Brainscape's Knowledge GenomeTM

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


See full index

MD1 GI - EXAM 1 > Oesophage: pathologies cliniques > Flashcards

Oesophage: pathologies cliniques Flashcards

1
Q

What is pyrosis?

A

Heartburn

P: position déclive/repas

Q: BRÛLURE

R: retrosternal, epigastric, central

S: 0-10

T: durée et évolution temporelle

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

What is odynophagie?

A

Pain when swallowing

P: swallowing (throat), transport (thorax)

Q: pression, burning, blockage, or cramp

R: neck, thorax

S: 0-10/10

T: évolution temporelle

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

What is dysphagie?

A

Difficulty when swallowing or moving food down the esophagus

P: déglutition, transport

Q: texture, solid vs. liquid

R: upper or bottom

S: cough

T: durée, évolution temporelle

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

What is dysphagie haute?

A

Difficulty swallowing

History: cough, pneumonia

Physical examination: deviation of epiglottis or tongue

Investigation: swallow study (Barium)

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

What is dysphagie bas?

A

Problems with peristalsis

History: trouble with liquids or solids

Physical examination: palpation sus-claviculaire (adénopathie gauche —> CANCER)

Investigation: transit, endoscopie, motility

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

What does acid reflux look like?

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

What are some possible complications related to œsophagite peptique? (5)

A

Œsophagite non-érosive: pyrosis (NERD)

Œsophagite érosive: pyrosis et odynophagie

Hémorragie aiguë: N/a

Hémorragie chronique: parfois, anémie ferriprive (iron deficiency)

Perforation: N/a

Sténose cicatricielle: dysphagie aux solides

Œsophage de Barrett: métaplaise (benin)

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

How is œsophagite peptique diagnosed?

A

Essai thérapeutique IPP —> proton pump inhibitor should fix in 48 hours-ish … if dysphagia and > 50, do an endoscopy because possible cancer

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

What is œsophagite peptique érosive?

A

Odynophagie

Most frequent complication of acid reflux

Treatment: IPP (need to take long term…)

If not treated or poorly

Fibrose cicatricielle: dysphagie

Sténose: dysphagie

Œsophage de Barrett —> RESOLUTION OF PYROSIS

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

What is Œsophage de Barrett?

A

A complication of œsophagite peptique

It is a form of metaplasia —> pav. epithelium replaced by cylindric epithelium with Goblet cells

If dysplasia… risk of malignant transformation increases by 30-40x

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

What is the symptomology of Œsophage de Barrett?

A

Pyrosis gets better —> severe at the start and diminishes progressively with replacement by intestinal metaplasia

If dysphagia —> associated with stenosis, should make you worry about esophageal cancer

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

What is the link between adenocarcinoma and Œsophage de Barrett?

A

Barrett = predisposition to adénoCa

Early detection = increase of survival rate therefore endoscopie aux 2 ans avec biopsies

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

What is œsophagite infectieuse?

A

Virale:

  • herpes, recurring odynophagia w/o dysphagia
  • cytomegalovirus, immunosuppressed individuals (post-transplant, HIV, chimio)

Mycotique:

  • MUSHROOMS —> Candida albicans: immunosuppression from inhaled steroids for asthma treatment allows for their proliferation in the throat
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is œsophagite éosinophilique, allergique?

A

Typical in pediatrics: dysphagie from solids/allergies

  • no resolution with IPP and pHmétrie normal (no reflux)
  • endoscopy shows ring like appearance of esophagus… looks similar to the trachea
  • diagnosed through biopsy showing presence of éosinophile en sous-muqueuse
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How is œsophagite éosinophilique treated?

A

Local corticotherapy (aerosol) —> better if oral so no systemic effects

  • exclusion diets to determine allergen
  • elementary diet of amino acids
  • dilations of esophagus when necessary
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is œsophagite caustique?

A

Ingestion of acide ou alkali (WORSE ONE)

  • Ulceration by chemical necrosis, worry about perforation
  • Scarring with irregular stenosis
  • Brachyœsophage et herniation hiatale
  • Risque in long term of epithelial neoplasia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is œsophagite médicamenteuse?

A

Ingestion of Rx that sticks to the wall of esophagus and causes irritation/potential ulceration

Prevention: drink water before and during pill swallowing

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

What is œsophagite radique?

A

Local effect of radiation —> can be 10 years later

  • acute: multifocal cellular necrosis
  • chronic: radiation stenosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are the two most common pathologie tumorales of the esophagus?

