Brainscape's Knowledge GenomeTM

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


See full index

GI block > GI Goljan esophageal disorders > Flashcards

GI Goljan esophageal disorders Flashcards

1
Q

What are signs and Sx of esophageal disease?

A

heartburn;

dysphagia for solids and progressing to liquids

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

Dysphagia for solids alone is a symptom for what? give examples

A

obstructive lesion;

esophageal cancer, esophageal web, stricture

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

Dysphagia for solids and liquids is a Sx for what?

A

motility disorder

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

How do the 2 different types of dysphagia differ?

A

Oropharyngeal => striated muscle dysmotility

Lower esophageal dysphagia => smooth muscle dysmotility

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

Examples of orpharyngeal dysphagia

A

dermatomyositis; myasthenia gravis; stroke

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

examples of lower esophageal dysphagia

A

systemic sclerosis; CREST syndrome; achalasia

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

characteristics of TE fistula

A

proximal esophagus ends blindly;

distal esophagus arises from trachea (air in stomach leading to distention)

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

what are the 4 clinical findings w/ TE fistula?

A

maternal polyhydramnios (excess amniotic fluid);
abdominal distention in newborn;
difficulty w/ feeding;
VATER syndrome

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

Why is maternal polyhydramnios associated w/ TE fistula?

A

swallowed amniotic fluid cannot be reabsorbed in small intestine

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

Define VATER syndrome associated w/ TE fistula

A

vertebral abnormalities;
anal atresia;
TE fistula;
Renal disease and absent radius

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

What causes plummer-vinson syndrome? what are clinical signs and symptoms associated?

A

chronic Fe deficiency;
leukoplakia in oral mucosa and esophagus;
intermittent dysphagia for solids => esophageal web/stricture

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

Differentiate true vs false diverticulum

A

true=> outpouching lined by mucosa, submucosa, muscularis propria, adventitia
false=> weakness in underlying muscle wall and outpouching of mucosa & submucosa into area of weakness

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

Define Zenker’s diverticulum and area of weakness

A

false type in upper esophagus => weakness in cricopharyngeus muscle

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

clinical findings w/ zenker’s diverticulum

A

painful swallowing;
halitosis (entrapped food);
regurgitate food through mouth;
diverticulitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Tx for zenker’s diverticulum

A

surgery

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

Epidemiology of hiatal hernia

A

found in 50% of ppl over 50 w/ incidence increasing w/ age;

women > men

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

What are the 4 associations w/ hiatal hernia?

A

Sigmoid diverticulosis (25%);
esophagitis (25%);
duodenal ulcers (20%);
gallstones (18%)

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

define the most common hiatal hernia

A 
slideing hernia (99%);
herniation of proximal stomach into thoracic cavity through diaphragmatic esophageal hiatus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

clinical findings w/ hiatal hernia

A 
heartburn;
nocturnal epigastric distress from acid reflux;
hematemesis;
ulceration, stricture;
bowel sounds heard over Left lung base
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

nonpharm Tx of hiatal hernia

A

reduce intake of foods/drugs that decrease LES tone;
avoid large quantities of food;
sleep w/ head of bed elevated

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

What are examples that may decrease LES tone?

A

coffee, chocolate, Ca channel blockers

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

what are pharm Tx of hiatal hernias?

A

H2 antagonists;
Proton pump inhibitors;
prokinetic agents

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

Define paraesophageal or rolling hernia

A

GE jxn remains at level of diaphragm;

part of stomach bulges into thoracic cavity

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

Define pleuroperitoneal diaphragmatic hernias

A

present early in life;
visceral contents extend through posterolateral part of diaphragm on L into chest cavity causes respiratory distress at birth;
loops of bowel are present in left pleural cavity on radiograph

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

Epidemiology of GERD

A

10% adults have it daily;
80% of pregnant women;
hiatal hernia in 70% w/ GERD

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

Risk factors for GERD

A

smoking, alcohol;
caffein, fatty foods, chocolate;
pregnancy, obesity;
hiatal hernia

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

pathogenesis of GERD

A

transient relaxation of LES => reflux of acid and bile into distal esophagus;
ineffective esophageal clearance of reflux material

28
Q

Clinical findings of GERD

A 
noncardiac chest pain (heartburn, indigestion);
nocturnal cough, nocturnal asthma;
acid injury to enamel;
early satiety, abdominal fullness;
bloating w/ belching;
Barrett's esophagus
29
Q

What are the 3 Dx tests for GERD?

A

24hr esophageal pH monitoring;
esophageal endoscopy;
manometry (LES < 10mmHg)

30
Q

define a complication of GERD

A

Barrett’s esophagus => glandular metaplasia in distal esophagus due to acid injury => gastric columnar cells and goblet cells

31
Q

2 complications of barrett’s esophagus

A

ulceration w/ stricture formation (most common);

glandular dysplasia w/ increased risk for distal adenocarcinoma

32
Q

infectious esophagitis is a complication of AIDS. what are the 3 most common pathogens?

