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93 Cards in this Set

  • Front
  • Back
Esophogus fails to unite
atresia
interconnection between the esophogus and trachea
fistula
What is a possible diagnostic indicator for atresia/fistula?
maternal hydramnios
What are 86% of atresias associated with?
fistulas
What is the most common type of fistula?
at the tracheal carina
Signs and Symptoms of atresia/fistulas
"SACCA"

1) excessive secretions
2) coughing & cyanosis when swallowing
3) aspiration pneumonia
4) distended abdomen
Diagnosis for atresia/fistula
-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)
Treatment for atresia/fistula
-is surgery delayed = gastrostomy to empty stomach

-thoracotomy to repair atresia & close fistula
Complication from treatment of atresia/fistula?
leakage at anastomosis and/or stricture
Prognosis of atresia/fistula
-feeding difficulties after due to poor motility or GERD

-Nissen fundoplication to relieve GERD
failure of lower esophagel sphincter to relax or spasm of LES
achalasia
cause of achalasia?
unknown
age group for achalasia
any age, but usually begins b/t ages 20 & 40
Signs and symptoms of achalasia?
"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
Diagnosis of achalasia
-barium x-ray
*birds beak
*rats tail
Ddx for achalasia
- scleroderma
-stenosing carcinoma
-stricture, diffuse esophageal spasm
Treatment for achalasia
-eat small portions, slowly, and with liquids

-chew thoroghly

-drugs to relax smoot muscle

-pneumatic dilation of sphincter w/ a tube dilating instrument
Prognosis of achalasia
-may complicate w/ aspiration pneumonia

-5% develop esophageal squamous cell carcinoma

-esophagitis, lower esophageal diverticula (epiphrenic diverticulum)
having a sensation of a lump in the throat
globus hystericus
experiened with extreme emotions (anxiety, grief, fear, exhilaration)
globus hystericus
What type of complaint is globus hystericus?
subjective
Diagnosis of globus hystericus
-need to rule out organic diseases

-food does not stick

-usually relieved with food or drink

-special test wth not reveal anything
Ddx for globus hystericus
-esophageal webs (plummer-vincent syndrome)

-diffuse esophageal spasm

-GERD

-muscle disorders

-malignancy
Treatment for globus pallidus
-reassurance & sympathy to calm down individual

-get tx for any underlying depression or anxiety disorders
dilated & tortuous superfical esophageal veins that may rupture
esophageal varices
upper GI bleed ("above" duodenum)
esophageal varices
What causes esophageal varices?
hepatic portal hypertension
Sign & symptoms of esophageal varices
-hematemesis

-coffee ground vomitus

-substernal pain

-black tarry stool
vomiting bright red blood is called?
hematemesis
What do you call coagulated and digested blood?
coffee ground vomitus
What causes substernal pain in esophageal varices?
pressure on the esophagus
What do you call black tarry stools?
melena
Diagnosis of esophageal varices
-endoscopy

-hepatic venogram w/ dye injection

-positive Gualac test
What tests for blood in the stool?
Gualac test
Ddx for esophageal varices
- gastritis
-esophagea laceration
-peptic ulcers
Tx for esophageal varices
-if emergency = balloon tamponade

