Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
88 Cards in this Set
- Front
- Back
|
What are the three anatomical constrictions of the esophagus?
|
cricopharyngeus; UES; LES
|
|
|
What is atresia?
|
absence of the lumen
|
|
|
What is stenosis?
|
narrowing
|
|
|
What is diverticulosis?
|
formation of outpouches
|
|
|
What is a fistula?
|
connection between two lumens
|
|
|
What is dysphagia?
|
difficulty swallowing
|
|
|
What is odynophagia?
|
pain swallowing
|
|
|
Where is heartburn located?
|
burning sensation behind sternum
|
|
|
What is treatment of esophageal atresia with tracheoesophageal fistula?
|
immediate surgical correction
|
|
|
Describe esophageal atresia with tracheoesophageal fistula?
|
lumen of esophagus ends in a blind pouch
|
|
|
What is the result of esophageal atresia with tracheoesophageal fistula?
|
food can not pass into stomach; food passes into trachea
|
|
|
What are S/S of esophageal atresia with tracheoesophageal fistula?
|
choking and coughing
|
|
|
What are the three ways by which esophageal diverticula are classified?
|
structure, location, pathogenesis
|
|
|
What are the structural classifications of an esophageal diverticula?
|
true and false
|
|
|
What is a true diverticula?
|
composed of all four layers of normal esophageal wall
|
|
|
What is a false diverticula?
|
outpouching occurs only in mucosa and submucosa layers
|
|
|
What are the classifications based on location (esophageal diverticula)?
|
upper esophageal, midportion, and epiphrenic
|
|
|
How is a Zenker's diverticula formed?
|
over time increased intrapharyngeal pressure due to FUNCTIONAL obstruction
|
|
|
How is Zenker's diverticula classified?
|
false and pulsion diverticula
|
|
|
What are the pathogenic classifications of esophageal diverticula?
|
tractional and pulsion
|
|
|
What is a tractional diverticula?
|
PULL from the OUTSIDE; fibrous adhesions
|
|
|
What is a pulsion diverticula?
|
PUSH from the INSIDE; increased intraluminal pressure
|
|
|
What is the manifestation of a Zenker's diverticula?
|
older women; posteriorly at sight of thyropharyngeal m; inferior boundary is cricopharyngeal m
|
|
|
What type of esophageal diverticula is associated with lymph node infection a/w TB?
|
midportion
|
|
|
What are the classifications typically of a midportion esophageal diverticula?
|
true and pulsion
|
|
|
What esophageal diverticula is a/w diaphragmatic hernias and GERD?
|
ephiphrenic
|
|
|
Where is an epiphrenic diverticula generally located (3)?
|
distal portion of esophagus; lateral wall; RIGHT > left
|
|
|
What esophageal diverticula is a/w hiatal hernias?
|
epiphrenic
|
|
|
How are epiphrenic esophageal diverticula generally classified?
|
false and pulsion
|
|
|
What happens in laryngopharyngeal reflux?
|
UES does not work properly and acid backflows into esophagus, enters throat in larynx
|
|
|
If a patient suffers with chronic cough, voice fatigue or changes, a globus sensation and a sore throat, what should be suspected?
|
laryngopharyngeal reflux
|
|
|
What are the two types of dysphagia?
|
transfer and transport
|
|
|
When does transfer dysphagia happen?
|
early in swallowing process
|
|
|
What are the S/S of transfer dysphagia?
|
coughing, gagging, nasal regurgitation
|
|
|
What is involved with transport dysphagia?
|
impaired movement down esophagus through LES; feeling food "getting stuck"
|
|
|
Patients with neurological problems generally have more difficulty swallowing liquids or solids?
|
liquids
|
|
|
Patients with structural problems generally have more difficultly swallowing liquids or solids?
|
solids
|
|
|
If a patient is greater than 40 years old with dysphagia, what should be suspected?
|
neoplasm
|
|
|
What S/S is indicative of presence of a neoplasm?
|
fast progression from solids to liquids dysphagia
|
|
|
In what instances must you rule out malignancy as a cause of dysphagia?
|
neoplasm and esophageal strictures
|
|
|
How does an esophageal stricture develop?
|
over years from scarring due to GERD
|
|
|
If a patient has symptoms of dysphagia, developing over years, of solids, what should be suspected?
|
esophageal stricture
|
|
|
What are the most common structural abnormalities of the esophagus?
|
webs and rings
|
|
|
What structural abnormality of the esophagus is a/w glossitis and iron deficiency anema?
|
webs (Plummer Vinson Syndrome)
|
|
|
Describe webs (3).
|
mucosal folds causing narrowing of lumen; thin constrictions; proximally located
|
|
|
What is the treatment for webs and rings?
|
dilation
|
|
|
What is the most common cause of intermittent dysphagia with solids?
|
schatzki ring
|
|
|
What are schatzki rings?
