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Pearls Esophagus

gi stuff

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
Created by: 1317331947