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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

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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

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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

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4
Q

What is dysphagie haute?

A

Difficulty swallowing

History: cough, pneumonia

Physical examination: deviation of epiglottis or tongue

Investigation: swallow study (Barium)

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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

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6
Q

What does acid reflux look like?

A
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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)

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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

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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

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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

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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

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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

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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
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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
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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
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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
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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

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18
Q

What is œsophagite radique?

A

Local effect of radiation —> can be 10 years later

  • acute: multifocal cellular necrosis
  • chronic: radiation stenosis
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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
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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

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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

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22
Q

What are some common risk factors for esophageal adenocarcinoma?

A

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

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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
How can esophageal tumours be treated?
**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
What are some of our natural anti-reflux mechanisms? (5)
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
What conditions are pré-disposante for RGO? (7)
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
What are some extra-esophageal manifestations of RGO? (3)
**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
How is RGO dx in the general population?
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
Red flags for RGO:
50 years old with RGO for 5 years Dysphagia and odynophagia without pyrosis Weight loss Anorexia Anemia Extra-esophageal manifestations
31
What are some indicators for further investigation of RGO?
No response to treatment after 4-8 weeks History of severe/chronic RGO with suspicion of complications (peptic stenosis, Barrett Esophagus)
32
What tests are available for RGO?
1. gastroscopie et biopsie 2. radiographie: gorgée barytée 3. pHmétrie de 24 heures —\> acid reflux 4. manométrie (15 mins)
33
How can RGO be treated?
**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
What is dysmotricité de transfert?
dysphagie haute: either motrice or mécanique
35
What causes the motor types of dysphagie haute?
**nerves 9-10-12** —\> ACV, ALS **muscles striés pharyngés** —\> myasthénie grave, occulopharyngcal muscular dystrophy
36
What causes mecanic types of dysphagie haute?
**diverticule de Zenker**: sac above cricopharyngeal muscle
37
What is dysmotricité de transport?
dysphagie basse: either motrice or mécanique
38
What are the two motor types of dysphagie basse?
**hypomotricity**: scleroderma, oesophagie radique **hypermotricity**: achalasia, spasme diffus, casse-noisette
39
What is the mechanical type of dysphagie basse?
due to malignant or benign **stenosis** (cancer/anneau de Shatsky)
40
What is Achalasia?
absence of esophageal peristalsis.. défaut de relaxation (hypermotricité) du SOI due to increase in pressure
41
What is primary achalasia?
idiopathic, plexus entérique intrinsèque * most frequent cause but etiology still unknown
42
What is secondary achalasia?
Caused by other things such as: *Chagas, Trypanosomia cruzi*, neoplastic infiltration, syndrome paranéoplasique
43
What are some clinical signs of achalasia?
Dysphagia of solids AND liquids Thoracic pain due to esophagus not emptying Regurgitation and vomiting Weight loss Pulmonary aspiration
44
How is achalasia investigated?
**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
How is achalasia treated?
**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
What are some signs of spasmes diffus de l'oesophage?
dysphagia, retrosternal thoracic pain, non propulsive peristalsis, intermittent pain caused by extreme temperatures, **radiographie barytée normale**
47
What is a hernie hiatale?
**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
Wha is diverticule de Zenker?
diverticulum of the mucosa of the human pharynx, just above the cricopharyngeal muscle (usually posterior left)
49
Who tends to get diverticule de Zenker and what are some signs/sx?
Older patients... Dysphagie haute, regurgitations of undigested food, cough, halitosis
50
What is Syndrome de Boerhaave?
Complete rupture of esophagus post vomiting or dilation of SOI
51
Signs and sx of Syndrome de Boerhaave?
Severe thoracic pain, subcutaneous emphysema (air bubbles), air in mediastinum, **HIGH MORTALITY RATES EVEN WITH SURGERY (50%)**
52
What is Mallory-Weiss?
Tear in muqueuse at GE junction
53
Signs and sx of Mallory-Weiss?
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
What is an Anneau de Schatzki?
Stenosis in bottom third of esophagus —\> between esophagus and stomach
55
What is Steak House Syndrome?
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)

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