Gi - Leonard - Esophagus

Front 1

Define Odynophagia

Back 1

Pain when esophagus is trying to do its normal work, like swallow

Front 2

What are the symptoms of esophageal atresia?

Back 2

vomiting, regurgitation

Front 3

Whats the most common fistula of the esophagus?

Back 3

TE, or Transesophageal fistula

Front 4

What are webs and rings in the esophagus?

Back 4

Webs = shelves
Rings = Circumferential

Front 5

Where do we mostly find Webs? Rings?

Back 5

Webs = upper esophagus

Rings = Lower esophagus (makes sense, b/c lower in the esoph the rings of the trachea begin...)

Front 6

Define Plummer Vinson syndrome

Back 6

A triad seen with WEBS: Iron def. anemia, glossitis (big tongue), Cheilosis (cracked lips)

Front 7

Pt has long-standing GERD. What esophageal abnormality will they have?

a. webs
b. rings

Back 7

WEBS

Front 8

What is a diverticula? What are the two types of esophageal diverticula that can form?

Back 8

Diverticula = pocket

Pseudo-diverticula (=lack cell walls)

True Diverticula

Front 9

What are the three types of diverticula? How do we distinguish them?

Back 9

Zenker, Traction, Epiphrenic

Based on their LOCATION in esopahgus

Zenker = above UES
Traction = mid esophagus
Epiphrenic = Above LES

Front 10

Define inlet patch of the esopphagus

Back 10

A congenital island of ectopic (=abnormal) gastric mucosa

Seen in as many as 10% of endoscopies ie THEY ARE COMMON

Front 11

What things can cause esophageal stenosis?

Back 11

Persistent GERD

Radiation

Basically anything causing prolonged epi damage to esophagus

Front 12

Define Achalasia of the esophagus

Back 12

Impaired sm. muscle relaxation of LES

=LES doesn't relax all the way, Inc. tone of LES, Aperistalsis = imbalance or failure of inhibitory neurons

Front 13

What is the primary cause of Achalasia?

Back 13

Idiopathic

Front 14

What is a secondary cause of Achalasia?

Back 14

Chagas , b/c it can destroy enteric ganglion cells

ALSO: Infiltrative disorders (amyloidosis, malignancy, sarcoidosis), diabetic neuropathy

Front 15

Pt comes in with portal hypertension, esophageal varices, and upper GI bleeding. What should be on your list of possible Dxs?

Back 15

Liver disease

Front 16

How do esophageal varices form?

Back 16

Portal hypertension causes collateral blood vessels to form = esophageal varices

Front 17

A patient with portal hypertension, esophageal varices, and upper GI bleeding presents with massive hematemesis. What has most likely occured?

Back 17

They have most likely ruptured one of their esophageal varices

Front 18

Define Mallory-Weiss tear

Back 18

Longitudinal tear in esophgus near GE junction

Front 19

A pt presents with severe retching and vomiting after a 3 day bender where much alcohol was consumed. Dx?

Back 19

B/c of the alcohol its prob a Mallory Weiss tear but another type of tear is the Boerhaave syndrome

Front 20

Define Hiatal hernia....What are the two types?

Back 20

Herniation of stomach through esophageal diaphragmatic hiatus

Two types = sliding and Paraesophageal

Front 21

Which type of hiatal hernia presents with the fundus of the stomach protruding upwards?

Back 21

Paraesophageal

Causes more symptoms that sliding hernia

Front 22

Which type of hiatal hernia presents with the cardia of stomach protruding upwards?

Back 22

Sliding

Front 23

Define Esophagitis

Back 23

Epi damage and inflamm

Front 24

Most common cause of Esophagitis?

Back 24

GERD

Front 25

What are the dif. types of esophagitis?

Back 25

GERD
Eosinophilic/Allergic
Infectious

*** However eosinophilic inflamm is common to ALL forms of esophagitis

Front 26

B/c eosinophilic inflamm is common to ALL forms of esophagitis, how do we distinguish it?

Back 26

True Eosinophilic Esophagitis is RESTRICTED TO THE esophagus = esp in Proximal and Mid-esophagus (vs. GERD = DISTAL Esophagus)

Front 27

Where in esophagus is GERD esophagitis seen?

Back 27

DISTAL

Front 28

In what pts do we see Infectious esophagitis?

Back 28

Immunocompromized

Front 29

What are some of the causes of infectious esophagitis?

Back 29

HSV = herpes = Herpetic ulcers

CMV

Candida (esp in HIV pts)

Front 30

Pt has ulcers in esophagus. What caused them?

Back 30

herpes ie infectious esophagitis

OR if they're well circumscribed (and multiple) = CMV

Front 31

Pt presents with multiple, well-circumscribed ulcers in esophagus and pseudo-hyphae within tissue. Can we treat with Acyclovir?

Back 31

We're thinking the cause of this infectious esophagitis is CMV b/c 1. multiple 2. well-circumscribed 3. pseudo-hyphea

NO Acyclovir will NOT treat CMV

Front 32

Where do HIV pts who have small white plaques, or candida esophagitis get the candida from?

Back 32

Candida is normal GI flora

Front 33

How do we treat esophagitis that presents with eosinophils in proximal and mid esophagus?

Back 33

This is true Eosinophilic Esophagitis

Tx = Corticosteroids

Front 34

A pt presents with CNS depressant use, is pregnant, smokes, has hypothyroidism, hiatal hernia, systemic sclerosis and complains of chest pain (heartburn) after eating. What do they have?

Back 34

GERD esophagitis

All these presenting signs are risk factors for Chornic exposure of esophagus to gastric juices

Front 35

How do we treat GERD esophagitis?

Back 35

Promote motility, H2 receptor blocker, PPI

If those don't work, Sx

Front 36

If we see intestinal goblet cell metaplasia, what has our GERD turned into?

Back 36

Barrett Esophagus

Front 37

Pt has Barrett esophagus, or intestinal goblet cell metaplasia. What do you tell them they are at risk for?

Back 37

Esophageal adenocarcinoma

Front 38

Barrett esophagus, which is goblet cell metaplasia, can be associated with what other changes in cells?

Back 38

Neoplastic change in glandular epi cells in metaplastic area

Front 39

Pathogist grade's your pts. neoplastic change in glandular epi cells as HIGH. What do you tell the pt regarding their risk of esophageal adenocarcinoma?

Back 39

HIGH

Front 40

95% of esophageal neoplasms are what? Due to what?

Back 40

Adenocarcinoma

Due to long standing GERD and Barrett esophagus

Front 41

Who most often presents with Esophageal Adenocarcinomas?

Back 41

MEN (7:1 vs. women)

Front 42

How do we stage esophageal adenocarcinomas and squamous esophaeal neoplasms?

Back 42

T-N-M

Front 43

HPV is a risk factor what Which esophageal cancer

a. adenocarcinoma
b. squamous cell carcinoma

Back 43

squamous cell carcinoma

Front 44

What does T-N-M stand for?

Back 44

T = superficial or deep
N = Node metastasis
M = Metastasis (distant, like to tissues etc)