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GI

Thiruvengadam-Dysphagia, Esophageal Cancer, Gastric Cancer

QuestionAnswer
dysphagia difficulty swallowing
odynophagia painful swallowing
xerostomia not enough saliva can occur in patients on anticholinergic drugs
Sjogren's syndrome auto-immune condition against exocrine glands that produce tears and saliva
achalasia degeneration of neurons in myenteric plexus-->incomplete LES relaxation, increased LES tone, and lack of peristalsis of the esophagus symptoms: difficulty swallowing, regurgitation, chest pain *bird beak appearance with barium swallow Tx: botox
radiation esophagitis inflammation of esophagus from physical injury from radiation therapy mucositis can occur followed by strictures
mucositis painful inflammation and ulceration of the mucous membranes lining the digestive tract-->usually adverse effect of chemo and radiotherapy treatment for cancer
globus pharyngeus/hystericus feeling of lump in lower neck that persists between swallowing but doesn't cause difficulty in swallowing
esophageal scleroderma autoimmune disorder primary defect: smooth muscle atrophy and fibrosis due to severe GERD secondary to distended LES and hypomotile esophagus smooth muscle replaced by scar tissue-->loss of peristalsis and a weakening of LES
squamous cell carcinoma of esophagus risk factors high incidence in China, Iran, and South Africa African American 3-4x more common in men smoking, alcohol, diet low in fruits/vegetables/fiber low socio-economic status achalasia, strictures, tylosis, other aero-digestive cancers
adenocarcinoma in lower esophagus risk factors high incidence in USA and western countries white 3-4x more common in men smoking, obesity, alcohol may not be risk factor GERD, Barrett's esophagus *H. pylori might be protective
esophageal cancer clinical features dysphagia, odynophagia, weight loss, chest pain, GI bleeding, voice hoarseness
diagnosis of esophageal cancer EGD EUS CT PET
rings and webs can cause intermitted solid dysphagia and food impaction
intestinal type gastric cancer high incidence in East Asia, Andean South America, Eastern Europe older subjects men>women sequence: superficial gastritis-->atrophic gastritis-->intestinal metaplasia-->dysplasia-->invasive cancer
diffuse type gastric cancer not common in high incidence countries poorer prognosis men=women even in younger age groups *signet ring cells
gastric cancer risk factors diet (fruit and vegetables are protective), pernicious anemia, atrophic gastritis, prior gastric surgery, gastric polyps, gastric mucosal hypertrophy
gastric cancer clinical features weight loss, abdominal pain, early satiety, nausea, GI bleeding, dysphagia, pseudoachalasia, Virchow's node, Sister Mary Joseph's node, Krukenburg tumor, rectal shelf of Blumer, ascites, liver metastasis, Leser-Trelat, Trousseau's syndrome
Virchow's node tumor extension to supraclavicular node seen in patients with gastric cancer
Sister Mary Joseph's node tumor extension to periumbilical nodules seen in patients with gastric cancer
Krukenburg tumor often (over 80%) found in both ovaries: malignancy that metastasized from a primary site--> classically GI tract but also from breast *gastric adenocarcinoma the most common source
Leser-Trelat sign explosive onset of multiple seborrheic keratoses (many pigmented skin lesions) often with an inflammatory base ominous sign of internal malignancy part of paraneoplastic syndrome
Schatzki ring narrowing of lower esophagus from mucosal or muscle (uncommon) tissue can cause intermittent solid food dysphagia and impaction or complete esophageal blockage
Case: 51 yr old woman was started on a tricyclic antidepressants, she reports difficulty swallowing because of a very dry mouth xerostomia
Case: 72 yr old woman with left LMN VII Palsy, food pools inside and drools Bell's Palsy
Case: 76 yr old man with severe rigidity, tremor, bradykinesia and transfer dysphagia Parkinsonism
Case: 61 yr old male Progressive Weakness of the legs (UMN defect in LE, LMN defect in the UE) and cranial nerve palsies motor neuron disorder
Case: 50 yr old woman swallows her Ibuprofen with her saliva, lying flat on her bed pill-induced esophagitis
Case: 47 yr old male with trouble swallowing liquids and solids. Regurgitates bland material achalasia
Case: 54 yr old obese man with a long history of severe reflux symptoms and intermittent dysphagia who recently presented with a meat impaction GERD and peptic esophagitis with a stricture
Case: 50 yr old with a hiatal hernia and a ring like narrowing at the SC junction Schatzki ring
Case: 67 yr old man, with weight loss, solids sticking in the lower chest. Smoker, ETOH++ Esophageal cancer
Case: 55 yr old male with NHL, complaints of dysphagia 4 months after Radiation Therapy Radiation esophagitis
Case: 54 yr old male with dyspepsia, EGD shows a slightly elevated plaque, biopsy – monoclonal aggregation of lymphocytes. EUS lesion restricted to mucosa, anti H. pylori treatment resolved plaque MALToma
Case: 47 yr old with HIV-AIDS with complaints of odynophagia Candida esophagitis
Case: 65 yr old with weight loss, dyspepsia for 3 months. EGD found a 2 cm ulcer with rolled up edges gastric adenocarcinoma
Created by: kphom001 on 2011-11-20



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