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Pearls Esophagus
gi stuff
| Question | Answer |
|---|---|
| What are some signs and symptoms of a GI problem | dysphagia, vomitting, hematemesis, hematochezia, melana, colics, diarrhea and constipation |
| Difference between hematochezia and melena | melena-dark tar like stools. Hematochezia-blood is not digested shows up in stool. |
| Abnormal development in the GI tract can manifest as | atresia (no lumen), stenosis, diverticulosis (outpouches), fistula (connection between two lumens) |
| What is the MC developmental abnormality of the esophagus | esophageal atresia with tracheoesophageal fistula |
| Pathogenesis of esophageal diverticula | traction diverticulas due to a pull from the outside. Pulsion diverticula-push from inside, increased intraluminal pressure |
| stucture of diverticula | true diverticula-all 4 layers are involved. False diverticula-outpouching of mucosa and submucosa only. |
| Locations of diverticula | upper-(zenkers), midportion-traction due to bronchial lesions, scarring of lymph nodes. Epiphrenic-usually assoc with hernia and GERD |
| What's going on when you get a zenkers diverticulum | usually occurs at an area of potential weakness in inferior pharyngeal constrictor muscle. |
| what is zenkers diverticulum usually assoc. with, and clinical manifestations | gastroesophageal reflux and hiatal hernia's. sensation of mass in throat, weight loss, noisy swallowing, regurgitation of undigested food |
| serious complication of zenker's diverticulum | aspiration pneumonia |
| Describe a epiphrenic diverticulum | distal esophagus, often assoc. with hiatal hernia. Usually on the right side |
| what can cause a midesophageal diverticulum | can be formed in response to pull from fibrous adhesions following lymph node infection |
| Signs/symptoms of a prob with the esophagus | dysphagia, odynophagia (pain with swallow), heartburn (#1), acid regurg |
| What are the three anatomical constrictions of the esophagus | cricopharyngeus, aortic arch/left main bronchus, gastroesophageal junction |
| LPR is lower pharyngeal reflux, what are it's s/sx | chronic cough, voice fatigue or changes, globus sensation and sore throat |
| What are the different kinds of dysphagia, describe them | transfer-early in swallowing process. Transport-perceived later in process, feeling of food getting stuck. |
| What is the s/sx of transfer dysphagia | gagging, coughing, nasal regurg. |
| Causes of transfer dysphagia | 80% neuromuscular, CVA, scleroderma, myasthenia gravis, parkinsonism, lead poisoning, discoordination for food to get down throat. |
| How do we see Hx and how do we work up dysphagia | acute vs chronic, solids vs liquids, interminttent or progressive, feeling of something getting stuck. |
| How do we examine a pt with dysphagia | focus on head and neck (!). Helpful to watch them swallow a glass of water. PE often normal |
| What is a common cause of structural/obstructive dysphagia | a possible neoplasm. Work up quickly to rule out malignancy |
| Esophageal stricture is due to | usually GERD, usually distal esopho, usually only solids |
| What are the most common structural abnormalities of the esophagus | Webs and Schatzki's rings |
| Webs in the esophagus are assoc. with | glossitis and iron deficiency anemia |
| What is the Most Common cause of intermittent dysphagia with solids | schatzki rings |
| Patient just had a big steak and presents with dysphagia. What do they probably have | schatzki ring causing impaction, tx by dilating |
| What is plummer-vinson syndrome | web in esophagus assoc with glossitis and iron deficiency anemia |
| Etiology of esophageal webs | thin web-like constrictions that are proximally located in esophagus |
| What does a schatzki's ring look like and what is it's histology | looks like a smooth concentric ring around the lower esophagus, composed of hypertrophied mucosa of squamocolumnar junction |
| Schatzki's ring are best visualized when patient does what | best seen with valsalva maneuver at full inspiration in prone patient as barium runs through |
| If schatzki's ring is greater than 2 cm then | you may see dysphagia |
| What happens if you have a neuromuscular disorder of the esophagus | you're going to have dysphagia. Liquids will be a prob more than solids, symptoms will be intermittent, CVA (stroke) is #1 cause. Polymyositis/dermatomyositis is #2 cause |
| What are the esophageal motility disorders | achalasia, diffuse esophageal spasm, nutcracker esophagus, hypertensive LES |
| Most common presenting symptoms of esophageal motility disorders | dysphagia, regurgitation, substernal pain, aspiration, weight loss |
| General characteristics of esophageal motility disorders | usually in 5th decade, chest pain/achy at rest, intermittent dysphagia. Tx with Nitro's and CCB's |
| What is achalasia | gradual progressive dysphagia for solids and liquids. Impaired relaxation of the distal esophagus |