A

Benign tumors are SUPER rare but called —> leiomyoma

  1. Epidermoid/malpighien cancer
    • upper 2/3rds: pav. epithélium
    • 2/3 of esophageal cancers but the frequency is diminishing
  2. Adénocarcinome
    • bottom third: glandular epithelium
    • frequency is increasing
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Info about malignant esophageal tumours:

A

1/10 of GI tumours

Most frequent in Asia —> 20% of all deaths due to cancer

More frequent in men than woman and in people > 50

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

What are some common risk factors for epidermoid esophageal cancer?

A

Caustic esophagitis

Toxins (alcohol, tabacco, tea)

Diet (nitrites and nitrosamines typically used as preservatives)

Ethnicities —> Asian, Black >>> White

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

What are some common risk factors for esophageal adenocarcinoma?

A

Chronic reflux (even if they use IPPs) and Barrett’s Esophagus

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

What are some clinical signs of esophageal tumours?

A

Lower or progressive dysphagia (solides and then progresses slowly to liquids)

Weight loss

Tumoral ulceration —> anémie ferriprive

Bronchial aspiration of contents of esophagus when laying down

24
Q

How can esophageal tumours be diagnosed?

A

Gorgée baryté:

  • lésions bourgeonnantes —> obstruction
  • lésions infiltrantes —> ulcerations, stenosis, rigidity

Endoscopy and biopsy: pathological dx (épi or adéno)

Bilan d’extension tumorale: opérabilité

  • paroi: esophagus has no péritoine —> very easily invade mediastinum
  • médiastin: heart, aorta, bronchi, trachea
  • ganglia in the mediastinum, para-tracheal, subclavicular
25
Q

How can esophageal tumours be treated?

A

Depends on tumour (either curative or palleative)

Curative:

  • Chimiotx with radiotx —> followed by ressection of esophagus and then replaced by stomach or colon depending on how far it goes down

Palliative:

Chimiotx and radiotx

  • tubular endoprosthesis —> metallic membrane that will “squish” tumour to make swallowing easier
26
Q

What are some of our natural anti-reflux mechanisms? (5)

A
  1. Inferior esophageal sphincter
  2. Diaphragm
  3. Intra-abdominal segment of esophagus
  4. Effective esophageal clearance
    • gravity
    • peristalsis ***
    • neutralization by bicarbonates in saliva
    • neutralization by esophageal bicarbonates
  5. Efficient gastric emptying
27
Q

What conditions are pré-disposante for RGO? (7)

A
  1. Increase in pressure on stomach
    1. obesity
    2. pregnancy
  2. decrease of pressure of SOI
    1. pregnancy —> progesterone (decrease contractility of GI tube)
    2. tabacco
    3. meds that relax smooth muscle (ex: HTA meds)
    4. scleroderma (fibrose)
    5. food: coffee, tea, fat, chocolate, alcohol, mint
  3. Destruction of SOI
    1. surgery (cancer)
    2. post-myotomie de Heller and botox injections (achalasia)
  4. Hypersecretion of acid (Zollinger-Ellison)
  5. Gastroparesis
    1. Primary
    2. Secondary —> diabetes, post-vagotomie, pyloric stenosis
  6. relaxation transitoires inappropriées
  7. poche d’acide au fundus
28
Q

What are some extra-esophageal manifestations of RGO? (3)

A

Laryngite de reflux:

  • morning hoarseness of voice
  • chronic pharyngitis
  • chronic cough due to irritation

Pulmonaire:

  • asthme nocturne non allergique
  • pneumonie d’aspiration récidicantes
  • hoquet chronique (hiccup)

Buccale:

  • perte de l’émail des dents
29
Q

How is RGO dx in the general population?

A

Based on clinical history

Most patients with RGO symptoms don’t initially require further investigation but are treated based on symptoms if there aren’t any red flags

30
Q

Red flags for RGO:

A

50 years old with RGO for 5 years

Dysphagia and odynophagia without pyrosis

Weight loss

Anorexia

Anemia

Extra-esophageal manifestations

31
Q

What are some indicators for further investigation of RGO?

A

No response to treatment after 4-8 weeks

History of severe/chronic RGO with suspicion of complications (peptic stenosis, Barrett Esophagus)

32
Q

What tests are available for RGO?

A
  1. gastroscopie et biopsie
  2. radiographie: gorgée barytée
  3. pHmétrie de 24 heures —> acid reflux
  4. manométrie (15 mins)
33
Q

How can RGO be treated?

