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141 Cards in this Set
- Front
- Back
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what is the name of the "worst case mallory weiss" scenario?
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boerhaave's
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what is the order of the 3 stage mechanical process in which the esophagas conveys food from mouth to stomach?
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1. oral stage
2. pharyngeal stage 3. esophageal stage |
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what is the name of the most superior scleraderma of the esophagas?
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zenker's diverticulum
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what is the upper 1/3 of the esophagas made of?
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striated muscle
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what is the lower 2/3 of the esophagas made of?
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smooth muscle
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what innervates the esophagas?
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the vagus and sympathetic divisions of the nervous system
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what is the mucosa of the esophagas made of?
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stratified squamous cells
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what is the main muscle layer of the esophagas?
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the muscularis propria
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what is the pH within the esophagas?
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5-7.
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if your patient has a pH of 4 or less in the esophagas what can you suspect?
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normal pH is between 5-7. less than 4 is pathologic and found in RELFUX
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what is the Z line?
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the esophageal-gastric junction which shows the transition from squamous cells to columnar cells.
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difficulty swallowing?
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dysphagia
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painful swallowing?
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odynophagia
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feels like a lump in the throat?
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globus hystericus
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if there is dysphagia during phase two of the swallowing process, what pathology does this indicate?
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spasm or carcinoma
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if there is dysphagia during phase one or the oral stage of swallowing, what pathology is indicated?
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a neuromuscular disorder
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if there is dysphagia during phase 3 or the esophageal stage of swallowing what pathology is indicated?
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narrowing by esophagitis and diverticulum
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what is the number one cause of dysphagia?
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esophagitis: phase 3
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a phase 3 type of dysphagia that develops slowly, muscle tone peristalsis is paralyzed and the sphincter is closed?
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achalasia
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a disease of unknown case affecting nerve cells in the brain and spinal cord, leading to muscular wasting; there is an upper motor lesion and the esophagas doesn't work well...what causes this dysphagia?
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lou gehrig's Ds: ALS
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with this cause of dysphagia, there are painless progressive symptoms, with weight loss. chest pain is common c hemoptysis, sore throat and hoarseness. what causes this phase 2-3 dysphagia?
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esophageal cancer
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this pathology causes phase 3 dysphagia and is associated c vomiting of undigested foods and halitosis?
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esophageal diverticulum
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what type of dysphagia do you suspect in a sudden onset of phase 2-3 c esophageal pain, gagging, coughing?
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foreign body
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what phase of dysphagia is esophageal spasm?
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phase 2: pharyngeal stage. the transport phase.
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which phase 3 dysphagia destroys the sphincter?
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gastric CA
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a phase one dysphagia, that a patient will also complain of eye and speech problems due to easy fatigability?
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myasthenia gravis
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anemia, esophageal web & dysphagia?
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plummer-vinson syndrome
phase 3 |
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female patient presents with glossitis, angular chelitis, palor and koilonychia...what do you immediately think?
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plummer-vinson syndrome
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what would an xray of the chest show upon CC of dysphagia?
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possible widening of the mediastinum, with an air fluid level in the esophagas
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what is the first specific diagnostic study for dysphagia?
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barium swallow:
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what will a barium swallow show on a patient with dysphagia?
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pre-esophageal swallowing function
nature of the peristalsis presence of reflux anatomy of esophagas: to R/O strictures, webs and carcinomas |
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what is the normal sphincter pressure within the esophagas?
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6-10mm Hg
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name the muscle associated with the upper esophageal sphincter?
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crichopharyngeal muscle
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pouches that are lined c one or more layers of the esophageal wall that can occur anywhere in the esophagus are called?
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esophageal diverticulum
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what is the MC/most important diverticulum that is a true divertic. as all layers are outpouched. it causes obstruction of the lumen and is above the UES?
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zenker's diverticulum
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which true diverticulum are large enough to cause obstruction c aspiration of its contents leading to respiratory complications?
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zenker's diverticulum
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which esophageal diverticulum are usually asymptomatic?
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the mid esophageal diverticulum
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which esophageal diverticulum are thought to be associated c motor abnormalities of the esoph?
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epiphrenic dvertic
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what type of cells make up 95% of esophageal cancer?
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squamous cell
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what is the most frequent benign neoplasm of the esophagas?
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leiomyoma
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what type of cell makes up esophageal cancer at the gastro-esophageal junction?
