SM_137b: Clinical Features of GI Disorders Flashcards
Describe esophageal anatomy
Esophageal anatomy
____ is discomfort / burning sensation behind the sternum
Heartburn is discomfort / burning sensation behind the sternum
(most common esophageal symptom)
____ is effortless return of food or fluid into the pharynx without nausea or retching
Regurgitation is effortless return of food or fluid into the pharynx without nausea or retching
____ is a feeling of food sticking / lodging in chest
Dysphagia is a feeling of food sticking / lodging in chest
____ is pain caused / exacerbated by swallowing
Odynophagia is pain caused / exacerbated by swallowing
____ is perception of a lump or fullness in the throat, felt even without swallowing
Globus is perception of a lump or fullness in the throat, felt even without swallowing
____ is excessive salivation and a compensatory response to reflux
Water brash is excessive salivation and a compensatory response to reflux
Describe transit related esophageal symptoms
Transit related esophageal symptoms
- Antegrade: food impaction, dysphagia
- Retrograde: regurgitation, aspiration
Perception related esophageal symptoms include ____ caused by ____ and ____
Perception related esophageal symptoms include discomfort caused by chest pain / pressure and heartburn
Structural abnormalities of esophagus often present with ____ and are diagnosed using ____
Structural abnormalities often present with dysphagia and are diagnosed with endoscopy
Propulsive disorders of esophagus usually present as ____ and are diagnosed with ____
Propulsive disorders of esophagus usually present as dysphagia for solids / liquids / GERD and are diagnosed with functional esophageal tests
Describe sensory abnormality etiology of esophageal symptoms
Sensory abnormality etiology of esophageal symptoms
- EGD negative
- Functional
- Nonspecific EMD
- Psychological
____ is herniation of the viscera stomach into the mediastinum through the esophageal hiatus of the diaphragm
Hiatal hernia is herniation of the viscera stomach into the mediastinum through the esophageal hiatus of the diaphragm
Type 1 hiatal hernia is a ____ and predisposes to ____
Type 1 hiatal hernia is a sliding hernia and predisposes to reflux
(95%)
In Type 2,3, and 4 subtypes of paraesophageal hernia, herniation may also include ____
In Type 2,3, and 4 subtypes of paraesophageal hernia, herniation may also include visceral structural than gastric cardia
Schatzki ring is ____
Schatzki ring is a lower esophageal mucosal ring
- Dysphagia when diameter < 13 mm
- Usually age > 40
- Some asymptomatic
- Treated with esophageal dilation
____ is an esophageal web higher in the esophagus
Cervical web is an esophageal web higher in the esophagus
- Circumferential webs -> intermittent dysphagia
- Treated with dilation
Plummer-Vinson syndrome occurs in ____ and presents with ____ and ____
Plummer-Vinson syndrome occurs in middle-aged females and presents with cervical web and iron deficiency
Zenker’s diverticulum is ____ and ____
Zenker’s diverticulum is a sac-like outpoching of the mucosa and submucosa through Killian’s triangle and an area of weakness between transverse fibers of the cricopharyngeus and oblique fibers of the lower inferior constrictor
Zenker’s diverticulum presents with ____, ____, ____, ____, and ____
Zenker’s diverticulum presents with pulmonary aspiration, halitosis, regurgitation, neck fullness, and gurgling in the throat
____ diverticulum occurs in the midportion of the esophagus and presents with regurgitation and dysphagia
Traction diverticulum occurs in the midportion of the esophagus and presents with regurgitation and dysphagia
Epiphrenic diverticulum occurs above ____, is usually associated with ____, and presents with ____ and ____
Epiphrenic diverticulum occurs above the lower esophageal sphincter, is usually associated with motility disorders like achalasia, and presents with regurgitation and dysphagia
Endoscopic findings of GERD include ____ and ____
Endoscopic findings of GERD include erythema and erosions
Describe pathophysiology of GERD
GERD pathophysiology
- Transient lower esophageal sphincter relaxations
- Lower esophageal sphincter hypotension
- Anatomic distortion of the esophagogastric junction
- Impaired salivation
- Impaired peristaltic emptying
Describe factors that worsen GERD
Factors that worsen GERD
- Obesity
- Pregnancy
- Gastric hypersecretory states
- Delayed gastric emptying
- Disruption of esophageal peristalsis
- Overeating -> gastric distension
GERD can be ____, ____, or ____
GERD can be non-erosive GERD, extra-esophageal GERD, or esophagitis
Describe GERD histology
GERD histology
Barrett’s esophagus is when ____
Barrett’s esophagus is when metaplastic columnar epithelium that predisposes to cancer development replaces the stratified squamous epithelium that normally lines the distal esophagus
Treatment for non-erosive GERD includes ____ such as ____ or ____
Treatment for non-erosive GERD includes pharmacotherapy to decrease acid secretion such as PPI or H2RA blcockers
Treatment for GERD esophagitis includes ____, ____, ____, and ____
Treatment for GERD esophagitis includes weight reduction, avoidance of foods, and eating modification
(lifestyle modification)
Treatment for extra-esophageal GERD is ____
Treatment for extra-esophageal GERD is surgery
Reflux testing includes ____ or ____
Reflux testing includes ambulatory 24-48h esophageal pH recording or intraluminal impedance
- Intraluminal impedance: detects any reflux events, both acid and non-acid
Eosinophilic esophagitis is ____ with symptoms related to ____
Eosinophilic esophagitis is a chronic immune-mediated food-antigen driven disease with symptoms related to esophageal dysfunction
- ≥1 biopsy specimens must show eosinophil-predominant inflammation
- Isolated to esophagus
Eosinophilic esophagitis endoscopy findings include ____, ____, ____, and ____
Eosinophilic esophagitis endoscopy findings include rings, furrows, exudates, and food impaction
Gold standard for eosinophilic esophagitis is ____
Gold standard for eosinophilic esophagitis is esophageal biopsy
- Superficial layering
- Eosinophilic microabscess
- Spongiosis
- Epithelial hyperplasia
- Degranulation
- Lamina propria fibrosis
Treatment for eosinophilic esophagitis are ____, ____, and ____
Treatment for eosinophilic esophagitis are drugs, diet, and dilation
- Medical therapy: swallowed topical steroids, swallowed viscous budesonide
- Dietary therapy: empiric elimination / six food elimination diet
- Endoscopic therapy: esophageal dilation
Suspect ____ in adults with dysphagia and diagnosis requires esopagogastroduodenoscopy and biopsy
Suspect eosinophilic esophagitis in adults with dysphagia and diagnosis requires esopagogastroduodenoscopy and biopsy
- Complications: food impaction, strictures, and perforation
____ presents with odynophagia and dysphagia and involves white plaques on the esophagus
Candidal esophagitis presents with odynophagia and dysphagia and involves white plaques on the esophagus
- Treat with oral fluconazole x 14 days
Herpetic esophagitis is caused by HSV-1 or HSV-2 and involves ____
Herpetic esophagitis is caused by HSV-1 or HSV-2 and involves punched out ulcerations on the esophagus
- Treatment: self-limited, acyclovir or valcyclovir if needed
CMV occurs in ____ patients and involves ____
CMV occurs in immunocompromised patients and involves serpiginous ulcerations
Treatment: ganciclovir
Pill esophagitis occurs when a swallowed pill lodges in the ____ and presents with ____ or ____
Pill esophagitis occurs when a swallowed pill lodges in the esophagus and presents with sudden onset chest pain or odynophagia
