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93 Cards in this Set
- Front
- Back
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Esophogus fails to unite
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atresia
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interconnection between the esophogus and trachea
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fistula
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What is a possible diagnostic indicator for atresia/fistula?
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maternal hydramnios
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What are 86% of atresias associated with?
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fistulas
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What is the most common type of fistula?
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at the tracheal carina
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Signs and Symptoms of atresia/fistulas
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"SACCA"
1) excessive secretions 2) coughing & cyanosis when swallowing 3) aspiration pneumonia 4) distended abdomen |
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Diagnosis for atresia/fistula
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-inability to pass nasogastric tube into stomach
-radiopaque catheter may show location on x-ray -radiopaque dye under fluoroscopy (risk=chemical pneumonia due to dye) |
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Treatment for atresia/fistula
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-is surgery delayed = gastrostomy to empty stomach
-thoracotomy to repair atresia & close fistula |
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Complication from treatment of atresia/fistula?
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leakage at anastomosis and/or stricture
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Prognosis of atresia/fistula
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-feeding difficulties after due to poor motility or GERD
-Nissen fundoplication to relieve GERD |
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failure of lower esophagel sphincter to relax or spasm of LES
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achalasia
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cause of achalasia?
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unknown
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age group for achalasia
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any age, but usually begins b/t ages 20 & 40
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Signs and symptoms of achalasia?
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"DCs & RN"
1) dysphagia of solids & liquids 2) chest pain/substernal fullness 3) regurgitation 4) nocturnal cough 5) insidious onset over many months or years |
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Diagnosis of achalasia
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-barium x-ray
*birds beak *rats tail |
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Ddx for achalasia
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- scleroderma
-stenosing carcinoma -stricture, diffuse esophageal spasm |
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Treatment for achalasia
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-eat small portions, slowly, and with liquids
-chew thoroghly -drugs to relax smoot muscle -pneumatic dilation of sphincter w/ a tube dilating instrument |
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Prognosis of achalasia
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-may complicate w/ aspiration pneumonia
-5% develop esophageal squamous cell carcinoma -esophagitis, lower esophageal diverticula (epiphrenic diverticulum) |
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having a sensation of a lump in the throat
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globus hystericus
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experiened with extreme emotions (anxiety, grief, fear, exhilaration)
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globus hystericus
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What type of complaint is globus hystericus?
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subjective
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Diagnosis of globus hystericus
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-need to rule out organic diseases
-food does not stick -usually relieved with food or drink -special test wth not reveal anything |
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Ddx for globus hystericus
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-esophageal webs (plummer-vincent syndrome)
-diffuse esophageal spasm -GERD -muscle disorders -malignancy |
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Treatment for globus pallidus
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-reassurance & sympathy to calm down individual
-get tx for any underlying depression or anxiety disorders |
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dilated & tortuous superfical esophageal veins that may rupture
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esophageal varices
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upper GI bleed ("above" duodenum)
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esophageal varices
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What causes esophageal varices?
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hepatic portal hypertension
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Sign & symptoms of esophageal varices
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-hematemesis
-coffee ground vomitus -substernal pain -black tarry stool |
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vomiting bright red blood is called?
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hematemesis
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What do you call coagulated and digested blood?
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coffee ground vomitus
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What causes substernal pain in esophageal varices?
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pressure on the esophagus
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What do you call black tarry stools?
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melena
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Diagnosis of esophageal varices
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-endoscopy
-hepatic venogram w/ dye injection -positive Gualac test |
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What tests for blood in the stool?
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Gualac test
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Ddx for esophageal varices
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- gastritis
-esophagea laceration -peptic ulcers |
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Tx for esophageal varices
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-if emergency = balloon tamponade
-sclerotherapy -variceal ligation or banding |
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Prognosis for esophageal varicies
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-40-50% die w/ first major bleed
-survivors have a recurrence w/in 1 yr & 1/2 will die -if tx in time, or small bleed = survival rate increases |
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6% of all malignant GI tumors
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carcinomas of the esophogus
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Why do carcinomas of the esophogus have a high mortality rate?
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NOT symptomatic during development
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Which cells make up the esophogus?
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stratified squamous epithelium
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Which malignant tumor of the esophogus constitutes 90% worldwide & usually upper 2/3?
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squamous cell carcinoma
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If GERD is untreated, what can it lead to?
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Barrett's esophagus
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If Brrett's esophagus is not treated, what can it lead to?
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adenocarcinoma
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Which malignant tumor of the esophagus costitues 50-80% in the US?
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adenocarcinoma
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Adenocarcinoma affects which part of the esophagus?
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lower 1/3
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Squamous cell carcinoma affects which part of the esophagus?
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upper 2/3
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Age for malignant tumors of the esophagus
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adults over 50
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Risk factors for malignant tumors of the esophagus in the US
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1) alcohol
2) tobacco |
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Risk factors for malignant tumors of the esophagus abroad.
