GI System Flashcards
What position is esophagogastroduodenoscopy performed most frequently?
left lateral decubitus
What are the respiratory complications of EGD?
desaturation, airway obstruction, laryngosapsm, aspiration
What is a major concern with colonoscopy?
Bowel prep – > high risk of dehydration
A barium contrast study can be used to demonstrate ___, ___,___, ___, and ____
esophageal reflux, hiatal hernia, ulcerations, erosions, strictures
What are the most common symptoms of esophageal diseae?
dysphagia, heart burn ,and regurgitation
____ is a symptom referring to difficulty swallowing.
dysphagia
Oropharyngeal dysphagia is commonly seen after what type of surgery?
Head and neck
What conditions are associated with oropharyngeal dysphagia?
stroke and Parkinson’s
Dysphagia only for solid foods indicates what kind of disorder?
Structural
Dysphagia for both liquids and solids indicates what kind of disorder?
motility
_____ is a symptom described as burning or discomfort behind the sternum, possilby readiating to the neck.
heartburn
_____ refers to the effortless return of gastric contents into the pharynx without hte nausea or retching that would be experienced with vomiting.
Regurgitation
What is odynophagia?
Pain with swallowing
What is Achalaisa?
A NM disorder consisting of esophageal outflow obstruction caused by inadequate relaxation of the LES and a dilated hypomotile esophagus
What are the s/s of achalasia?
dysphagia w/ both liquids and solids, regurgitation, heratburn, and chest pain
What disease is associated with an increased risk of esophageal cancer?
Achalasia
What is a common complication of achalasia?
pulmonary aspiration
How is achalasia diagnosed?
By esophagram
A “birds beak” appearance is associated with waht?
Achalasia
T/F: Treatment for achalasia relieves the obsturction and corrects the peristaltic deficiency of the esophagus.
False - all treatments are palliative. They relieve the obstruction but cannot correct the peristaltic deficiency of the esophagus
What two medications can be used ot try to relax the LES with Achalasia?
Nitrates and CCB
What are invasive treatments for Achalasia?
Endoscopic botulinum toxin injection, pneumatic dilation, lap Heller myotomy, per oral endoscopic myotomy
Are those with achalasia considered full stomachs?
Yes
In what disease does the dilated esophagus retain food for many days?
Achalasia - therefore the duration of fasting is meaningless
In what patient population does distal esophageal spasm typically occur?
eldelry patients
What causes distal esophageal spasm?
ANS dysfunction
What does an esophagram show in a patient with distal esophageal spasm?
Corkscrew or rosary bead esophagus
pain produced by distal esophageal spasm can sometimes mimic _____
angina pectoris
What medications reduce pain associated with distal esophageal spasm?
Nitroglycerin, Traxodone and Imipramine (both antidepressants), and Sildenafil (phosphodiesterase inhibitor)
What are esophgeal diverticular?
Outpouching of the wall of hte esophagus
What location does Zenker’s diverticulum occur?
pharyngoesophageal, mideosphageal, or epiphrenic?
Pharyngoesophageal
What S/S occur with small-medium sized Zenker’s diverticula?
asymptomatic
_____ appears in a natural zone of weakness in the posterior hypopharyngeal wall and can cause significant bad breath from retention of food.
Zenker’s diverticulum
T/F: Zenker’s diverticular can comrpess the esophagus.
True - if they become large and filled with fluid… this leads to dysphagia
How is anesthesia induced in esophageal diverticula?
Head-up position WITHOUT cricoid pressure
(b/c cricoiod pressure reducing the risk of aspiration during RSI is doubtful in this case)
T/F: An NGT is used to decompress esophagus and abomdne after induction in esophageal diverticula?
False - insertion of a NGT is avoided b/c it can perf the diverticulum
A _____ is a herniation of part of the stomach into the thoracic cvity through the _______ in the diaphragm.
hiatal hernia; esophageal hiatus
How does esophageal cancer present?
With progressive dysphagis to solid food and weight loss
What are post-op complications of esophagectomy
ARDS, anastomotic leaks, dumping syndrome, esophageal stricture
What risk persists for life after esophagectomy?
Significant risk of aspiration
What are the most common S/S of GERD?
heratburn and regurgitaiton
What are natural antireflux mechanisms? (3)
- LES
- crural diaphragm
- anatomic location of the GE junction below the diaphgramatic hiatus
At rest, the ___ exerts a high pressure that prevents gastric contents from entering esophagus.
LES
What is the average resting tone of the LES in patients wtihout GERD?
29 mmHg
What is the average resting tone of the LES in patients with GERD?
13 mmHg
What are 3 common physiologic causes of GERD?
- transient LES relaxation
- LES hypotension
- anatomic distortion of the GE junction
What is therapy for GERD?
lifestyle modificaiton
What foods should be avoided with GERD?
Ones that reduce LES tone (fatty & fried, alcohol, peppermint, chocolate) and acidic foods (citrus and tomato)
Which is more effective for GERD to inhibit gastric acid secretion: PPI or H2 blockers?
PPI
What is a surgical option for severe GERD?
Nissen fundoplication
Cimetidine effect begins in _____
1-1.5 hours
What are the MOA of cimetidine and ranitidine?
decrease gastric acid secretion and increase gastric pH
What isthe DOA of cimetidine?
3 hour
Is ranitidine or cimetidine more potent?
Ranitdine
