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Digestive system disorders > S1 MTA - Esophageal disorders and varix > Flashcards

S1 MTA - Esophageal disorders and varix Flashcards

1
Q

Most common cause of achalasia

A
  • Idiopahtic (most common)
  • Secondary: related to cancer (mostly complaints of dysphagia), chagas (central or South America) or GERD
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2
Q

Both primary and secondary achalasia are not curable

A

False, secondary achalasia is curable

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3
Q

Parasite that causes Chagas

A

Trypanosoma cruzi

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4
Q

Whats the normal physiology of the esophagus

A

Muscular tube with a sphincter at each end, UES and LES, innervated by the vagus nerve to control peristalsis

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5
Q

Whats aperistalsis?

A

Lack of contractions related to myogenic or neurogenic processes

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6
Q

4 histological layers of esophagus

A
  • Mucosa (epithelium, lamina propia, musculares mucosae)
  • Submucosa
  • Muscular (circular interna, longitudinal externa)
  • Adventitia
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7
Q

NT that normally regulate peristalsis and act at LES

A
  • Substance P and ACH are excitatory
  • VIP and NO are inhibitory
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8
Q

How do NTs act in achalasia

A

Degeneration of inhibitory ganglion cells that secrete NO and VIP in the myenteric plexus

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9
Q

Definition of achalasia

A

Failure of the LES and non peristaltic contractions in the distal 2/3 of the esophagus

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10
Q

Symptoms of achalasia

A
  • Dysphagia to solids and liquids (first solids then liquids)
  • Regurgitation of non-digested food
  • Retrosternal pain and cramps
  • Weight loss
  • Halitosis
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11
Q

Failure of the lower esophageal sphincter due to nervous damage; the sphincter can’t relax… accompanied by NO peristalsis

A

Achalasia

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12
Q

2 main neurotransmitters that are involved in achalasia

A
  • Absence of Nitric Oxide
  • Presence of ACH
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13
Q

Pathophysiology of achalasia

A

Atrophy of Auerbach plexus → less release of inhibitory NT (NO and VIP) → inability to relax LES → dysfunctional peristalsis

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14
Q

Manometry findings on patients with achalasia

A
  • Absent/ uncoordinated peristalsis @ lower 2/3 of esophagus
  • Incomplete or absent relaxation of LES
  • High resting LES pressure
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15
Q

Characteristic sign of achalasia

A

Bird-beak sign

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16
Q

Surgical treatment for achalasia

A
  • Heller or LES myotomy
  • Pneumatic dilation is a less invasive procedure that can be done
    POEM (endoscopic myotomy of the circular muscle layer)
  • Diltiazem (medication)
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17
Q

Medical treatment for achalasia

A
  • Nitrates
  • Diltiazem
  • Calcium channel blockers
  • Botulinum toxin (every 6 months)
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18
Q

Can you see a motility disorder when doing an endoscopy?

A

No, motility disorders can’t be seen

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19
Q

Classification of esophageal motility disorders

A

Primary and secondary

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20
Q

What are the types of dysphagia

A
  • Oropharyngeal
  • Esophageal
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21
Q

Difficulty initiating swallowing, piecemeal swallowing, coughing, regurgitation and a sensation of food remaining in the pharynx

A

Oropharyngeal

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22
Q

Main causes of oropharyngeal dysphagia

A
  • Neurological due to stroke
  • Structural due to Zenker’s diverticulum
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23
Q

Difficulty seconds after initiating the swallow, with both solids and liquids; dolor precordial

A

Esophageal dysphagia

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24
Q

Main causes of esophageal dysphagia

A
  • Mechanical intrinsec (peptic stricture, GERD)
  • Extrinsic causes
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25
Q

Hypercontractile and hypertensive peristalsis caused by vigorous esophageal contractions

A

Jackhammer esophagus

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26
Q

Barium swallow in someone with DES will show the …. sign

A

Corkscrew or rosary beads

27
Q

Premature and uncoordinated esophageal contractions when swallowing “so DEScoordinated it can’t even be a considered peristalsis”

A

DES (diffuse esophageal spasm)

28
Q

LES relaxation is common in pathologies like DES and jackhammer

A

Yes

29
Q

Symptoms of DES and jackhammer include

A
  • Dysphagia to mostly liquids
  • Retrosternal pain
  • Reflux symptoms
  • Globus sensation
  • Upper respiratory symptoms
30
Q

Esophageal manometry findings in JHE and DES

A

20% of the cases: hypertensive esophageal contractions JHE; premature non propagative contractions for DES

31
Q

Treatment for DES and JHE

A
  • Small bites with drinks in between
  • No very hot/ cold food
  • No bread, rice or chunky meat
  • NO OPIOIDS
  • Nitrates, calcium channel blockers, peppermint oil
  • PPI if GERD
32
Q