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adenocarcinoma-5%
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a diverticulum that is thought to be associated c motor abnormalities of the esophagas?
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epiphrenic diverticulum
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what is the MC esophageal carcinoma?
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squamous cell Ca
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wt loss, progressive solid food dysphagia, odynophagia, are indicitive symptoms of what?
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esohpageal carcinoma
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what are some possible causes for esophageal carcinoma?
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idiopathic for the most part.
environmental issue: potential toxins HPV candidal infections/HIV population h.pylori increased risk after tx:monitor patient tobacco vit A & C deficiencies barrett's esophagus |
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where are 50% of the cancerous lesions found in the esophagus?
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in the lower 1/3
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what would some of the abnormal lab finding you would expect to see in a patient with esophageal carcinoma
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CBC; anemia due to malnutrition
LFT's if enzymes are elevated to R/O metas. |
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what imaging studies are typically performed upon susicion of esohphageal ca
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xray: chest, may show adenopathy
barium swallow: usually the first study to be completed. Upper endoscopy |
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what factors can predispose to squamous cell CA?
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smoking
alcohol achalasia plummer-vinson syndrome |
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SQUAMOUS CELL CANCER OF THE ESOPHAGUS RESPONDS TO RADIATION THERAPY? true or false
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true
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a type of esophageal cancer that is thought to arise from gastric mucosa and is sometimes due to columnar metaplasia of the esophagas?
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adenocarcinoma 5-10%
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this pathologic occurrance is due to the columnar metaplasia of the esophagus at the abnormal curvature of the Z line, and is most commonly found as a complication of long standing gastro-esophageal reflux?
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Barrett's Esophagus
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what are the clinical manifestations of esophageal carcinoma?
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dysphagia: solids then liquids
anorexia & weight loss regurg/ aspiration to complete obstruct. GERD recurrent gram- pneumonias clubbing substernal pain hoarseness gross G.I. bleed |
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what tests can be performed to diagnose esophageal carcinoma?
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double contrast barium study
endoscopy w/ mucosal biopsy & cytology endoscopic US CT of chest / abd for staging eval laparoscopic/thorascopic eval |
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what is the prognosis for esophageal carcinoma?
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the overall survival rate for 5 years is 15%
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what classification is used for staging of the tumors of the esophagus?
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the TNM classification
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what does TNM classification stand for?
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T=primary tumor
N=nodes M=metastic |
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what are the TNM stages?
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stage I = T1, N0, M0
stage II = T2, N1, M0 stage III= T3, N1, M0 stage IV= any T or N, M1 |
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diseases of smooth muscles, soft tissue or tumor obstructrion, intrinsic nervous system with MS, ALS or following CVA affect cause what type of pathology to the esophagus?
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motility disorders of the esophagus
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failure of relaxation due to intrinsic nervous system with subsequent esophageal dilation, with dysphagia and non-acidic regurg
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achalasia- cardiospasm
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what would an xray of the esophagus in a patient with achalasia reveal?
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dilated, fluid feilled esophagus (birds beak)
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In this disorder, the smooth muscle layer of the esophagus has impaired peristalsis, and the lower esophageal sphincter (LES) fails to relax properly in response to swallowing.
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achalasia or cardiospasm of the esophagus
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what are some treatment options for achalasia?
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balloon dilation
botulism toxin (endoscopy guided to inject toxin into sphincter) myotomy (last resort) |
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a disorder of motility characterized by episodic dysphagia and chest pain, that may resemble angina.
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esophageal spasm
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this disorder can affect people of any age, but is more common in the 6th and 7th decades of life. The diagnosis is made by an esophageal motility study, which evaluates the pressure of the esophagus at various points along its length
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nutcracker esophagus
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how can nutcracker esophagus or esophageal spasm be treated?
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nitrates
CCB |
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a motility disorder of the esophagus, present with two key symptoms: either with chest pain (typically given termed as non-cardiac chest pain as it is esophageal in origin), which is usually found in disorders of spasm, or with dysphagia, or difficulty swallowing, could be?
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nutcracker esophagus or any motility disorder of the esophagus
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on Xray of this motility disorder of the esophagus, you would see simultaneous uncoordinated contractions , a peristaltic esophagus+ free re-flux +strictures. the manometry would show low resting LES pressure, c absent peristalsis or low-amp peristaltic contractions?
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DES: diffuse esophageal spasm
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how do you treat DES?
