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Y3R5: Medicine I 🩺 > L12: Esophageal Diseases > Flashcards

L12: Esophageal Diseases Flashcards

1
Q

Def of GERD

A
  • A condition which develops when the reflux of stomach contents causes troublesome symptoms and/or complications.
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2
Q

Incidence of GERD

A
  • It is one of the most common conditions affecting the gastrointestinal system.
  • Anywhere from 36-77% of people have symptoms of GERD (heartburn, regurgitation of acid etc.)
  • Spread equally between men and women.
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3
Q

Normally, esophageal reflux is prevented by the following mechanisms …..

A
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4
Q

Etiology & Pathogenesis of GERD

A
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5
Q

Contributing Factors to GERD

A
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6
Q

Factors that Decrease LES Pressure

A
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7
Q

Factors that directly irritate gastric mucosa

A
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8
Q

Other Conditions Associated with GERD

A
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9
Q

CP of Classic GERD

A

Heartburn sensation

  • Mainly Epigastric & may radiate retro-sternal even to the lower jaw
  • It occurs 30 - 60 m after meals
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10
Q

what increases symptoms of GERD?

A

bending, straining, lying down & pregnancy

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11
Q

what Decreases symptoms of GERD?

A

Standing, oral intake of water or alkali

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12
Q

Extra esophageal Manifestations of GERD

A
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13
Q

Barret’s Esophagus is thought to be caused by ……

A

 Ongoing injury.
 Inflammation.
 Damage to the lining of the esophagus.

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14
Q

Symptoms of complicated GERD

A
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15
Q

Def of Barret’s Esophagus

A

a change from the normal (squamous) mucosa to a specialized intestinal type (columnar metaplasia).

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16
Q

Barret’s Esophagus is associated with ……..

A

increased risk of esophageal adenocarcinoma.

(Risk of cancer per year in Barrett’s esophagus 0.5% )

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17
Q

Are Investigations needed for GERD?

A

Usually not needed (clinical diagnosis) but may be indicated in:

  • Red-flags (bleeding, weight loss, dysphagia etc.)
  • Persistent symptoms after therapeutic trial of 4-8 weeks of PPI twice daily.
  • High risk for Barrett’s (male, age >50, obese, white, tobacco use, long history of symptoms).
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18
Q

Investigations of GERD

A
  • Barium swallow
  • Endoscopy
  • 24-hr pH Monitoring
  • Esophageal Manometry
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19
Q

Barium Swallow in GERD

A
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20
Q

Endoscope in GERD

A
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21
Q

24-Hr pH Monitoring in GERD

A
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22
Q

DDx in GERD

A
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23
Q

Esophageal Manometry in GERD

A
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24
Q

TTT of GERD

A
  1. Lifestyle Modification
  2. Drugs
  3. Surgery
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25
Q

Indications of Pharmacologic Therapy in GERD

A

if no response to lifestyle modifications

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26
Q

Lifestyle modification in GERD

A

cornerstone

 Diet control
 Weight reduction
 Raising head during sleep
 Take dinner 2-4 h before sleeping
 Avoid Tight corset

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27
Q

Categories of drugs in GERD

A
  • Antacids
  • Prokinetic
  • Acid Suppression Therapy
  • Baclofen
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28
Q

Examples of antacids in GERD

A

Aluminum hydroxide & Magnesium hydroxide (help symptoms, not the disease).

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29
Q

Prokinetic Drugs in GERD

A

Itopride, metoclopramide & Domperidone

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30
Q

Acid suppression therapy in GERD

A
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31
Q

MOA of baclofen in GERD

A

GABA B agonist, reduces the transient LES relaxations that enable reflux episodes.

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32
Q

SE of Baclofen

A

Usage is limited by side effects of dizziness, somnolence, and constipation

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33
Q

Pharmacokinetics of H2 antagonist

A
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34
Q

Absorbtion of H2 antagonist

A

Well absorbed → oral and IV doses similar.

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35
Q

Peak of H2 antagonist

A

Peak 1-3 hours.

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36
Q

Metabolism & Elimination of H2 antagonist

A
  • Hepatic metabolism (cimetidine and ranitidine).
  • Renal elimination → famotidine and nizatidine.
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37
Q

SE of H2 antagonist

A
  • Most common side effects→ diarrhea, constipation, CNS (mental confusion, headaches, dizziness).
  • Especially at risk → elderly, high doses, renal dis.
38
Q

Pharmacokinetics of Proton Pump Inhibitors

A
39
Q

Effect of PPI

A

Inhibit > 90% of gastric acid secretion within 24 hours.

40
Q

Preparations of PPI

A

Unstable in acid media so they are enteric coated.

41
Q

Absorbtion & Peak of PPI

A

Rapidly absorbed and peak 2-4 hours.

42
Q

Elimination & Metabolism of PPI

A

Eliminated hepatically and plasma T½ ~ 1-2 hours, antisecretory effect is 1 ½ to 3 days.