A

Changing lifestyle habits: stop smoking, stopping meds that dim. SOI pressure, raising bed to 15° angle, weight loss (if significant obesity), avoiding certain irritating foods and drinks, avoid eating fatty/large meals

Taking antacids

  1. Maalox, pepto, gaviscon —> over the counter
  2. Anti-H2 —> not used as much anymore (ending in tidine —> over the counter)
  3. IPPs —> prescription (ending in prazole)

Surgery

34
Q

What is dysmotricité de transfert?

A

dysphagie haute: either motrice or mécanique

35
Q

What causes the motor types of dysphagie haute?

A

nerves 9-10-12 —> ACV, ALS

muscles striés pharyngés —> myasthénie grave, occulopharyngcal muscular dystrophy

36
Q

What causes mecanic types of dysphagie haute?

A

diverticule de Zenker: sac above cricopharyngeal muscle

37
Q

What is dysmotricité de transport?

A

dysphagie basse: either motrice or mécanique

38
Q

What are the two motor types of dysphagie basse?

A

hypomotricity: scleroderma, oesophagie radique

hypermotricity: achalasia, spasme diffus, casse-noisette

39
Q

What is the mechanical type of dysphagie basse?

A

due to malignant or benign stenosis (cancer/anneau de Shatsky)

40
Q

What is Achalasia?

A

absence of esophageal peristalsis.. défaut de relaxation (hypermotricité) du SOI due to increase in pressure

41
Q

What is primary achalasia?

A

idiopathic, plexus entérique intrinsèque

  • most frequent cause but etiology still unknown
42
Q

What is secondary achalasia?

A

Caused by other things such as: Chagas, Trypanosomia cruzi, neoplastic infiltration, syndrome paranéoplasique

43
Q

What are some clinical signs of achalasia?

A

Dysphagia of solids AND liquids

Thoracic pain due to esophagus not emptying

Regurgitation and vomiting

Weight loss

Pulmonary aspiration

44
Q

How is achalasia investigated?

A

Manométrie —> no péristalstis and SOI with incomplexe relaxation and high pressure even at rest

Signs on radiology:

  • Dilation of esophagus without ulcerations
  • No peristalsis
  • Distal esophagus “en bed d’oiseau”
45
Q

How is achalasia treated?

A

Medical: dilation of SOI

Surgical: myotomie du SOI

Rx: Ca blockers (per os), nitrates (per os), botox injection in SOI but can make future surgeries hard due to potential scarring

46
Q

What are some signs of spasmes diffus de l’oesophage?

A

dysphagia, retrosternal thoracic pain, non propulsive peristalsis, intermittent pain caused by extreme temperatures, radiographie barytée normale

47
Q

What is a hernie hiatale?

A

Most common: glissement de la jonction gastroesophageal dans le thorax

  • Signs/symptoms?
    • RGO, no ischemic risk

More rare kind: hernie hiatale par roulement

  • Stomach rolls up out of hiatus… GE junction stays in place, little to no RGO, dysphagia, RISK OF ISCHEMIA!
48
Q

Wha is diverticule de Zenker?

A

diverticulum of the mucosa of the human pharynx, just above the cricopharyngeal muscle (usually posterior left)

49
Q

Who tends to get diverticule de Zenker and what are some signs/sx?

A

Older patients…

Dysphagie haute, regurgitations of undigested food, cough, halitosis

50
Q

What is Syndrome de Boerhaave?

A

Complete rupture of esophagus post vomiting or dilation of SOI

51
Q

Signs and sx of Syndrome de Boerhaave?

A

Severe thoracic pain, subcutaneous emphysema (air bubbles), air in mediastinum, HIGH MORTALITY RATES EVEN WITH SURGERY (50%)

52
Q

What is Mallory-Weiss?

A

Tear in muqueuse at GE junction

53
Q

Signs and sx of Mallory-Weiss?

A

No thoracic pain, upper digestive tract hemmorrhage after vomiting

Classic case: repeated vomiting (+++) —> hématémèse (50% at first vomit)

Spontaneous resolution within 24hrs ish in 90% of cases

54
Q

What is an Anneau de Schatzki?

A

Stenosis in bottom third of esophagus —> between esophagus and stomach

55
Q

What is Steak House Syndrome?

A

Dysphagia due to solids, subite et douloureuse after big bite that blocks SOI/junction which keeps food stuck in esophagus

MD1 GI - EXAM 1 (15 decks)

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