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NTG/anticholinergics/ CCB's
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a web + iron deficiency anemia + women that may be assoc c leukoplakia of the lip?
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Plummer-Vinson syndrome
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a symmetrical submucosal fibrous thickening occurring at the LES junction?
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schatzki's ring
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membranes of connective tissue covered by normal squamous epithelium, that can occur anywhere along the esophagus, but mostly in the upper 1/3?
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esophageal webs
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what is the term for increased, clear non regurgitated oral salivary secretions in the moth from vagAL reflex?
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water brash
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what is the most common symptom of esophageal disease?
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heartburn (pyrosis) aka ingestion, acid regurg, sour stomach & bitter belching
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reflux esophagitis that is defined as any symptomatic clinical condition or histopathologic alteration of esophageal mucosa that is resultant from episodes of acid gastroeophageal reflux?
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GERD
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duodenal ulcers, diabetes, gastritis
hypothyroidism can all be considered contributory to what disease as they cause delays in gastric empyting time? |
GERD
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what is the MC cause of GERD?
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incompetent LES sphincter
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what type of hernia is present in 80% of patients with GERD but is not necessarily indicitive of the disease?
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hiatal hernias
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Tylosis (Palmarplantar ketoderma) is an Autosomal genetic trait for adult onset of diffuse hyperkeratosis of the palms & soles virtually 100% relationship with this morbid disease?
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esophageal carcinoma
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New onset of dysphagia in a patient > 40 yrs of age with risk factors..you should suspect?
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esophageal carcinoma
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if your patient has aggravating factors such as High fat & spicy food, caffeine & chocolate, bending over or lying down, ETOH intake, nocturnal eating, smoking, emotions and obesity medications (prednisone, antibiotics ) are indicitive of what disorder?
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GERD
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what are two things that increase the LES tone?
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gastrin and cholinergics
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what are some typical findings of GERD?
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heart burn
regurg water brash |
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what are some atypical symptoms of GERD?
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chest pain
cough laryngitis |
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what are some of the laboratory test performed to diagnose GERD?
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xrays: barium swallow
upper endoscopy 24 hr esophageal pH monitor |
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what is a manometry used for?
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to evaluate esophageal peristalsis & LES tone by recording muscle pressures within the esophagus
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how is severe or persistant GERD treated pharmacologically?
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pro-motility drugs: GAVISCON or prn H2 blockers
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what are some drugs that should be avoided if you have GERD?
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drugs that reduce LES tone:
anticholinergics nitrates Ca Channel blockers BC pills |
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what are some examples of H2 antagonists (histamine blockers)
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tagament
pepcid axid zantac |
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what are some examples of PPI's (proton pump inhibitors)
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prilosec
prevacid |
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what is the safest treatment for GERD?
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sucralfate: binds mucous secretions
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repeated strenuous retching or vomiting may be responsible for he tears in the mucosa is known as what kind of tears?
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mallory-weiss tears
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this syndrome is a complete, transmural laceration (rupture) of the lower part of esophagus with exit of the gastric content and air into the mediastinum in the patient with a pre-existing esophageal disease?
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boerhaave's syndrome
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this inflammatory syndrome can be associated with swallowing meds, ingesting alkali or acids, post radiation or infective agents like Candida...the dx often requires endoscopy and biopsy?
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esophagitis
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submucosal veins dilated by increased pressure within the portal system, most prominant in the distal esophagus?
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esophageal varices
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dilated torturous veins that are usually due to portal HTN?
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esophageal varices
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where are most FB's located?
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foreign bodies: in the upper esophageal sphincter
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p presents with constipation c abd cramps for long period of time is most likely?
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IBS
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what are the top 3 causes for SBO?
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adhesions
hernia volvulus |
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what are the top 3 causes for LBO?
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neoplasm
volvulus diverticular ds, stricture |
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what drug should be avoided in giving to elderly patients and why?
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tylenol c codine because it causes constipation
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what is the most common endocrine dysfunction that causes constipation?
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hypothyroidism
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what neurological dysfunctions can cause constipation?
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diabetic autonomic neuropathy
spinal cord injury head injury CVA MS Parkinson's |
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aganglionosis of the distal colon or rectum
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hirschprung's disease
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on a DRE for constipation what are you checking for?
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tenderness or masses
tone hemorrhoids, fissures, stenosis, tumor, impaction |
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what do you need to rule out in a constipation diagnosis?