IRP and DCI stand for…

A
33
Q

Differential diagnosis for motility disorders (achalasia)

A

DES and JHE

34
Q

Secondary achalasia

A
  • Chagas
  • Amyloidosis
35
Q

Most common cause of esophageal varicosities

A

Portal hypertension

36
Q

The main cause for portal hypertension is…

A

Cirrosis (alcoholism, hepatitis C and hepatitis B)

37
Q

Most of the esophageal varices occur at the middle third of the esophagus, due to the transition of smooth to straited muscle

A

False, it most commonly occurs at lower third of the esophagus

38
Q

Signs and symptoms of esophageal varices

A
  • Hematemesis and melena
  • Hemodynamic instability
  • Tachycardia
  • Hypotension & orthostatic hypotension
39
Q

When doing an endoscopy ¿what characteristics do varices have?

A
  • Blue
  • Round
  • Surrounded by congested mucosa
  • Soft and compressible
40
Q

Common type of pattern found when doing an endoscopy on a patient with esophageal varices

A

Honeycomb pattern

41
Q

If a patient is bleeding from the esophageal varices ¿what’s the next step?

A

Band ligation or sclerotherapy

42
Q

Prophylactic medications to treat esophageal varices

A
  • beta blockers
  • vasopressin, somatostatin, terlipressin…
  • antibiotic
43
Q

Last resource when treating esophageal varicosities. Also used for patients with poor liver function.

A

TIPS procedure (transjugular intrahepatic protosystemic shunt)

44
Q

Diagnosis for achalasia

A
  • Endoscopy to discard malignancies or obstruction
  • GOLD STANDARD: manometry
  • Barium swallow
45
Q

Liver blood supply comes from…

A
  • 25% hepatic
  • 75% portal
46
Q

Division of portal hypertension

A
  • Acute: acute portal vein thrombosis
  • Chronic: chronic thrombosis, cirrhosis, schistosomiasis
47
Q

Whats portal hypertension

A

Pathological elevation of portal venous pressure resulting from increase in blood flow or its obstruction

48
Q

Causes of portal hypertension are divided into

A
  • Prehepatic
  • Intraahepatic
  • Posthepatic
49
Q

Causes of posthepatic portal hypertension

A
  • Hepatic vein obstruction
  • Budd Chiari syndrome (hepatic vein thrombosis)
  • Right sided heart failure
50
Q

Whats Budd Chiari syndrome

A

Budd-Chiari syndrome is a rare condition resulting from hepatic vein obstruction that leads to hepatomegaly, ascites, and abdominal discomfort.

51
Q

Causes of intrahepatic portal hypertension

A
  • Damage to the liver: fibrosis, cirrosis
  • Pre, post and sinusoidal causes
52
Q

Whats the number one cause of portal hypertension

A

Cirrhosis

53
Q

Cirrhosis is caused by…

A
  • Alcohol/ non alcoholic in wtf is a kilometer land
  • Fatty liver disease in magic Mexico
54
Q

Clinical manifestations of cirrhosis

A
  • Ascites
  • Caput medusae
  • Splenomegaly
55
Q

Most patients with cirrhosis are symptomatic

A

False, 80 to 90% are asymptomatic

56
Q

Percentage of patients that develop esophageal varices secondary to portal hypertension

A

40%

57
Q

Esophageal varices

A
  • Common @ lower 1/3 of the esophagus
  • Only seen @ endoscopy
  • Bleed b4 diagnosed
  • Platelets are low because they stay in the spleen
58
Q

Primary prophylaxis for esophageal varices (b4 they bleed)

A
  • 1) patient diagnosed with portal hypertension
  • 2) endoscopy search
  • 3) non selective beta blockers to small varices
  • 4) band ligation of medium/ big varices
  • 5) eradicate varices (every 6 to 12 months)
59
Q

Treatment for acute variceal bleeding

A
  • 1) patient arrives bleeding
  • 2) octreotide and antibiotics (ceftriaxona)
  • 3) endoscopy and band ligation OR balloon tamponade
  • 4) secondary prophylaxis
  • 5) rebleed? band ligation or TIPS
60
Q

Secondary prophylaxis for esophageal varices (patient was bleeding but not anymore)

A
  • 1) patient stabilized
  • 2) band ligation and non selective beta blockers
  • 3) still bleeding? TIPS
  • if TIPS is done there’s no need for band ligation or non selective beta blockers
61
Q

Non selective beta blockers used to treat esophageal varices

A

Propanolol or nadolol

62
Q

Only vasoactive associated to a decrease in mortality due to esophageal varices

A

Terlipresin

63
Q

Medication associated with decreasing esophageal varices bleeding with the secretion of glucagon

A

Octerotide

64
Q

Vasoactive medications that are associated with hiponatremia as an adverse effect

A

Terlipresin and vasopressin

Digestive system disorders (8 decks)

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