Thoracics Flashcards
what is GERD
when significant symptoms or tissue changes occur with heartburn, with 2 or more episodes per week and extraluminal symptoms like dysphagia
normally there is the LES and 2 cm of intraabdominal esophagus beneath the diaphgram at the angle of His –> there is esophageal motility and the antacid effect of saliva
typical symptoms of GERD
heart burn
water brash (sour taste)
triggers (lying down, alcohol, spicy/fatty food, chocolate, caffeine etc)
atypical symptoms of GERD
chest pain
regurg
respiratory sx
belching
alarm symptoms of GERD
weight loss
dysphagia
hematemesis/melena/anemia
tests used in evaluating GERD
barium esophagram
where do you find a hiatal hernia
at junction between esophagus and stomach
what 4 tests should you consider before doing anti-reflux surgery for GERD
- gold standard to confirm GERD is 24 hour pH monitoring–> pH probe inserted to GE junction, left in for 24 hours as patient goes home with diary of symptoms–> gives a DeMeester score
- Upper GI endoscopy –> identify anatomy, hiatus hernia, esophagitis, Barrett’s
- UGI contrast study–> confirm anatomy, hiatus hernia, visualize swallowing/reflux
- esophageal manometry–> measures pressures in the esophagus, rules out motility disorders
define barrett’s esophagus
intestinal metaplasia of the esophagus–> squamous to intestinal columnar
*associated with risk of malignancy
risk factors for barretts esophagus
chronic reflux
hiatus hernia
motility disorders
obesity
how do you characterize dysphagia?
- solids? liquids?
- progressive?
- painful?
- weight loss?
- cervico-thoracic versus oropharygneal
what is cervico-thoracic dysphagia
related to food getting stuck in the thoracic esophagus
what is orophayngeal dysphagia
initiation of swallowing, choking or coughing, associated with neuromuscular diseases, strokes
what do you order to evaluate dysphagia?
esophagastroscopy
what type of esophageal cancer is associated with chronic GERD
adenocarcinoma
what type of esophageal cancer is associated with achalasia
SCC
typically mid-esophageal in location
what is achalasia
failure of LES opening when you eat, causing back up of food in esophagus
how do you stage esophageal cancer
TNM
T–tumour size and location into wall
N–nodal involvement and number of nodes involved
M–distant mets
how do you treat esophageal cancer
surgery, chemo, radiation
surgery–> usually entails esophagectomy–> often multiple approaches and different cavities
may have pre or postop chemo with or without radiation
investigate with CT/PET, endoscopic U/S, biopsy
what is the overall survival rate of lung cancer
less than 10%
lung ca is often asymptomatic early, and patients usually present with metastatic disease (usually what brings up symptoms)
beware of new resp symptoms in smokers, this may represent lung ca
most common symptoms of lung ca? next most common?
cough–75%
dyspnea–50%
symptoms of lung ca
cough dyspnea wheeze hemoptysis pneumonia extrapulmonary--> invasion of nearby structures--> chest pain, dysphagia etc...
list 4 examples of conditions associated with paraneoplastic syndromes
- increased cortisol secretion from small cell lung cancer (ACTH secretion)
- hyponatremia–> SIADH
- hypercalcemia–> PTH related peptide secretion
- bone manifestations
what is the best investigation for lung ca
CXR
there are some worrisome imaging characteristics (also on CT)
what signs do you look for on CXR that suggest lung cancer
- spiculation –> looks like a star
- thick walled cavitation
- lack of calcification (though eccentric asymmetric calcification is also worrying
- growth over time