|
prominant, smooth, annular narrowing of the DISTAL esophagus
|
|
|
How is a schatzki ring best visualized?
|
with a valsalva maneuver at full inspiration in prone patient during barium swallow
|
|
|
What is the number one motor lesion cause of dysphagia?
|
CVA
|
|
|
If you have a patient with intermittent symptoms, difficulty swallowing liquids, what would you suspect?
|
neuromuscular disorder
|
|
|
If you have a 20 - 40 year old male, with S/S of regurgitation, weight loss, and odonophagia, what would you suspect?
|
achalasia
|
|
|
What is the cause of achalasia?
|
impaired LES relaxation; absence of esophageal peristalsis thus bolus of food becomes trapped in esophagus PROXIMAL to stricture
|
|
|
What is the pathogenesis of achalasia?
|
viral infection/environmental factors
|
|
|
How would you diagnose achalasia?
|
barium swallow with BIRD'S BEAK at LES
|
|
|
What is the surgical treatment of achalasia?
|
myotomy (Heller's myotomy)
|
|
|
What is the non-surgical treatment of achalasia?
|
CCBs, long acting nitrates; pneumatic dilation; botulinum toxin to LES
|
|
|
What is the most effect non-surgical treatment of achalasia?
|
pneumatic dilation
|
|
|
What esophageal motility disorder requires manometry for diagnosis?
|
diffuse esophageal spasm
|
|
|
If, on barium swallow, you note a CORKSCREW esophagus, what do you suspect?
|
esophageal spasm
|
|
|
What is the treatment for diffuse esophageal spasm?
|
CCBs, nitrates, botulinum toxin; anoxilytic agents in conjunction with anti-reflux therapy
|
|
|
If you have patient who complains of angina-like chest pain, with pain at night, spontaneous onset, regurgitation, odynophagia, dysphagia that is meal induced, what should you suspect?
|
nutcracker esophagus
|
|
|
How would you diagnose nutcracker esophagus?
|
high amplitude, long duration contractions; with high pressure waves (>180 mmHg) in distal esophagus
|
|
|
What is the most common form of esophagitis?
|
chemical
|
|
|
What is the #1 cause of infectious esophagitis?
|
candida
|
|
|
What is the most common cause of chemical esophagitis (GERD)?
|
HCL regurgitated from the stomach
|
|
|
What are complications of GERD?
|
esophageal strictures, ulcers, bleeding, perforation, Barret's esophagitis, esophageal adenocarcinoma
|
|
|
What is Barret's esophagitis?
|
metaplasia of esophagus
|
|
|
What is Barrett's esophagitis most often caused by?
|
GERD
|
|
|
What section of esophagus is typically involved with Barrett's Esophagus?
|
lower segment
|
|
|
How do you diagnose Barrett's esophagus?
|
endoscopy, SALMON RED patches, COLUMNAR replacing squamous epithelium
|
|
|
What is the #1 cause of esophageal perforation?
|
endoscopy
|
|
|
What is Boerhaave Syndrome?
|
emesis-induced esophageal perforation
|
|
|
What type of esophageal perforation is generally seen in alcoholics?
|
Boerhaave Syndrome
|
|
|
If you have a patient who claims to drink a six-pack of beer every night and has severe vomiting with severe chest pain/dyspnea following, what should you suspect?
|
Boerhaave Syndrome
|
|
|
What is Hammon's crunch and what is it indicative of?
|
air in mediastinum being moved by beating heart; esophageal perforation
|
|
|
What is an associated finding of esophageal perforation?
|
cervical crepitis caused by pneumomediastinum
|
|
|
How is esophageal perforation diagnosed?
|
CXR (first GASTROGRAFIN); CT/Endoscopy confirms
|
|
|
What is the most common cause of esophageal bleeding?
|
cirrhosis
|
|
|
What is first line for control of esophageal bleeding?
|
endoscopy
|
|
|
Describe Mallory-Weiss Syndrome.
|
ARTERIAL bleeding from longitudinal mucosal lacerations of DISTAL esophagus/PROXIMAL stomach
|
|
|
What is treatment initially of Mallory-Weiss Syndrome?
|
supportive, as most stop spontaneously
|
|
|
What is the treatment for ongoing Mallory-Weiss Syndrome?
|
electrocoagulation, sclerotherapy, laser photocoagulation, angiographic embolization, surgery
|
|
|
What is the cause of Mallory-Weiss Syndrome?
|
violent retching, large food
|
|
|
What population is Mallory-Weiss typically seen in?
|
alcoholics
|
|
|
What is the most common type of esophageal cancer?
|
adenocarcinoma arising from Barrett's Mucosa
|
|
|
If you see a patient with smooth appearing hands and dysphagia, what should you suspect?
|
scleroderma
|
|
|
What is sclerodactyly?
|
diffuse thickening of skin on hands; smooth appearance
|
