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clin med > intro & Esophageal disorders > Flashcards

intro & Esophageal disorders Flashcards

1
Q

Abd pain is a ____ not a _____

A

symptom, not a Dx

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2
Q

not all abd pain is of ____ origin

A

GI

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3
Q

Abdominal pain, if there area no alarm signs, what can you do?

A

its ok to watch and wait

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4
Q

4 common features in GI disorders

A

dysphagia (difficulty swallowing)
odynophagia (pain with swallowing)
regurgitation
heartburn-pyrosis (reflux)

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5
Q

older pt with new swallowing/heartburn complaint.. think?

A

RED FLAG

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6
Q

what SHOULD be gold standard test for esophageal disorders?

A

EGD (aka upper endoscopy)

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7
Q

who do you refer to for pharynx/swallowing problems?

A

ENT and/or speech pathology

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8
Q

are the sphincters of the esophagus true sphincters?

A

NO

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9
Q

physiological reflux is common, ____ and ____. what is usually the presenting symptom? what does the pathology include?

A

physiological reflux is common, short lived, and asymptomatic.
heartburn is usually the presenting symptoms to pathologic reflux.
-pathology includes symptoms (including nocturnal)

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10
Q

what percent of healthy people experience heartburn at least once a month? what percent develop mucosal damage?

A

44%

50%

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11
Q

GERD red flags/ alarm symptoms (5)

A

anemia, chest pain (not burning) , dysphagia, hematemesis, weight loss
*any chronic symptoms of GERD are bad

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12
Q

how can GERD cause asthma exacerbation?

A

microaspiration

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13
Q

cause of GERD

A

too much acid or poor LES (lower esophageal sphincter) function
-both show the same symptoms

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14
Q

GERD Dx: pursue a Dx eval if…

A

symptoms are chronic, refractory or if there are alarm symptoms

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15
Q

4 types of GERD Dx tests (2 major 2 minor)

A

major: endoscopy and ambulatory pH monitoring
minor: esophageal manometry (LES pressure)
and barium swallow

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16
Q

technical gold standard Dx test for GERD (and what is the one more commonly used?)

A

technically: pH ambulatory monitoring
real: EGD

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17
Q

what is pH ambulatory monitoring and who is it good for?

A

Useful in Pts who have not benefited from a trial of anti-secretory meds or have refractory problems, or has a normal endoscopy and cont’d symptoms.

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18
Q

results from both EGD nor pH monitoring …

A

do NOT correlate well with severity of symptoms

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19
Q

early/mild esophagitis vs erosive/severe

A

early: reddened
severe: has gone into submucosa

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20
Q

Goals for GERD txt

A

prevent reflux, lower acid secretion, prevent complications of esophagitis

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21
Q

txt for GERD

A 
lifestyle modifications (diet, elevate bed with blocks)
neutralize acid with meds (antacid, PPI, H2 blocker)
surgery (fundoplication)
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22
Q

what is a Nissen fundoplication?

A

fold fundus of stomach and wrap around esophagus to prevent reflux (increase pressure)

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23
Q

antacids ____ but do not _____ acids.

A

neutralize but do not suppress

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24
Q

what are the antacids? antacids should be taken when?

A

Mg++, Al++, Ca++ salts

immediately after meals (when you have symptoms)

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25
Q

two drugs to help reflux, second-line to antacids.

A

H2 blockers

PPI (preferred)

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26
Q

what do H2 blockers do for GERD?

A

block production of acid by gastric parietal cells

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27
Q

when are PPIs taken?

A

before you eat (this is when the enzyme works best)

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28
Q

one downside to PPIs?

A

inc risk for infection cause its taking away the acid that normally neutralizes bacteria that comes with food.

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29
Q

___ have good healing action for ulcers (GERD)

A

PPIs

30
Q

which GERD medication has diagnostic value? how is this applicable?

A

PPIs
take PPI (trial for a month) and symptoms go away…
and stay gone w/ discontinuance : mild problem
and come back w/ discontinuance : maybe something worse (peptic ulcer disease, stomach cancer, etc)

31
Q

how do you take PPIs? efficacy between PPIs? usual starting dose?

A

step-up and step-down approach, taken before meals, no difference in efficacy among the PPIs

OTC omeprazole 20 mg qd is usual starting dose.

32
Q

for severe disease, give PPIs …

A

BID for 2-4 weeks then qd
8-12 weeks
most will relapse at discontinuance w/out lifestyle modification

33
Q

GERD complications: 4

A

esophageal stricture, esophageal ulceration, hemorrhage, barrett esophagus

34
Q

what is barretts esophagus?

A

longterm acid exposure predisposes for adenocarcinoma

  • metaplastic columnar epithelial cells replace squamous epithelium
  • not a Cancer but neoplastic changes that inc. the risk for cancer
35
Q

barretts esophagus presents in __% of people with longterm GERD

A

10

36
Q

when to use endoscopy for barrett’s?

A

to ID barett:
screening after 5 years w/longstanding reflux
periodic re-assessment

37
Q

txt for barrett’s

A

resection of that part of the esophagus (b/c does not get better with acid suppression, neoplastic change has already occurred)

38
Q

what is a haital hernia? symptomatic?

