkinsons
Anatomic: neoplasma, Zenker’s Diverticulum
6
Q
Causes of Esophageal dysphagia
A
Neurologic: diffuse esophageal spasm, Achalasia
Autoimmune disorder: Scleroderma
Obstructive lesions: strictures, rings/webs, carcinoma
7
Q
What are common esophageal symptoms
A
Chest pain
Dysphagia
Odynophagia
8
Q
Zenker’s Diverticula
A
diverticulum in the esophagus that can retain food and cause a ton of problems
needs surgery
9
Q
What age group presents with Zenker’s diverticula?
A
> 50 years old
10
Q
What is the treatment for Zenker’s Diverticula
A
surgery
11
Q
Achalasia
A
nerves in the esophagus get damaged, making it difficult for food and liquid to pass into the stomach
leads to dilated esophagus
cause is unknown
insidious onset
12
Q
Achalasia triad
A
increased LES resting pressure
inability of the LES to relax
absence of peristalsis in body of the esophagus
13
Q
What is the treatment for achalasia?
A
medications: nitrates, CCB
BoTox injection
Endoscopic pneumatic dilation
surgical intervention
14
Q
Schatzki’s ring
A
ring of mucosal issue in the distal esophagus which can cause narrowing and dysphagia
15
Q
Eosinophilic Esophagitis
A
allergic inflammatory condition
eosinophilic infiltration of mucosa
typically presents with dysphagia and food impaction
16
Q
Epi of eosinophilic esophagitis
A
child and adults
M > F
17
Q
What is the treatment for eosinophilic esophagitis?
A
dietary modification
topical (inhaled) and oral steroids
dilation with stricture
18
Q
Who is more likely to get esophageal infections?
A
immunocompromised
19
Q
What is the most common symptom for esophageal infections
A
odynophagia
20
Q
What is the most common infection of the esophagus?
A
candidiasis
herpes and CMV can also infect
21
Q
Risk factors for medication -induced esophagitis?
A
don't drink enough fluids with drugs supine after taking medications pre-existing swallowing disorders decreased salivation anatomic abnormalities
22
Q
What drugs are most common for causing drug induced esophagitis?
A
doxycycline iron potassium vitamin C aspirin NSAIDs alendronate
23
Q
Common abnormalities seen with GERD?
A
LES incompetence
hiatal hernia
increased intra-abdominal pressure
24
Q
Common clinical presentations of GERD?
A
substernal discomfort throat discomfort hoarseness coughing wheezing gingivitis
25
How do you dx GERD?
typical sxs without alarm signs require no specific investigations (unless concern of cardiac disease)
studies:
- barium study
- pH monitoring
- endoscopy
- esophageal manometry
- radionuclide scanning
26
What are the common sxs of esophageal spasm?
chest pain
| dysphagia
27
What are the alarm sxs of GERD?
dysphasia
odynophagia
weight loss
anemia
28
Barrett's Epithelium
```
10% of pts with GERD have this
asymptomatic
M > F
RISK OF GETTING CA
Risk of adenocarcinoma is 40X greater than the general population
```
29
Who gets an endoscopy in regards to GERD?
- pts with 5 year hx of uncontrolled GERD
- pts >45 years with new dx of GERD
- alarm sxs
WHY?
concerned about them having Barrett's epithelium and thus a 40X great risk of adenocarcinoma
30
What are the 2 types of esophageal cancer and who gets them?
SCC (EtOH, smoking)
| Adenocarcinoma (comes from Barrett's)
31
What is the treatment for esophageal cancer?
Surgery is the only option
5 year survival is 5-10%
32
Which meds are really important to ask about when evaluating for PUD?
NSAIDs
steroids
anticoags/antiplatelets
33
What is the gold standard for dx PUD?
endoscopy
EGD - esophagogastroduodenoscopy
34
What are risk factors for PUD?
```
ASA/NSAIDs
H. pylori infection
acid hypersecretory state
anticoagulation
chronic disease that might disrupt the mucosal blood flow (CV, cirrhosis, etc)
hospitalization, ventilation
```
35
What are the sxs of PUD?
```
Epigastric pain (MC --seen in 80 - 90% of pts)
N/V
Anorexia
Melena
Hematemesis
Weight loss
```
36
Where are PUD most common?
5x more common in the duodenum
if in the stomach, benign ulcers are located most commonly in the antrum
37
____% of regular NSAID users will get PUD?
10-20%
50% have gastric erosions
38
Not everyone taking NSAIDs gets ulcers, what are the risk factors of taking NSAIDs progressing to ulcers?
```
hx of GI complications
older age
anitcoag use
steroid use
higher dosage
```
39
H. Pylori
gram NEGATIVE rod
Infects GI tract —-leads to immune response and inflammation —-produces urease which reacts with urea to form ammonia —-ammonia is what directly breaks down intestinal mucosa
40
What are the risk factors for H. Pylori?
Low socioeconomic status
elderly and childhood
minority groups
immigrant populations
41
How can you test for H. Pylori?
Urea breath test
stool antigen
gastric biopsy
serology (hardly ever used)
42
What is the treatment for H. Pylori?
Triple therapy
2 ABX for 2 weeks (Clarithromycin and Amoxicillin)
PPI
be sure to check stool after treatment for eradication
43
How effective are PPIs wit ulcers?
90% of duodenal ulcers heal after 4 weeks
| 90% of gastric ulcers heal after 8 weeks
44
H2 blockers
used in PUD
block histamine --which is used in acid production
```
rapid onset (<1hour)
take longer to heal compared to PPIs
```
not used as commonly these days
45
Zollinger-Ellison Syndrome
makes up 0.1-1% of all pts with duodenal ulcers
46
What are the sxs of gastritis and duodenitis?
