0328110900 - Gi E2 - Esophageal Dz (Yonts)

Front 1

What is the reading assignment for 0328110900 - GI E2 - Esophageal Dz (Yonts)?

Back 1

Current
Diagnosis & Treatment
Gastroenterology, Hepatology, & Endoscopy
2009
Pages 139-174

Front 2

What are the "alarm signs" for GERD symptomlogy?

Back 2

dysphagia, odynophagia (pain with swallowing), weight loss, persistent nause/vomiting, persistent symptoms despite tx, GI bleeding, advanced age, anemia, family hx of upper GI CA

Front 3

What is the primary pathophysiologic causes of GERD?

Back 3

inappropriate relaxation of the LES

Front 4

What are the two main patterns of LES dysfunction?

Back 4

1. Hypotensive LES (severe GERD, scleroderma)
2. Transient inappropriate relaxation (mild GERD, hiatal hernia)
p139-140

Front 5

What medications decrease LES pressure?

Back 5

beta agonist, alpha blockers, anticholinergics, CCBs, diazepam, estrogen, narcotis, PRO, theophylline, TCAs
p140

Front 6

What medications cause direct mucosal injury?

Back 6

alendronate (fosomax), ASA, iron salts, NSAIDs, KCl tabs, quinidine, teracyclines (doxy)
p140

Front 7

What foods exacerbate GERD symptoms?

Back 7

Caffeine, chocolate*, peppermint*, EtOH* (red wine), soda, citrus, tomato, vinegar, large & fatty* meals, smoking*. * = decrease LES pressure

Front 8

What lifestyle factors or medical factors exacerbate GERD symptoms?

Back 8

weight gain, smoking, eating then lying down, pregnancy, scleroderma, immunocompromised, spinal cord injury

Front 9

What are the symptoms of GERD?

Back 9

Heartburn, regurgitation, dysphagia

Front 10

How is GERD diagnosed?

Back 10

1. tx with PPI, if pt improves, then dx = GERD,
2. if pt does not improve, scope or barium swallow

Front 11

What is reflux esophagitis and how is it treated?

Back 11

Inflammation of the esophagus. Tx: lifestyle mods (diet, quit smoking, elevate head of bed, etc), H2-blocker/PPI, prokinetics, ABs, OMT, surgery, etc.

Front 12

What is gastroparesis and what are the symptoms?

Back 12

delayed gastric emptying not ass’d w/presence of an obstructing structural lesion in the stomach or distally in the GI tract. MCC = idiopathic, diabetic neuropathy, p-surgical. Other: Parkinson’s, collagen vascular disorders, intestinal pseudo-obstruction, paraneoplastic syndromes, SMA Syndrome, median arcuate ligament syndrome. Idiopathic = viral-like gastroenteritis, GERD, nonulcer dyspepsia, and cholecystectomy.
p201

Front 13

What are complications of GERD?

Back 13

bleeding from esophageal erosions/ulceration, stricture formation, Barrett’s esophagus, adenocarcinoma

Front 14

How does H2 blockers and PPI’s work?

Back 14

irreversibly block proton pump on parietal cells. H2 blocker: block H2 receptor on parietal cell – more AEs than PPIs

Front 15

What is the most widely performed procedure for GERD, and what percentage of patients regain symptoms ten years after the procedure?

Back 15

Nissen Fundoplication:  fundus is wrapped 360 degrees around esophagus to promote LES closure. Last resort tx. Also used in tx of paraesophageal hiatal hernias. 80-90% sx free for 10yrs.

Front 16

What is Barrett esophagus?

Back 16

intestinal metaplasia in esophagus

Front 17

How is Barrett esophagus diagnosed?

Back 17

requires both visual (endoscopic) and histologic (biopsy) evidence

Front 18

How is the gastro-esophageal junction (GEJ) identified?

Back 18

Internal:
1. The squamocolumnar epithelial junction/Z-line (not in Barretts)
2. Transition from smooth epithelium to rugal folds.

External:
1. Circular esophageal muscle fibers join oblique fibers of stomach
2. Gastroesophageal fat pad

Front 19

How is low grade esophageal dysplasia defined?