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1) dietary
2) environment |
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Sign and symptoms of malignant tumors of the esophagus
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-dysphagia & odynophagia
-weight loss -chest pain -disrupted peristalsis -nausea, vomiting, regurgitation, & coughing |
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difficulty swallowing
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dyphagia
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painful swallowing
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odynophagia
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Diagnosis for malignant tumors of the esophagus
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-barium x-ray
-endoscopic exam -CT scan -biopsy |
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Tx for malignant tumors of the esophagus
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-surgery
-if stage I = endoscopic removal -stent = palliative care -resection of part of esophagus if large lesion & pts health can tolerate |
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Prognosis for malignant tumors of the esophagus
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-poor
-5 yr survival is less than 20% -most die w/in 1st yr of diagnosis |
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Stage I tumor development
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In situ (only affects 1 layer of tissue)
-mucosa -submucosa |
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Stage II tumor development
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More than 1 layer of tissue is affected
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Stage III tumor development
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More than 1 layer of tissue is affected
-lymph node involvement -adjacent structures |
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Stage IV tumor development
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metastasis to distant structures
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What is a risk factor for esophageal adenocarcinoma?
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Barrett's esophagus
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What is a complication of longstandng GERD?
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Barrett's esophagus
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Replacemet of squamous epithelium with metaplastic pseudocolumnar epithelium of the lower part of the esophagus.
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Barrett's esophagus
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Signs and symptoms of Barrett's Esophagus
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-dysphagia
-hematemesis -constant heartburn -pain deep to the breastbone -weight loss |
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Diagnosis for Barrett's Esophagus
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-endoscopic exam
-biopsy |
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Tx of Barrett's Esophagus
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-watch the person (diet)
-endoscopic resection or ablation (if cells mutate to high grade dysplasia) -esophagectomy |
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Prognosis for Barrett's Esophagus
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-pre-malignant condition
-50% of high grade dysplasia found to have adenocarcinoma -more than 80% mortality rate with adenocarcinoma |
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uncoordinated contractions of the esophagus
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diffuse esophageal spasm
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"corkscrew" esophagus
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diffuse esophageal spasm
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Etiology of diffuse esophageal spasm?
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unknown
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Does not transport food properly down esophagus?
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diffuse esophageal spasm
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Signs and symptoms of diffuse esophageal spasm
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1) severe chest pain
2) dysphagia 3) regurgitation |
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Diagnosis for diffuse esophageal spasm
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barium x-ray
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Tx for diffuse esophageal spasm
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-self resolving condition
-nitroglycerin -calcium channel blockers -botulinum toxin -endoscopic balloon dilation |
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interruption of blood supply to an area of the heart
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myocardial infarction
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What does a myocardial infarction lead to?
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damage or death of the cardiac muscle
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Myocardial infarction pain has a similar pattern to what?
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esophageal diseases
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Signs and symptoms of a myocardial infarction
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- chest, epigastric, neck & jaw pain
- shortness of breath - nausea/vomiting - sweating -anxiety -pain usually lasts longer than 20 minutes |
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Diagnosis of myocardial infarction
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- electrocardiogram (Q wave)
-blood test -echocardiogram |
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What are the cardiac markers in a blood test indicating a pt has a myocardial infarction?
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1) creatine kinase
2) troponin |
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Palliative tx for a myocardial infarction
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-oxygen
-aspirin -nitroglycerine -morphin (decrease pain) |
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What does an echocardiogram show?
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circulation through the chambers of the heart
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Which part of an electrocardiogram is looked at to see if a pt has a myocardial infarction?
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Q-wave
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chest discomfort due to ischemia with exertion or at rest
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angina pectoris
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Etiology of an angina pectoris
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atherosclerosis of coronary arteries
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Signs & symptoms of angina pectoris
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- chest discomfort described as tightness, heaviness, or a choking sensation
-epigastric discomfort -nausea, vomiting -pallor |
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Diagnosis of angina pectoris
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-stress test with electrocardiogram
-coronary angiogram |
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If a pt has an angina pectoris, what will a stress test with electrocardiogram show?
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ST segment depression
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Palliative tx for angina pectoris
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-nitroglycerin
-beta & calcium channel blockers (decrease workload of the heart) |
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AKAs for Prinz-Metal variant angina
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1) variant angina
2) angina inversa |
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chest pain at rest which could occur in cycles is called?
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Prinz-Metal variant angina
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Etiology of Prinz-Metal variant angina
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vasospasm of coronary arteries
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Diagnosis of Prinz-Metal variant angina
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-angiogram w/ ergonovine IV as a provocation test
-electrocardiogram |
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What will an electrocardiogram show if a pt has Prinz-Metal varian angina?
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ST segment elevation
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