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141 Cards in this Set

  • Front
  • Back
what is the name of the "worst case mallory weiss" scenario?
what is the order of the 3 stage mechanical process in which the esophagas conveys food from mouth to stomach?
1. oral stage
2. pharyngeal stage
3. esophageal stage
what is the name of the most superior scleraderma of the esophagas?
zenker's diverticulum
what is the upper 1/3 of the esophagas made of?
striated muscle
what is the lower 2/3 of the esophagas made of?
smooth muscle
what innervates the esophagas?
the vagus and sympathetic divisions of the nervous system
what is the mucosa of the esophagas made of?
stratified squamous cells
what is the main muscle layer of the esophagas?
the muscularis propria
what is the pH within the esophagas?
if your patient has a pH of 4 or less in the esophagas what can you suspect?
normal pH is between 5-7. less than 4 is pathologic and found in RELFUX
what is the Z line?
the esophageal-gastric junction which shows the transition from squamous cells to columnar cells.
difficulty swallowing?
painful swallowing?
feels like a lump in the throat?
globus hystericus
if there is dysphagia during phase two of the swallowing process, what pathology does this indicate?
spasm or carcinoma
if there is dysphagia during phase one or the oral stage of swallowing, what pathology is indicated?
a neuromuscular disorder
if there is dysphagia during phase 3 or the esophageal stage of swallowing what pathology is indicated?
narrowing by esophagitis and diverticulum
what is the number one cause of dysphagia?
esophagitis: phase 3
a phase 3 type of dysphagia that develops slowly, muscle tone peristalsis is paralyzed and the sphincter is closed?
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?
lou gehrig's Ds: ALS
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?
esophageal cancer
this pathology causes phase 3 dysphagia and is associated c vomiting of undigested foods and halitosis?
esophageal diverticulum
what type of dysphagia do you suspect in a sudden onset of phase 2-3 c esophageal pain, gagging, coughing?
foreign body
what phase of dysphagia is esophageal spasm?
phase 2: pharyngeal stage. the transport phase.
which phase 3 dysphagia destroys the sphincter?
gastric CA
a phase one dysphagia, that a patient will also complain of eye and speech problems due to easy fatigability?
myasthenia gravis
anemia, esophageal web & dysphagia?
plummer-vinson syndrome
phase 3
female patient presents with glossitis, angular chelitis, palor and koilonychia...what do you immediately think?
plummer-vinson syndrome
what would an xray of the chest show upon CC of dysphagia?
possible widening of the mediastinum, with an air fluid level in the esophagas
what is the first specific diagnostic study for dysphagia?
barium swallow:
what will a barium swallow show on a patient with dysphagia?
pre-esophageal swallowing function
nature of the peristalsis
presence of reflux
anatomy of esophagas: to R/O strictures, webs and carcinomas
what is the normal sphincter pressure within the esophagas?
6-10mm Hg
name the muscle associated with the upper esophageal sphincter?
crichopharyngeal muscle
pouches that are lined c one or more layers of the esophageal wall that can occur anywhere in the esophagus are called?
esophageal diverticulum
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?
zenker's diverticulum
which true diverticulum are large enough to cause obstruction c aspiration of its contents leading to respiratory complications?
zenker's diverticulum
which esophageal diverticulum are usually asymptomatic?
the mid esophageal diverticulum
which esophageal diverticulum are thought to be associated c motor abnormalities of the esoph?
epiphrenic dvertic
what type of cells make up 95% of esophageal cancer?
squamous cell
what is the most frequent benign neoplasm of the esophagas?
what type of cell makes up esophageal cancer at the gastro-esophageal junction?
a diverticulum that is thought to be associated c motor abnormalities of the esophagas?
epiphrenic diverticulum
what is the MC esophageal carcinoma?
squamous cell Ca
wt loss, progressive solid food dysphagia, odynophagia, are indicitive symptoms of what?
esohpageal carcinoma
what are some possible causes for esophageal carcinoma?
idiopathic for the most part.
environmental issue: potential toxins
HPV candidal infections/HIV population
h.pylori increased risk after tx:monitor patient
vit A & C deficiencies
barrett's esophagus
where are 50% of the cancerous lesions found in the esophagus?
in the lower 1/3
what would some of the abnormal lab finding you would expect to see in a patient with esophageal carcinoma
CBC; anemia due to malnutrition
LFT's if enzymes are elevated to R/O metas.
what imaging studies are typically performed upon susicion of esohphageal ca
xray: chest, may show adenopathy
barium swallow: usually the first study to be completed.