Back 19

mucosal cells w/nuclei larger and hyperchromatic w/irreg. contours basally located in cell w/minimal-no stratrification..

Front 20

How is indefinite grade esophageal dysplasia defined?

Back 20

pathologist is not certain whether changes seen in the tissue are due to dysplasia. nuclear enlargement, crowding, hyperchromatism, prominence of the nucleoli, and mild stratification can be seen but are confined to the lower portion of the glands whereas the upper portion of the glands and surface epithelium show less abnormality or are normal.
P152

Front 21

How is high grade esophageal dysplasia defined?

Back 21

Distortion of gland architecture present/marked. Glands composed of branching and lateral budding of crypts and a villi-form configuration of mucosal surface. Dx requires loss of nuclear polarity and absence of consistent relationship of nuclei to each other.

Front 22

What type of dysplasia has to be confirmed by 2 or more GI pathologists?

Back 22

Any dx of high grade dysplasia

Front 23

What is odynophagia?

Back 23

painful swallowing

Front 24

What are the two types of dysphagia and do the two types of dysphagia differ?

Back 24

a. Oropharyngeal dysphagia - difficulty forming a bolus or initiating a swallow, nasal and oral regurgitation more common, commonly presents with general neuromusk. dz
b. Esophageal dysphagia - solids and liquids are problematic and symptoms localize in the chest and regurg, coughing and choking at night occur unrelated to swallowing, symptoms of GERD
p155, 160

Front 25

What symptoms suggest the patient is having oropharyngeal dysphagia?

Back 25

difficulty controlling food in the mouth, inability to control food or saliva in the mouth, difficulty initiating a swallow, coughing, choking, frequent pneumonia, unexplained weight loss, gurgly or wet voice after swallowing, nasal regurgitation, and difficulty swallowing. 

Front 26

What causes cricopharyngeal achlasia?

Back 26

persistent spasm/failure of UES relaxation

Front 27

What are some of the primary and secondary causes of cricopharyngeal achlasia?

Back 27

1* if confined to cricopharyngeus muscle w/o neurologic or systemic cause (idiopathic/intrinsic myopathy).

2* if by another disease process.

Front 28

What is a classic finding of cricopharyngeal achlasia?

Back 28

cricopharyngeal bar on barium swallow – posterior wall of pharynx at level of cricoids cartilage.

Front 29

What is a Zenker diverticulum?

Back 29

diverticulum in posterior wall of hypopharynx above cricopharyngeus muscle.

pic is just for reference

Front 30

What is a globus pharyngeus or globus sensation?

Back 30

sense of lump in throat w/o dysphagia. often psychological.

Front 31

What are the three components of esophageal peristalsis?

Back 31

1. Inhibitory innervation dz – pregang vagus and post gang myenteric: relax LES and grade peristaltic contraction (VIP, NO).

2. Excitatory innervation dz – pregang vagus and post gang = basal LES HTN, HTN contraction and force of peristaltic contraction (ACh, Sub P).

3. smooth mm. dz: phasic muscles contract for peristalsis, tonic muscles = tone

p159-161

Front 32

What are the pathogenic causes of esophageal dysphagia?

Back 32

motor/excitatory nerves – hypotonic muscles/LES. Enhanced contraction: HTN-LES, HTN-peristalsis. Disordered innervations: achalasia, DES

p160

Front 33

What are the symptoms of esophageal motor dysfunction?

Back 33

achalasia, DES, dysphagia, GERD, CP, regurgitation

Front 34

What are the probable casues of esophageal chest pain?

Back 34

hypertensive esophageal disorders, sustained longitudinal muscle contraction, esophageal hypersensitivity, and esophageal sensory neuropathy p163

Front 35

What is achlasia?

Back 35

thoracic esophagus dz of inhibitory innervation causing lack of esophageal peristalsis and incomplete relaxation of the LES

Front 36

What is the preferred initial method of evaluation of dysphagia?

Back 36

barium swallow

Front 37

What are the symptoms of achlasia?

Back 37

esophageal dysphasia to liquids and solids, chest pain, regurgitation

Front 38

How is Eosinophilic Esophagitis dx'ed?

Back 38

DIAGNOSIS REQUIRES > 20 ESOSINOPHILS PER HIGH POWERED FIELD