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25 Cards in this Set
- Front
- Back
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3 types of esophageal disorders
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1. Motility
2. Gastroesophageal reflux 3. Neoplasms |
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Myriad of ways a motility disorder can present
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1. Heartburn
2. Halitosis 3. Dysphagia 4. Regurgitation 5. Vomiting 6. Wt. Loss 7. Belching 8. Chest Pain |
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5 Examples of Motility Disorders
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1. Scleroderma
2. Reflux 3. Achalasia 4. Nutcracker Esophagus 5. Diffuse Esophageal Spasm |
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Diffuse Esophageal Spasm
general definition |
Non-specific, non-propagated motility disorder
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Diffuse Esophageal Spasm
presentation |
Chest Pain
Dysphagia for solids and liquids (ESP COLD ONES) |
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Diffuse Esophageal Spasm
Tests |
Barium Swallow (reveals Corkscrew)
Esophageal Manometry (spastic) |
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Diffuse Esophageal Spasm
Rx |
Nitrates
Ca Channel Blockers Esophageal Dilation |
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Achalasia
Definition |
Failure of lower esophageal sphincter to relax due to loss of ganglion cells in the myenteric plexus and loss of VIP and NO
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Achalasia
Tests |
Barium Swallow (shows big dilation)
Upper GI Endoscopy Esophageal Manometry (nada) Chest X-Ray (to rule out pneumonia) |
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Achalasia
Presents with? |
Vomiting (old stuff)
Halitosis Wt. Loss Possible Pneumonia (due to aspriating food) |
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Achalasia
Rx |
Ca Channel Blockers and Nitrates
Sildenafil (viagra)to block PDE and increase cGMP-->relaxation Dilation Botulinum toxin Myotomy (cut the muscle) |
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Gastroesophageal Reflux
Etiology |
Inappropriate relaxation of the lower esophageal sphincter (LES)
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Gastroesophageal Reflux
What cause an increase in LES pressure? |
Motilin
ACh Gastrin |
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Gastroesophageal Reflux
What causes a decrease in LES pressure? |
Progesteron
Chocolate Smoking Anticholinergic Drugs Connective Disorders (like scleroderma) |
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Gastroesophageal Reflux
Presents with? |
Heartburn
ENT issues (change in voice) Reflux into lungs (asthma) Dental Problems Dysphagia-->anemia Chest Pain |
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Gastroesophageal Reflux
Tests |
Barium Swallow
Upper GI endoscopy Manometry 24hr pH Acid Infusion Test (berstein) Nuclear Scan |
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Gastroesophageal Reflux
Rx (non pharm) |
Non-Pharm
Wt reduction Stop smoking, boozing, NSAIDs, cokes, tight clothing, elevate head end of bed |
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Gastroesophageal Reflux
Rx (pharm) |
Antacids
H2-receptor antagonists, sucralfate, prokinetics Proton Pump Inhibitors |
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Gastroesophageal Reflux
Rx (endoscopic and surgical) |
Endo:
Suturing Radiofrequency Therapy Surg: Fundoplication |
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Gastroesophageal Reflux
Complications |
Anemia
Extraesophageal Stricture GI bleeding Barret's esophagus and cancer Barret's ulcer |
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Two Types of Neoplastic Conditions?
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Squamous Cell Carcinoma
Adenocarcinoma |
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Risk Factors for Esophageal Cancer
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Achalasia
Vit A, Riboflavin, or Fe Deficiency Obesity Tylosis Radiation Corrosive Esophagus Geographic location Barrett Smoking Booze |
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Clinical Fts of Esophageal Cancer
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Bleeding
Metastasis Aspiration Anemia Wt. loss Dysphagia Chest Pain Nutritional Def. |
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Tests for Neoplastic Conditions
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CXR
CT Scan Upper GI Endoscopy Endoscopic Ultrasound PET Scan |
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Therapeutic Options for Neoplasms
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Curative:
Chemo/Radiation Surgery Palliative: Stent Tumor debulking by laser Nutrition |
