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P&T Block 3 Pulm & GI > L77 > Flashcards

L77 Flashcards

1
Q

Medical term for heartburn. Where do pts describe this pain?

A

Pyrosis

“Substernal burning”

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2
Q

Define dysphagia

A

Difficulty swallowing

Dx via history

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3
Q

Define odynophagia

A

Pain w/ swallowing

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4
Q

Describe a mechanical problem causing dysphagia

A

Tumor or stricture -> obstruction of esophageal lumen

Gradual onset: can’t do solids, THEN soft/liquids

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5
Q

Describe a motor problem causing dysphagia

A

Can’t handle solids AND liquids from the start

Might be effected by temperatures -> hot/cold inducing spasm to get symptoms

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6
Q

Define GERD

A

Reflux of normal gastric content (acid) damages esophagus

LES is too relaxed

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7
Q

What is a hiatal hernia?

A

GE jxn + part of stomach herniate above the diaphragm

Won’t cause GERD, but can worsen existing GERD

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8
Q

Treat GERD non-medically

A

Elevate head of bed
No food before bed
Decrease fat in diet // weight loss -> obesity issue

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9
Q

Meds to treat GERD

A

Antacids
H2 receptor antagonists
PPIs - most effective

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10
Q

How do you dx GERD?

A

History
NO tests
+ medications -> symptoms resolve
Increase meds if needed -> symptoms resolve
Only do tests for GERD if pts still have symptoms on BID PPI

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11
Q

Do you cure GERD?

A

NO

Meds treat the symptoms - stop meds, pts will recur

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12
Q

If you DO need to perform tests to confirm a GERD dx, what are your 5 options?

A
  1. Barium swallow + XR
  2. Endoscopy
  3. Esophogeal manometry
  4. Ambulatory pH monitoring
  5. Multichannel intraluminal impedance (MII) = pH monitoring
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13
Q

What pts do you use barium swallow for? Who don’t you use for?

A

Yes: dysphagia b/c will show narrowing
No: GERD

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14
Q

Why do you decide to scope for GERD?

A

Want to eval MUCOSAL INJURY
Ex:
- Erosive esophagitis
- Barrett’s esophagus

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15
Q

Why would you do an ambulatory pH monitoring study?

A

Quantify amt acid reflux

ONLY detects acid in the esophagus

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16
Q

Why would you do a MII-pH monitoring study?

A

To see acid AND non-acid reflux into esophagus

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17
Q

4 complications of GERD

A

Ulcerative esophagitis
Peptic stricture
Barrett’s esophogus -> adenocarcinoma

18
Q

What is a peptic stricture?

A

Acid refluxes from stomach -> esophagus

Injury, heal - over and over = NARROWING of DISTAL esophagus

19
Q

Is a peptic stricture mechanical or motor?

A

Mechanical

Dysphagia to solids which progresses over time

20
Q

Treat peptic stricture

A

Balloon to open stricture

Anti-reflux therapy (lifestyle + H2A or PPIs)

21
Q

What is Barrett’s esophagus?

A

Reflux over time causes the epithelium of distal esophagus to change
Squamous (normal) -> columnar
Why? Better able to resist the acid
BIG DEAL b/c this metaplasia could progress to cancer

22
Q

What type of cancer might Barrett’s progress to?

A

Adenocarcinoma
White MEN
Distal esophagus - makes sense b/c of pathophys of progression: GERD -> Barrett’s -> adeno

23
Q

You can get squamous cell cancer of the esophagus. Who gets this? Where does it effect the esophagus?

A

Black men
H/o drinking, smoking
** MID esophagus **

24
Q

Does esophageal cancer present as mechanical or motor?

A

Mechanical

Dysphagia progressing from solids to liquids

25
Q

How do you det treatment course for esophageal cancer? What are the treatment options?

A

STAGE 1st
Cure: radiation + chemo + surg
If can’t remove: palliative

26
Q

What test is the gold standard for esophageal motility issues?

A

Manometry!!!

Conventional or high resolution

27
Q

What is achalasia? Pathophys? Mechanical or motor?

A

LES can’t relax -> food won’t go down
Motor - can’t swallow solids or liquids
↓ganglion cells of LES

28
Q

Usually achalasia is idiopathic. What are secondary causes?

A

Cancer

Chaga’s disease

29
Q

What’s the main difference between achalasia and peptic stricture resulting from GERD

A

Achalasia = hypertensive LES + NO peristalsis
- Absent peristalsis OR contractions are all at the same time which nets no perstalsis
Stricture has normal peristalsis above it

30
Q

2 treatment options for achalasia

A

Balloon dilation -> rupture
Lapro to cut open
Could also try drugs but not really effective

31
Q

Spastic esophageal motility disorders

  • M v F
  • Co-existing conditions
  • Presenting symptoms
  • 2 example diseases you need to know
A 
Female
\+ IBS or psych 
Presents as CHEST pain
1. Nutcracker esophagus
2. Diffuse esophageal spasm
Definitive test for either is **MANOMETRY** (manometry for motility issues!)
32
Q

Manometry for nutcracker esophagus

A

See peristalsis -> wave amplitudes are HUGE

Normal sequence but just pushing very tightly

33
Q

Manometry for DES

A

No peristalsis b/c simultaneous contractions
W/ periods of normal peristalsis intermittently
Looks like CORK SCREW!!!

34
Q

How can you treat the motility disorders?

A

Smooth muscle relaxants = Ca CBs

Psychotropic meds for hypersensitivity = trazadone

35
Q

What is scleroderma’s connection to the esophagus?

A

= CT disorder

Smooth muscle atrophy -> fibrosis of esophagus

36
Q

Scleroderma manometry

A 
Hypotensive LES (**difference from achalasia)
Aperistalsis in distal 2/3 esophagus
37
Q

IC pt presents w/ dysphagia. Disease?

A

Candida

Treat w/ fluconazole

38
Q

IC pt presents w/ odynophagia + chest pain. Disease options?

A

HSV - discrete ulcers
CMV - ulcers that coalesce into giant ulcers
Treat both w/ anti-virals

39
Q

Young man w/ h/o allergies presents with dysphagia. Disease? Treat?

A

Eosinophilic esophagitis

Treat by removing allergic foods or PO steroids

40
Q

Plummer Vinson syndrome

  • Pt profile
  • Pathophys
  • Where in esophagus
A

Post-menopausal women w/ Fe def anemia
Intermittent solid food dysphagia
= SEMI circum membranes, SQUAMOUS cells
Close off UPPER esophagus

41
Q

Schatzki’s ring

  • Patho
  • Where in esophagus
  • 2 presentations
A

Total circum ring of mucosa tissue
DISTAL esophagus
Intermittent food dysphagia or meat gets stuck

42
Q

Zenker’s diverticulum

A 
Old men
Esophageal outpouching = motility issue due to UES dysfxn
Present:
1. Dysphagia
2. Neck mass -> gurgling in throat
3. Regurg food into mouth

P&T Block 3 Pulm & GI (31 decks)

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