Pearls Esophagus Word Scramble
|
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
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 |
Created by:
1317331947
Popular Medical sets