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SYSTEMIC PROCESSES
hypothyroid hyperparathyroidism causing hypercalcemia neoplasm bedrest |
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what is the most common cause of constipation outside the colon?
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poor dietary habit
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what are some causes of constipation : outside the colon?
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poor dietary habit
medications systemic endocrine or neurologic psychological factors |
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if a patient has an acute onset of constipation what blood tests should you check?
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K
Ca TSH |
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what blood tests should chronic laxative users have performed?
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BUN, creatinine, electrolytes
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which study is preferred to dx for a patient who did not present with an acute constipation?
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barium study
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what is a gastrografin enema?
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it has the advantage of acting as an osmotic laxative which may aid in the evacuation of the colonic contents
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when DONT you use a contrast study in the GI?
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diverticulitis
toxic megacolon |
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how can you treat constipation?
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bulk former
stool softners saline laxatives stimulants lactulose |
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patient presents with acute abdominal pain, fever, leukocytosis, and/or other symptoms suggesting possible systemic or intra-abdominal processes, imaging studies are used to rule out sources of sepsis or intra-abdominal problems. what studies would these include?
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Upright chest roentgenogram and a flat and upright abdominal film
Abdominal CT scan Gastrografin enema or lower GI endoscopy |
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why is Gastrogafin preferred in patients with an acute presentation of constipation?
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because this prevents the risk of extravasation of barium into the peritoneal cavity through a perforated diverticulum or colon cancer
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what is the term for severe constipation resulting from an obstruction in the intestines?
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obstipation
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what are the top 3 cancers of the GI tract?
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colon
pancreas stomach |
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what are white patches on oral buccal or linguinal membranes?
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leukoplakia
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Red plaques or patches present with early small ulcer & often the first sign of malignant change
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erthyroplakia
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what type of cancer is found in the stomach predominantly? 90%
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adenocarcinoma
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what are some poor dietary factors that can contribute to carcinoma of the stomach?
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excess Na intake
low roughage & nitrates |
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patient presents with abdominal distention. complains of dysphagia. and has been spitting up blood on occasion. labs return and you diagnose pernicious and iron def. anemia...what could be a major underlying disease?
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carcinoma of the stomach
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collections of symptoms that result from substances produced by the tumor, and they occur remotely from the tumor itself.
The symptoms may be endocrine, neuromuscular or musculoskeletal, cardiovascular, cutaneous, hematologic, gastrointestinal, renal, or miscellaneous in nature |
paraneoplastic syndrome
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what is the name and suggestive diagnosis for a solitary enlarged, left sided supraclavicular lymph node?
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Virchow Node: indicitive of carcinoma of the stomach
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anterior ridge of a perirectal pouch or "cul-de-sac" mass
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blumer shelf: ca
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ovarian metastatic site often confused with ovarian disease and is sometimes hard to separate in the case of adenocarcinoma?
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krukenberg tumor
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a palpable periumbilical mass is also called?
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sister joseph's nodule
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an enlarged Left axillary node is also referred to as?
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irish's nodule
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what is the most common tumor world wide
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liver carcinoma: hepatocellular
almost exclusively secondary cirrhosis from hepatitis B & C infections |
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what is a specific blood test you can look for an increase in to diagnose hepatocellular carcinoma?
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increased alpha-fetoprotein AFP
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what are the labs to look for to confirm your dx of hepatocellular carcinoma?
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increase LFT
depressed coagualtion (elevated PT) increased AFP (alpha-fetoprotein |
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what is the tx for hepatocellular carcinoma?
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palliative at best.
most patients with HCC die within 1 year after dx. |
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what is the MC carcinoma of the bile duct?
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adenocarcinoma
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what are the symptoms of carcinoma of the bile duct?
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painless jaundice
palpable mass + courvoisier's sign |
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where in the pancreas is carcinoma most commonly found?
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2/3 in the head
ductal 90% = exocrine : adenocarcinoma of ampulla area |
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what are the top 3 ranked cancers in men?
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lung
colon prostate |
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what are the top 3 ranked cancers in women?
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breast
colon lung |
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superficial thrombophlebitis aka?
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trousseau's sign
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palpable gall bladder aka?
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courvoisier's sign
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Includes removal of small portion of duodenum, distal stomach, GB, CBD, regional nodes, some jejunum & pancreas
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A Whipple procedure: performed for temporary relief of pancreatic carcinoma
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