43
Q

SE of PPI

A
  • GI (nausea, diarrhea), CNS (dizziness, headache) skin rash, gynecomastia, increase liver enzymes.
44
Q

Def of Refractory Esophagitis

A

persistent heartburn and/or regurgitation despite 8 weeks of double-dose PPI therapy

45
Q

Types of Surgery in GERD

A
  • Laparoscopic Nissen fundoplication  gold standard surgical treatment
  • Laparoscopic anterior 180° fundoplication (180° LAF)
  • Bariatric surgery in obese patients  Roux-en-Y gastric bypass
46
Q

Indications of Surgery in GERD

A
47
Q

Incidence of Achalasia

A

Affects all ages and both genders.

48
Q

what ia another name for Achalasia?

A

Cardiospasm

49
Q

Def of Achalasia

A

Rare, chronic disorder.

50
Q

Pathophysiology of Achalasia

A

Failure of relaxation of LES & loss of peristalsis in the distal esophagus

51
Q

Etiology of Achalasia

A

Degeneration of the Auerbach’s plexus

1) Idiopathic
2) pseudo-achalasia: e.g. malignancy,
3) Chagas disease (Trypanosoma cruzi)

52
Q

CP of Achalasia

A
53
Q

Typical Patient with Achalasia

A

adults aged 25-60 years, equally in both males & females.

54
Q

Dysphagia in Achalasia

A
  • Early intermittent then progressive
  • Early liquids > solids then both solids & liquids
55
Q

Globus Sensation in Achalasia

A

Substernal chest pain —> during / after a meal

56
Q

Investigation for Achalasia

A
  • Barium swallow
  • Esophageal manometry: definitive diagnosis.
57
Q

Barium Swallow in Achalasia

A

esophagus terminates in narrowing at LES (Bird’s beak - parrot peak)

58
Q

Manometry in Achalasia

A

 Absent or incomplete LES relaxation.
 Loss peristalsis.

59
Q

Endoscopic pneumatic dilation in Achalasia

A

 LES disrupted using balloons of progressively larger diameters.

 Repeat dilations are often required.

60
Q

Goals of TTT of Achalasia

A
  1. Relieve symptoms & improve esophageal emptying.
  2. Prevent development of mega esophagus.
61
Q

Surgery in Achalasia

A

Heller myotomy:
 Done laparoscopically.
 LES surgically disrupted.
 Often has antireflux surgery at same time.
 1 to 2 weeks for recovery

62
Q

Drug Therapy in Achalasia

A

Smooth muscle relaxants.
- Botulinum toxin injection 1 to 2 years relief.

Drugs:
- nifedipine, Nitrates or sildenafil (relax LES)

63
Q

Symptomatic TTT in Achalasia

A

 Semisoft diet.
 Eating slowly.
 Drinking with meals.
 Sleeping with HOB elevated

64
Q

Def of Hiatus Hernia

A
  • Protrusion of the upper part of the stomach upward through diaphragmatic esophageal hiatus
65
Q

Types of Hiatus Hernia

A
  • Type I ( Sliding)
  • Type II ( Para-esophageal or rolling hernia )
  • Type III ( Mixed )
66
Q

Def of Sliding Hiatus Hernia

A

Herniation of the GEJ through the esophageal hiatus into the thorax

67
Q

CP of Sliding Hiatus Hernia

A

asymptomatic or heart burn

68
Q

Investigations in Sliding Hiatus Hernia

A

Barium swallow & Upper endoscopy

69
Q

TTT of Sliding Hiatus Hernia

A

 Weight reduction, small meals, sleeping in semi-sitting position, PPI & Prokinetics.

 Fundoplication indicated in resistant cases

70
Q

Def of Para-esophageal or rolling hernia

A

small part of the fundus of the stomach rolls up alongside the esophagus

71
Q

CP of Para-esophageal or rolling hernia

A

asymptomatic, No GERD symptoms

72
Q

Investigations of Para-esophageal or rolling hernia

A

Barium swallow & Upper endoscopy

73
Q

Complications of Para-esophageal or rolling hernia

A

Mediastinal compression, Volvulus of the stomach can occur

74
Q

Stages of Swallowing

A
75
Q

Def of Dysphagia

A
  • Sensation that food is hindered in its passage from the mouth to the stomach.
  • Most patients complain that food “sticks” “hangs up” “stops”
76
Q

Def of Odynophagia

A

painful swallowing

77
Q

Intaluminal Causes of oropharyngeal dysphagia

A
78
Q

Extraluminal Causes of oropharyngeal dysphagia

A
79
Q

Neuromuscular Causes of oropharyngeal dysphagia

A
80
Q

CNS Causes of oropharyngeal dysphagia

A
81
Q

PNS Causes of oropharyngeal dysphagia

A
82
Q

MEP Causes of oropharyngeal dysphagia

A
83
Q

Muscle Causes of oropharyngeal dysphagia

A
84
Q

Metabolic Causes of oropharyngeal dysphagia

A
85
Q

intraluminal Causes of Esophageal dysphagia

A
86
Q

Extraluminal Causes of Esophageal dysphagia

A
87
Q

Neuromuscular Causes of Esophageal dysphagia

A
88
Q

Primary Causes of neuromuscular Esophageal dysphagia

A
89
Q

Secondary Causes of Neuromuscular Esophageal dysphagia

A
90
Q

Algorithm for dysphagia

A
91
Q

Done

A

..

Y3R5: Medicine I 🩺 (47 decks)

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