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28 Cards in this Set
- Front
- Back
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What type of epithelium lines the esophagus compared to the rest of the GI tract?
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squamous cell epithelium vs columnar in the rest of the GI tract
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Manometry helps differentiate between?
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Hiatal hernia vs GERD
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***Type 1 Hiatal Hernia
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-"sliding"
-goes through the diaphragm -MC hernia -100:1 (compared to paraesophageal) |
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Type 2 Hiatal Hernia
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-Paraesophageal
-part of the stomach pushes on the side |
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What is the Patho of Type 1 Hiatal Hernia?
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-LES sphincter mechanism becomes incompetent - not a "true" sphincter
-reflux of acid gastric juice -may lead to mucosal erosion, ulceration, and scarring |
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Prevalence of Type 1 Hiatal Hernia***
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-MC in women who have been prego
-M&F w/ inc intrabd pressure -***w/ reflux is freq found in pts who are overweight, due to incr intraabd pressure pushing upwards -many pts have no sx |
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Symptoms of Type 1 Hiatal Hernia***
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-burning epigastric or substernal pain or tightness, w/ no radiation
-confused w/ pain of MI -**Put pt lying and upsidedown -> stomach will go above diaphragm if there is a hernia -> able to see w/ xray or endoscopy |
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What late symptoms of Type 1 Hiatal hernia suggest stricture formation?
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-dysphagia and vomiting
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What is the clinical presentation of Type 2 Hiatal Hernia***
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-generally no sx until they incarcerate and become ischemic
-**dysphagia, bleeding, occasionally resp distress are the presenting sx -very dangerous and rare but needs surgery every time!*** |
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What confirms hiatal hernia and reflux esophagitis diagnosis?***
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Fluoroscopy using a barium swallow
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Tx of hiatal hernias
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1. avoidance of gastric stimulants
2. Elimination of tight garments 3. Reg use of antacids 4. inc the pH of reflux gastric juice (H blockers, maybe metoclopramide 5. don't eat/drink before bed 6. wt loss in obese pts |
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What is surgical nissen fundoplication?**
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-wrap gastric fundus stomach around the LES and stitch in place
-when stomach contracts it closes the esophagus instead of putting gastric acid into it (no GERD) |
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Highlights of Achalasia***
(see Jones for more info) |
-failure to relax not due to spasm
-painless dyspagia -asp PNA is common -complain of spitting up foul-smelling secretions simply when leaning forward |
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***Diagnosis and Tx of Achalasia
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-*dilation of proximal esophagus is classic, "bird's beak" on Xray
-med tx not helpful -***surgical transaction of the muscle, esophageal myotomy--> Tx of choice |
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What is the 2nd MC manifestation of esophageal motility disorders?***
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-Esophageal Diverticulum
-Pulsion or traction --> depending on the mech that leads to their development (pulsion MC) |
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*What are Cervical (Zenker's) dirverticula?
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-pulsion are are closely related to dysfxn of cricopharyngeal muscle
-c/o regurg of recently swallowed food -putrid breath odor -tx by excision of diverticula and myotomy of circopharyngeal muscle |
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Diverticula of the distal third of the esophagus are a/w?
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-dysfunction of the esophagogastric junction as a result of chronic stricture from acid reflux, antireflux surgical procedures, achalasia
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Diverticula of the middle third of the esophagus are a/w?
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-mediastinal inflammation from TB or histoplasmosis, which results in scar formation and subsequent contracture that places "traction" on the esophagus
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Benign Esophageal Neoplasms
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-rare, leiomyomas are the MC intramural tumors
-potential for malig degen quite low -indent the lumen of esophagus on contrast radiography |
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Malignant Esophageal Neoplasms
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-usually arises from squamous epi
-commonly in black men in a/w alcohol or tobacco abuse ***~10% of pts w/ Barrett's esophagus will have adenoCA |
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Making the diagnosis of Malignant Esophageal Neoplasms***
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-***Endoscopy is the gold standard of diagnosis w/ biopsy
-operate on the type and stage of the cancer. Need to see extent of tumor involvement via CT of chest and upper abd -"Apple core" on barium swallow |
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How do you tx tumors in the upper esophagus?
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-radiotx is the primary mode
-surgery tx, take part of jejunum |
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How do you tx tumors in the middle esophagus?
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-usually tx by a staged procedure w/ total thoracic esophagectomy and bypass
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How do you tx tumors in the lower esophagus?
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-best tx by esophagogastric resection and end to end anastomosis in mid chest
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What is a Bochdalek type of diaphragmatic hernia?
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-stomach in chest due to rupture of diaphragmatic hernia
-place nasogastric tube to decompress stomach |
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What happens in traumatic rupture of the diaphragm?
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-it is from inc intra-abd pressure
-displacement of lung -stomach is above diaphragm -can also see spleen above b/c it is attached to the stomach |
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***What is Boerhavve's syndrome
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-spontaneous perforation secondary to forceful vomiting
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What happens when you ingest caustic material?
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-inspect mouth to assess injury
-neutralization and induced emesis is not usually recommended, bc caustic material will redamage esophagus -endscopy, airway, patency of esophagus, NO STEROIDS |