A

protrusion of portion of the stomach through the haitus of the diaphragm into the thoracic cavity
- usually asymptomatic

39
Q

if you have ___ and ____, GERD symptoms are usually worse

A

hiatal hernia and reflux

40
Q

what is achalasia?

A

esophageal motality disorder, absence of peristalsis in lower 1/2 of esophagus (LES failure)

  • leads to progressive dysphagia, regurg, spasm
  • weight loss and halitosis (b/c food gets trapped)
41
Q

best for Dx of achalasia?

A

barium swallow- dilated tapering to “birds beak” appearance of esophagus

42
Q

txt for achalasia?

A

balloon dilation of LES
Ca++ channel blockers or botox (block hyper-reactive smooth muscle reaction)
myotomy (cuts in muscle)

43
Q

smooth muscle spastic disorder: what is it? what does it feel like? symptoms are progressive or intermittent?

A

diffuse esophageal spasm
feels like “non-cardiac chest pain”
dysphagia w/ non-coordinated contractions
sympt: intermittent

44
Q

txt for smooth muscle spastic disorder

A

nitroglycerine (same as for angina)

also Ca++ blocker and anti-depressants

45
Q

what is scleroderma?

A

subQ tissue becomes progressively calcified and stiffened.

  • peristalsis wave defect
  • reduced LES pressure
46
Q

what % of patients with scleroderma have GI issues?

A

90%

47
Q

txt for scleroderma?

A

depends on symptoms (txt with reflux or motility medications)

48
Q

pill-induced esophagitis: what is it and what pills usually cause it?

A

caused by delayed transit time in esophagus
ASA, NSAIDS, Ferrus Sulfate,
Tetracyclines*** (alendronate/fosamax)

49
Q

caustic esophagitis

A

strong alkali and acids (drano, lye, bleach)

  • alkali injury generally worse than acid
  • can lead to death, strictures, etc.
50
Q

txt for caustic esophagitis

A

IV H2 blockers
NG tube
(don’t try to neutralize, just flush out)

51
Q

eosinophilic esophagitis: what is it and how does it present?

A

allergy in esophagus

- almost always present with dysphagia/regurg/food impaction with GERD-like complaints

52
Q

who gets eosinophilic esophagitis?

A

men>women, often presents in children, STRONG FH, with atopy (eczema, asthma, allergies)

53
Q

txt: eosinophilia esoph. on Bx responds to ___ better than _____. But how will we txt?

A

steroids better than PPIs

but… txt with PPIs then topical ICS if poor response (swallow the spray!)

54
Q

only test of cure for eosinophilia esoph. is what?

A

re-biopsy, so we often just txt symptoms

55
Q

infectious esophagitis, commonly seen in what people? common pathogens?

A

immunosuppressed patients

Herpes, Candida, CMV

56
Q

symptoms for infectious esoph.

A

dysphagia and odynophagia (very painful)

57
Q

txt for infectous esoph.

A

txt underlying condition, appropriate anti-infectives

58
Q

esophageal rings: what are they? etiology? Sx? Txt?

A

thin, diaphragm-like membranes - mucosal and (mostly) muscular

  • etiology: varied (reflux, hernia, etc)
  • Sx: intermittent dysphagia
  • txt: dilation and txt underlying cuase
59
Q

esophageal webs are more ___ while rings are more ____

A

webs: mucosal
rings: muscular

60
Q

what is a schatzki ring? what does it cause?

A 
mucosal ring
oropharyngeal dysphagia (disfunctional swallowing)
61
Q

esophageal diverticula (aka ____)

A

Zenker’s : caused by motility d/o of upper esophagus; relaxation/contraction problems, causes high pressures that result in diverticuli (pouches/herniation in muscular wall of pharynx)

62
Q

symptoms of esophageal diverticula? txt?

A

regurg and really FOUL breath

txt: excision

63
Q

risk factors for esophageal cancer

A

men, smokers, alcohol.

64
Q

___ year abstinence of smoking and alcohol reduce risk for esophageal cancer by ___ %

A

10 year

10 %

65
Q

risk factors for AC esophageal cancer

A

barretts and GERD

increased BMI

66
Q

esophageal cancer is uncommon but…

A

lethal!

67
Q

esophageal cancer: presentation & Dx

A

late with no symptoms of early disease

Dx: endoscopy, CT to evaluate metastasis/nodal involvement, PET scan

68
Q

txt for esophageal cancer

A

early detection and prevention, major surgery for resection, maybe radiation/chemo, brachytherapy (palliative radiation), stenting for dysphagia

69
Q

esophageal varicies

A

dilation of esophago-gastric venous plexus (from elevated portal HTN)

70
Q

mallory-weiss syndrome

A

Mucosal lacerations at the gastro-esophageal junction or gastric cardia
Hematemesis associated with persistent retching and vomiting, often following an alcoholic binge
Distension of the nondistensible lower esophagus causes tears

71
Q

mallor weiss syndrome: tear: Majority of patients ______ _______ with only minor blood loss, but ~__% may have more serious sequelae
Monitor for …

A

heal spontaneously

10%shock, need for transfusion

clin med (88 decks)

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