Upper endoscopy
what factors can predispose to squamous cell CA?
plummer-vinson syndrome
a type of esophageal cancer that is thought to arise from gastric mucosa and is sometimes due to columnar metaplasia of the esophagas?
adenocarcinoma 5-10%
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?
Barrett's Esophagus
what are the clinical manifestations of esophageal carcinoma?
dysphagia: solids then liquids
anorexia & weight loss
regurg/ aspiration to complete obstruct.
recurrent gram- pneumonias
substernal pain
gross G.I. bleed
what tests can be performed to diagnose esophageal carcinoma?
double contrast barium study
endoscopy w/ mucosal biopsy & cytology
endoscopic US
CT of chest / abd for staging eval
laparoscopic/thorascopic eval
what is the prognosis for esophageal carcinoma?
the overall survival rate for 5 years is 15%
what classification is used for staging of the tumors of the esophagus?
the TNM classification
what does TNM classification stand for?
T=primary tumor
what are the TNM stages?
stage I = T1, N0, M0
stage II = T2, N1, M0
stage III= T3, N1, M0
stage IV= any T or N, M1
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?
motility disorders of the esophagus
failure of relaxation due to intrinsic nervous system with subsequent esophageal dilation, with dysphagia and non-acidic regurg
achalasia- cardiospasm
what would an xray of the esophagus in a patient with achalasia reveal?
dilated, fluid feilled esophagus (birds beak)
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.
achalasia or cardiospasm of the esophagus
what are some treatment options for achalasia?
balloon dilation
botulism toxin (endoscopy guided to inject toxin into sphincter)
myotomy (last resort)
a disorder of motility characterized by episodic dysphagia and chest pain, that may resemble angina.
esophageal spasm
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
nutcracker esophagus
how can nutcracker esophagus or esophageal spasm be treated?
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?
nutcracker esophagus or any motility disorder of the esophagus
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?
DES: diffuse esophageal spasm
how do you treat DES?
NTG/anticholinergics/ CCB's
a web + iron deficiency anemia + women that may be assoc c leukoplakia of the lip?
Plummer-Vinson syndrome
a symmetrical submucosal fibrous thickening occurring at the LES junction?
schatzki's ring
membranes of connective tissue covered by normal squamous epithelium, that can occur anywhere along the esophagus, but mostly in the upper 1/3?
esophageal webs
what is the term for increased, clear non regurgitated oral salivary secretions in the moth from vagAL reflex?
water brash
what is the most common symptom of esophageal disease?
heartburn (pyrosis) aka ingestion, acid regurg, sour stomach & bitter belching
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?
duodenal ulcers, diabetes, gastritis
hypothyroidism can all be considered contributory to what disease as they cause delays in gastric empyting time?
what is the MC cause of GERD?
incompetent LES sphincter
what type of hernia is present in 80% of patients with GERD but is not necessarily indicitive of the disease?
hiatal hernias
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?
esophageal carcinoma
New onset of dysphagia in a patient > 40 yrs of age with risk should suspect?
esophageal carcinoma
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?
what are two things that increase the LES tone?
gastrin and cholinergics
what are some typical findings of GERD?
heart burn
water brash
what are some atypical symptoms of GERD?
chest pain
what are some of the laboratory test performed to diagnose GERD?
xrays: barium swallow
upper endoscopy
24 hr esophageal pH monitor
what is a manometry used for?
to evaluate esophageal peristalsis & LES tone by recording muscle pressures within the esophagus
how is severe or persistant GERD treated pharmacologically?
pro-motility drugs: GAVISCON or prn H2 blockers
what are some drugs that should be avoided if you have GERD?
drugs that reduce LES tone:
Ca Channel blockers
BC pills
what are some examples of H2 antagonists (histamine blockers)
what are some examples of PPI's (proton pump inhibitors)
what is the safest treatment for GERD?
sucralfate: binds mucous secretions
repeated strenuous retching or vomiting may be responsible for he tears in the mucosa is known as what kind of tears?