| symptoms of achalasia | regurgitation, weight loss, odynophagia |
| What is the pathogenesis of achalasia | idiopathic inflammatory changes, selective loss of postganglionic inhibitory neurons, loss of inhibitory input from neurons in esophageal myenteric plexus. |
| What is the proposed causes of achalasia | initial insult to esophagus-environment or viral. Leads to myenteric plexus inflammation, and an autoimmune response. Chronic inflammation leads to idiopathic achalasia |
| What kinds of neurons are spared in achalasia | postganglionic cholinergic |
| If you see an esophagus that looks like a birds beak when viewed with barium swallow you might be looking at | achalasia |
| Tx of achalasia | surgery (myotomy, hellers). Non surgical emergencies-CCB's, long acting nitrates, pneumatic dilation, botox |
| Which GI condition requires esophageal manometry to dx | dysmotility disorder |
| Tx of dysmotility disorder | control any reflux, Nitro/CCB's, botox, anxioytic agents -trazodone- in conjunction with antireflux therapy |
| diffuse esophageal spasms are due to | neuromuscular abnormalities |
| What condition shows up as a "corkscrew esophagus" on CXR with barium contrast | diffuse esophageal spasm |
| Most common finding in non-cardiac angina like pain | nutcracker esophagus |
| If you have high pressure waves in the distal esophagus what could you be dealing with | nutcracker esophagus |
| What is difficult about esophageal chest pain | tough to tell between that and ischemic pain |
| what can you give patients with esophageal chest pain that doesn't help you rule out ischemia | nitro's |
| How can you diff between ischemic chest pain and esophageal chest pain | exercise induced pain |
| Esophagitis can be caused by what two common processes | inflammatory and infectious process |
| Other causes of esophagitis | GERD, corrosive, cytotoxic drugs |
| Infectious causes of esophagitis | fungal-candida, viral-herpes or CMV, bacterial-only in ulcerated mucosa |
| Most common form of esophagitis | chemical |
| Complications of GERD | esophageal strictures, ulcers, bleeding, perforation, barretts, adenocarcinom |
| with barrett's you see what inside esophagus | salmon red patches, squamous epithelium is destroyed |
| barrett's progresses from esophagitis to ____________ | carcinoma at end stage if not corrected |
| MC cause of esophageal perforation | endoscopy |
| Other causes of esophageal perforation | alcohol or emesis |
| boerhaaves syndrome is typically seen in | any patient after severe vomitting, caused by acute pressure rise in esophagus from forceful vommiting against closed glottis |
| boerhaaves should be suspected in | anyone with severe chest pain/dypsnea following forceful vomitting |
| what else is assoc. with someone that has boerhaaves | cervical crepitus, acute pain that is unrelenting diffuse in chest, neck and abdomen, exacerbated by swallowing. Dysphagia dysnea, hematemesis and cyanosis may all be present |
| what else besides emesis can cause a tear in esophagus | foreign bodies that have chemicals, sharp objects, or blunt objects that cause necrosis |
| What will the physical exam show with an esophageal tear | abdominal rigidity, hypotension, fever, tachycardia, tachypnea. Possible air in subQ tissue. Pleural effusion in 50% of patients. |
| what constrast media do we use in an esophageal perforation | gastrografin |
| What is the general approach to esophageal bleeding | airway management, NG tube, gastric lavage, transfusion, GI consult. |
| When do usually see varices in the esophagus | chronic liver disease and portal hypertension |
| First line control to stop esophageal bleeding | endoscopy first, sclerotherapy and ligation are second line, but mortality is high |
| what is a mallory-weiss syndrome | aterial bleeding from longitudinal mucosal lacerations of distal esophagus/proximal stomach. Usually seen in 4-6th decade |
| Initial tx of mallory-weiss syndrome | supportive usually stops it, but if continued--electrocoagulation, sclerotherapy, laser photocoagulation, angiographic embolization, surgery |
| Mallory-weiss is typically seen in | alcoholics |
| does a mallory-weiss condition require surgery and what do we see on CXR | no, usually self resolves, and nothing on CXR, it only involves lacerations not a complete rupture, just mucosal layer |
| What is the most common kind of esophageal cancer | adenocarcinoma |
| what conditions can affect the esophagus | scleroderma, Rheumatoid, SLE, diabetes, polymyositis, sjogrens |
| How does scleroderma affect the esophagus | affects smooth muscle of the esophagus-smooth muscle atrophy/collagen deposition. Results in severe GERD, erosive gastritis, strictures, barretts |
| diabetes affects the esophagus how | hypotensive LES, prone to candidiasis |
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