```
anorexia
epigastric pain
GI bleeding
nausea
vomiting
```
47
What do you see on endoscopy for gastritis?
subepithelial hemorrhages
petechiae
erosions
48
What causes erosive gastritis?
```
medications (NSAIDs)
EtOH
stress
portal HTN (liver dz or cirrhosis)
Ischemia
Caustic ingestion
Radiation
```
49
What causes non-erosive gastritis?
H. Pylori
Pernicious anemia
esopinophilic gastritis
50
What causes specific gastritis?
infections (necrotizing)
Menetrier disease
Granulomatous (Crohns, sarcoid)
51
Gastroparesis
motility of the stomach is either abnormal or absent
stomach is unable to contract normally, and therefore cannot crush food nor propel food into the small intestine
52
What are sxs of gastroparesis?
```
bloating
N/V
early satiety
epigastric pain
regurg of undigested food
weight loss
```
53
Bezoar
undigested food in the stomach that has to be removed
| in pts with gastroparesis
54
How do you dx gastroparesis?
EGD (upper endoscopy)
| gastric emptying test
55
Who gets gastroparesis?
```
DM
infections
endocrine disorders
Meds (benzos, CCB, narcotics)
Easting disorders
```
56
What is the treatment for gastroparesis?
diet (small, frequent meals)
avoid high fiber (stays in the stomach longer)
feeding tube
anti-emetics
Metoclopramide (reglan) BBW --crosses BBB
Domperidone (not available in the US)
Erythromycin (acts on motilin)
surgery
57
Can you tell the difference between cardiac disease and esophageal disease?
No!
They mimic one another
```
Squeezing chest pain
Localized or radiate
May be triggered by cold or hot substances (this is the only one that might be the difference between the two)
Not always triggered by swallowing
Can awaken you from sleep
```
58
A pt comes in complaining of a lump on his neck that only appears after he eats, making it difficult to swallow, however if he presses on the lump he can swallow easier. He comes to you today because he woke up this morning with last nights dinner on his pillow. What do you think this guys has?
Zenker’s diverticula
False diverticula of the esophagus that can be large enough it retains food and compresses the actually esophagus
- fullness or gurgling in the neck
- coughing, aspiration
- regurgitation of retained food
- obstructive sxs by compression
59
On X-ray with contrast you see clear bilateral notches on the esophagus, what do you suspect?
Schatzki’s ring
60
How does an esophageal infection from herpes differ than CMV on scope?
Herpes typically coalesce and cause ulcerations
| CMV is classic small solitary ulcer
61
Are you more likely to see odynophagia or dysphagia with medication inducted esophagitis?
Odynophagia
62
Esophageal spasm
(Aka nutcracker esophagus?)
Altered peristalsis that prevents the food from moving effectively down into the stomach
Presents with chest pain and dysphagia
Must distinguish from cardiac disease
63
Who gets GERD?
Males and females
60% of adults >65 y/o have monthly sxs
64
What is GERD?
Reflux of gastric contents into the esophagus —-primary offending agent is acid
65
What are complications of GERD?
```
Bleeding
Stricture
Ulceration
Barret’s epithelium
Adenocarcinoma
```
66
What is the primary role of endoscopy with GERD?
Determine:
- presence of tissue injury
- presence of barrett’s epithelium
- etiology of dysphagia
- evidence of bleeding
67
Bravo Capsule
A dx test of pH monitoring for GERD
| Placed 5cm above the LES
68
What dietary modifications should a pt with GERD be on?
Small volume meals
Low fat diet
Avoidance of precipitating factors
Avoid recumbency after eating
Avoid medications which decrease LES pressure
69
What types of medications are available for pts with GERD?
```
Antacids (neutralization)
Acid suppression
-H2 receptor antagonists
-PPI
Prokinetic agents
-metachlopromide (reglan)
```
70
What surgery options are there for pts with GERD?
Anti-reflux surgery reserved for recalcitrant sxs and complications
- <5% require surgical intervention
- 2-8% morbidity, <1% mortality
Open v s laparoscopic procedures
71
Esophageal SCC affects which part of the esophagus?
Top 1/3
72
Adenocarcinoma of the esophagus affects which part of the esophagus?
Lower 1/3
73
What is the most common cause of acute upper hemorrhage?
PUD
74
What is the most common sx seen with PUD?
Epigastric pain
75
What is the most common cause of gastroduodenal injury in the US?
NSAIDS
Can affect any portion of the GI tract at any dose
76
What medications do you give prior to endoscopy?
IV PPI
Why? To suppress acid, facilitate clot formation and stabilization
Duration: at least until EGD, and then based on findings
77
How do you control acute ulcer bleeding?
Pt gets admitted to hospital
Given PPI IV prior to endoscopy (EGD)
Early endoscopy (within 24hr) is the most effective way to control acute ulcer bleeding
Endoscopic hemostasis starts with injection of saline or epi or ethanol
If that fails move to cautery methods and if that fails move to mechanical therapy such as clips or banding
78
What is coaptive coagulation?
Direct pressure and thermal therapy
| Used with injection therapy for PUD endoscopy treatment of a bleeding ulcer
79
When do we move to surgical therapy for PUD?
If our attempts to stop bleeding endoscopically have failed
We don’t typically get to this phase
80
What is the post-endoscopy management for pts who had bleeding ulcers?
PPI IV x 72 hours
81
How do PPIs work?
Bind the acid-secreting enzyme H+ K+ ATPase or “proton pump” permanently inactivating it
Inhibits >90% of 24 hour acid secretion
82
For pts who are normally on baby aspirin for CV disease but have presented with bleeding ulcer, what do you do?
Stop the aspirin until bleeding is resolved, then restart them on aspirin
83
What is the treatment for Zollinger-Ellison Syndrome?
High dose PPI
| Removal of tumor