-sclerotherapy

-variceal ligation or banding
Prognosis for esophageal varicies
-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
6% of all malignant GI tumors
carcinomas of the esophogus
Why do carcinomas of the esophogus have a high mortality rate?
NOT symptomatic during development
Which cells make up the esophogus?
stratified squamous epithelium
Which malignant tumor of the esophogus constitutes 90% worldwide & usually upper 2/3?
squamous cell carcinoma
If GERD is untreated, what can it lead to?
Barrett's esophagus
If Brrett's esophagus is not treated, what can it lead to?
adenocarcinoma
Which malignant tumor of the esophagus costitues 50-80% in the US?
adenocarcinoma
Adenocarcinoma affects which part of the esophagus?
lower 1/3
Squamous cell carcinoma affects which part of the esophagus?
upper 2/3
Age for malignant tumors of the esophagus
adults over 50
Risk factors for malignant tumors of the esophagus in the US
1) alcohol
2) tobacco
Risk factors for malignant tumors of the esophagus abroad.
1) dietary
2) environment
Sign and symptoms of malignant tumors of the esophagus
-dysphagia & odynophagia
-weight loss
-chest pain
-disrupted peristalsis
-nausea, vomiting, regurgitation, & coughing
difficulty swallowing
dyphagia
painful swallowing
odynophagia
Diagnosis for malignant tumors of the esophagus
-barium x-ray
-endoscopic exam
-CT scan
-biopsy
Tx for malignant tumors of the esophagus
-surgery
-if stage I = endoscopic removal
-stent = palliative care
-resection of part of esophagus if large lesion & pts health can tolerate
Prognosis for malignant tumors of the esophagus
-poor
-5 yr survival is less than 20%
-most die w/in 1st yr of diagnosis
Stage I tumor development
In situ (only affects 1 layer of tissue)
-mucosa
-submucosa
Stage II tumor development
More than 1 layer of tissue is affected
Stage III tumor development
More than 1 layer of tissue is affected
-lymph node involvement
-adjacent structures
Stage IV tumor development
metastasis to distant structures
What is a risk factor for esophageal adenocarcinoma?
Barrett's esophagus
What is a complication of longstandng GERD?
Barrett's esophagus
Replacemet of squamous epithelium with metaplastic pseudocolumnar epithelium of the lower part of the esophagus.
Barrett's esophagus
Signs and symptoms of Barrett's Esophagus
-dysphagia
-hematemesis
-constant heartburn
-pain deep to the breastbone
-weight loss
Diagnosis for Barrett's Esophagus
-endoscopic exam
-biopsy
Tx of Barrett's Esophagus
-watch the person (diet)
-endoscopic resection or ablation (if cells mutate to high grade dysplasia)
-esophagectomy
Prognosis for Barrett's Esophagus
-pre-malignant condition

-50% of high grade dysplasia found to have adenocarcinoma

-more than 80% mortality rate with adenocarcinoma
uncoordinated contractions of the esophagus
diffuse esophageal spasm
"corkscrew" esophagus
diffuse esophageal spasm
Etiology of diffuse esophageal spasm?
unknown
Does not transport food properly down esophagus?
diffuse esophageal spasm
Signs and symptoms of diffuse esophageal spasm
1) severe chest pain

2) dysphagia

3) regurgitation
Diagnosis for diffuse esophageal spasm
barium x-ray
Tx for diffuse esophageal spasm
-self resolving condition

-nitroglycerin

-calcium channel blockers

-botulinum toxin

-endoscopic balloon dilation
interruption of blood supply to an area of the heart
myocardial infarction
What does a myocardial infarction lead to?
damage or death of the cardiac muscle
Myocardial infarction pain has a similar pattern to what?
esophageal diseases
Signs and symptoms of a myocardial infarction
- chest, epigastric, neck & jaw pain

- shortness of breath

- nausea/vomiting

- sweating

-anxiety

-pain usually lasts longer than 20 minutes
Diagnosis of myocardial infarction
- electrocardiogram (Q wave)

-blood test

-echocardiogram
What are the cardiac markers in a blood test indicating a pt has a myocardial infarction?
1) creatine kinase

2) troponin
Palliative tx for a myocardial infarction
-oxygen
-aspirin
-nitroglycerine
-morphin (decrease pain)
What does an echocardiogram show?
circulation through the chambers of the heart
Which part of an electrocardiogram is looked at to see if a pt has a myocardial infarction?
Q-wave
chest discomfort due to ischemia with exertion or at rest
angina pectoris
Etiology of an angina pectoris
atherosclerosis of coronary arteries
Signs & symptoms of angina pectoris
- chest discomfort described as tightness, heaviness, or a choking sensation

-epigastric discomfort

-nausea, vomiting

-pallor
Diagnosis of angina pectoris
-stress test with electrocardiogram

-coronary angiogram
If a pt has an angina pectoris, what will a stress test with electrocardiogram show?
ST segment depression
Palliative tx for angina pectoris
-nitroglycerin

-beta & calcium channel blockers (decrease workload of the heart)
AKAs for Prinz-Metal variant angina
1) variant angina

2) angina inversa
chest pain at rest which could occur in cycles is called?
Prinz-Metal variant angina
Etiology of Prinz-Metal variant angina
vasospasm of coronary arteries
Diagnosis of Prinz-Metal variant angina
-angiogram w/ ergonovine IV as a provocation test

-electrocardiogram
What will an electrocardiogram show if a pt has Prinz-Metal varian angina?
ST segment elevation