A

HSV (multinucleated squamous cells w/ intranuclear inclusions)
CMV (basophilic intranuclear inclusions)
Candida (yeasts and pseudohyphae)

33
Q

How does infectious esophagitis present?

A

painful swallowing (odynophagia)

34
Q

What happens w/ ingestion of strong alkali (lye) or acid (HCl)?

A

corrosive esophagitis

35
Q

complications of corrosive esophagitis

A

stricture formation;
perforation;
squamous cell carcinoma

36
Q

epidemiology and pathogenesis of esophageal varices

A

dilated submucosal left gastric veins => complication of portal HTN from cirrhosis

37
Q

most common cause of esophageal varices

A

alcohol abuse

38
Q

clinical findings of esophageal varices

A

rupture w/ massive hematemesis;

MOST COMMON CAUSE OF DEATH IN CIRRHOSIS

39
Q

what is the initial management of esophageal varices?

A

endoscopy (most important Dx procedure);
assess/maintain intravascular volume;
insert NG tube to confirm upper GI bleeding

40
Q

What is the prevention/treatment of esophageal varices from bleeding?

A

Beta blockers and isosorbide;
transjugular intrahepatic portasystemic stent (TIPS);
octreotide IV drip (somatostatin analogue) for bleeding;
endoscopic ligation and scleroTx;
open surgery w/ stapling

41
Q

Define Mallory-Weiss syndrome. what does it cause

A

mucosal tear in proximal stomach and distal esophagus from retching in alcoholics and bulimia => hematemesis

42
Q

Define Boerhaave’s syndrome. what causes it?

A

rupture of distal esophagus => causes are endoscopy, retching, bulimia

43
Q

Complications of Boerhave’s syndrome

A

Pneumomediastinum=> air dissects subQ into anterior mediastinum; crunching sound on auscultation
pleural effusion contains food, acid, amylase

44
Q

3 motor disorders of esophagus

A

systemic sclerosis;
CREST syndrome;
Achalasia

45
Q

epidemiology of achalasia

A

bimodal=> 20-40yr and again after 60yr;
men and women affected equally;
risk for esophageal cancer

46
Q

4 pathogenetic causes of achalasia

A

1) incomplete relaxation of LES;
2) destruction of ganglion cells in myenteric plexus;
3) dilation of esophagus prox to LES w/ absent peristalsis;
4) acquired cause is Chagas’s disease

47
Q

What causes destruciton og ganglion cells in myenteric plexus leading to achalasia?

A

AI destruction of myenteric plexus => HLA-DQw1 association

48
Q

What are the results of destruciton of ganglion cells in myenteric plexus?

A

decreases proximal smooth muscle contraction;

loss of NO synthase producing neurons leading to incomplete relaxation

49
Q

How does Chagas disease lead to achalasia?

A

dstruction of ganglion cells by amastigotes (lack flagella)

50
Q

clinical findings of achalasia

A 
nocturnal regurg of undigested food;
dysphagia for solids / liquids;
chest pain and heartburn;
frequent hiccups;
nocturnal cough from aspiration;
difficulty belching
51
Q

How is achalasia diagnosed?

A

abnormal barium swallow (dilated bird beak tapering at distal end);
abnormal esophageal manometry (detects aperistalsis and failure of LES relaxation)

52
Q

Nonpharm Tx of achalasia

A

pneumatic dilation; esophagomyotomy

53
Q

short term pharm Tx of achalasia

A

long acting nitrates;
CCB;
botox

54
Q

what is most common benign tumor of esophagus

A

leiomyoma

55
Q

What is the cause of the most common primary cancer of esophagus in US?

A

Barrett’s esophagus causes adenocarcinoma of distal esophagus

56
Q

What is the most common primary esophageal cancer of developing countries

A

squamous cell carcinoma

57
Q

Who is most likely to get squamous cell carcinoma of esophagus?

A

blacks > whites;

men > women

58
Q

Risks for squamous cell carcinoma of esophagus

A

smoking (most common);
alcohol abuse, lye strictures;
achalasia, plummer vinson syndrome

59
Q

most common locations of scc of esophagus

A

upper (15%)
middle (50%)
lower (35%)

60
Q

where does squamous cell carcinoma of esophagus spread?

A

local nodes 1st and then to liver and lungs

61
Q

clinical findings associated w/ squamous cell carcincoma

A 
dysphagia for solids initially;
weight loss of short duration;
painless enlargement supraclavicular nodes
dry cough and hemoptysis;
hoarseness;
odynophagia;
hypercalacemia
62
Q

What does dry cough and hemoptysis in squamous cell carcinoma suggest?

A

tracheal invasion

63
Q

Hoarseness in squamous cell carcinoma indicates what?

A

invasion of recurrent laryngeal nerve

64
Q

hypercalcemia in squamous cell carcinoma indicates what?

A

PTH related peptide similar to squamous cancer in lungs

65
Q

Px of squamous cell carcinoma of esophagus?

A

5yr survival is 13%

GI block (11 decks)

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