mallory-weiss tears
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?
boerhaave's syndrome
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?
submucosal veins dilated by increased pressure within the portal system, most prominant in the distal esophagus?
esophageal varices
dilated torturous veins that are usually due to portal HTN?
esophageal varices
where are most FB's located?
foreign bodies: in the upper esophageal sphincter
p presents with constipation c abd cramps for long period of time is most likely?
what are the top 3 causes for SBO?
what are the top 3 causes for LBO?
diverticular ds, stricture
what drug should be avoided in giving to elderly patients and why?
tylenol c codine because it causes constipation
what is the most common endocrine dysfunction that causes constipation?
what neurological dysfunctions can cause constipation?
diabetic autonomic neuropathy
spinal cord injury
head injury
aganglionosis of the distal colon or rectum
hirschprung's disease
on a DRE for constipation what are you checking for?
tenderness or masses
hemorrhoids, fissures, stenosis, tumor, impaction
what do you need to rule out in a constipation diagnosis?
hyperparathyroidism causing hypercalcemia
what is the most common cause of constipation outside the colon?
poor dietary habit
what are some causes of constipation : outside the colon?
poor dietary habit
systemic endocrine or neurologic
psychological factors
if a patient has an acute onset of constipation what blood tests should you check?
what blood tests should chronic laxative users have performed?
BUN, creatinine, electrolytes
which study is preferred to dx for a patient who did not present with an acute constipation?
barium study
what is a gastrografin enema?
it has the advantage of acting as an osmotic laxative which may aid in the evacuation of the colonic contents
when DONT you use a contrast study in the GI?
toxic megacolon
how can you treat constipation?
bulk former
stool softners
saline laxatives
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?
Upright chest roentgenogram and a flat and upright abdominal film
Abdominal CT scan
Gastrografin enema or lower GI endoscopy
why is Gastrogafin preferred in patients with an acute presentation of constipation?
because this prevents the risk of extravasation of barium into the peritoneal cavity through a perforated diverticulum or colon cancer
what is the term for severe constipation resulting from an obstruction in the intestines?
what are the top 3 cancers of the GI tract?
what are white patches on oral buccal or linguinal membranes?
Red plaques or patches present with early small ulcer & often the first sign of malignant change
what type of cancer is found in the stomach predominantly? 90%
what are some poor dietary factors that can contribute to carcinoma of the stomach?
excess Na intake
low roughage & nitrates
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?
carcinoma of the stomach
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
what is the name and suggestive diagnosis for a solitary enlarged, left sided supraclavicular lymph node?
Virchow Node: indicitive of carcinoma of the stomach
anterior ridge of a perirectal pouch or "cul-de-sac" mass
blumer shelf: ca
ovarian metastatic site often confused with ovarian disease and is sometimes hard to separate in the case of adenocarcinoma?
krukenberg tumor
a palpable periumbilical mass is also called?
sister joseph's nodule
an enlarged Left axillary node is also referred to as?
irish's nodule
what is the most common tumor world wide
liver carcinoma: hepatocellular
almost exclusively secondary cirrhosis from hepatitis B & C infections
what is a specific blood test you can look for an increase in to diagnose hepatocellular carcinoma?
increased alpha-fetoprotein AFP
what are the labs to look for to confirm your dx of hepatocellular carcinoma?
increase LFT
depressed coagualtion (elevated PT)
increased AFP (alpha-fetoprotein
what is the tx for hepatocellular carcinoma?
palliative at best.
most patients with HCC die within 1 year after dx.
what is the MC carcinoma of the bile duct?
what are the symptoms of carcinoma of the bile duct?
painless jaundice
palpable mass
+ courvoisier's sign
where in the pancreas is carcinoma most commonly found?
2/3 in the head
ductal 90% = exocrine : adenocarcinoma of ampulla area
what are the top 3 ranked cancers in men?
what are the top 3 ranked cancers in women?
superficial thrombophlebitis aka?
trousseau's sign
palpable gall bladder aka?
courvoisier's sign
Includes removal of small portion of duodenum, distal stomach, GB, CBD, regional nodes, some jejunum & pancreas
A Whipple procedure: performed for temporary relief of pancreatic carcinoma