Term
| 2 distinct areas that may caus dysphagia: |
|
Definition
1. oropharyngeal
2. esophageal |
|
|
Term
| which type of disorders cause dysphagia of liquids/solids? |
|
Definition
1. motility disorders: liquids and solids
2. Mechanical obstruction: solids |
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|
Term
|
Definition
|
|
Term
| 4 etiologies of odynophagia: |
|
Definition
1. caustic ingestion/reflux
2. pill-induced esophagitis
3. infection
4. obstructing tumor |
|
|
Term
| sour tasting regurge indicates: |
|
Definition
| it is from the stomach w gastric acid mixed in |
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|
Term
| bitter tasting regurge indicates: |
|
Definition
| it is from the duodenum; bile |
|
|
Term
|
Definition
| outpouring of saliva in response to GERD |
|
|
Term
| most common of all esophageal sx: |
|
Definition
|
|
Term
aggravating factors of pyrosis:8
Pneumonic: FC SPICES |
|
Definition
1.Fat
2. Caffine
3. Spicy
4. Position (lying flat)
5. Intoxicant (alc)
6. Chocolate
7. Emotions
8. Smoking |
|
|
Term
| how does reflux differ from angina:4 |
|
Definition
1. pain during sleep - not so in angina
2. lasts hours to days
3. hot/cold food/liquids aggrevate
4. releived with antacid |
|
|
Term
| elderly, alcohol, hiatal hernia, abn esophageal motility are all risk factors for: |
|
Definition
|
|
Term
| 4 drugs infamous for pill induced esophagitis: |
|
Definition
1. Foxamex
2. doxycycline
3. Vit C
4. NSAIDs |
|
|
Term
| Esophageal varicies are caused by: |
|
Definition
| Portal HTN from alcoholic and viral liver cirrhosis |
|
|
Term
| where do the varicies occur in the esophagus? |
|
Definition
| lower 1/3, gastroesophageal junction, bleeding is most common in the distal 5cm of esophagus |
|
|
Term
| prognosis of esophageal varicies: |
|
Definition
1. bleeds in 1/3 of cases
2. 50% of bleeds stop spontaneously
3. of the bleeds 20% mortality wn 6wks |
|
|
Term
| tx/management of esophageal varicies: |
|
Definition
1. Betal blockers
2. endoscopic variceal ligation |
|
|
Term
| describe Mallory-Weiss Syndrome: |
|
Definition
| mucosal laceration of the gastroesophageal junction from portal HTN & 50% have hx of vomiting/retching |
|
|
Term
| dx of Mallory-Weiss syndrome: |
|
Definition
| Endoscopy shows eliptical or longitudinal ulcer |
|
|
Term
|
Definition
1. fluids
2. xfuse if indicated
3. hemostatisis; epi injetion or cautery |
|
|
Term
| describe Barret's Esophagus: |
|
Definition
| constant reflux causes change of squamous to collumnar epi, can evolve to cancer |
|
|
Term
| epidemiology of barret's esophagus: |
|
Definition
1. 10-20% of GERD patients
2. Males 3:1
3. avg pt = 55yo white male |
|
|
Term
|
Definition
|
|
Term
| describe Zenker's Diverticulum: |
|
Definition
| protrusion of PHARYNGEAL mucosa @ the esophopharyngeal junction from the loss of elasticity of the UES causing halitosis and regurge |
|
|
Term
| dx of zenkers diverticulum: |
|
Definition
|
|
Term
|
Definition
|
|
Term
| 3 most common motility disorders of the esophagus: |
|
Definition
1. Achalasia (enteric nervous sys)
2. diffuse esophageal spasm
3. scleroderma (smooth m dz) |
|
|
Term
|
Definition
| loss of ganglion cells in the enteric nervous sys of the esophagus leads to impaired relaxation of the LES and absent peristalsis |
|
|
Term
| epidemiology of achalasia: |
|
Definition
|
|
Term
| TQ: "bird Beak stricture" |
|
Definition
| Achalasia seen in barium swallow |
|
|
Term
|
Definition
1. dysphagia
2. non-acidic regurge |
|
|
Term
|
Definition
1. barium swallow (bird beak)
2. x-ray
3. manometry |
|
|
Term
| manometry findings in achalasia: |
|
Definition
1. high resting LES pressure
2. incomplete or abn relaxation of LES upon swallow
3. incomplete/abn peristalsis |
|
|
Term
| 2 pharmacotherapies for achalasia: |
|
Definition
1. nitrates
2. calcium channel blockers
both are poorly tolerated or ineffective |
|
|
Term
|
Definition
1. pharmacotherapy
2. mechanical dilation excellent short term need to repeat in 5yrs
3. surgical myotomy; remission @85% @10yrs but develop GERD post-op
4. Botulinum toxin injection |
|
|
Term
| uncommon motor disorder assoc w degeneration of Auerbach's plexus |
|
Definition
|
|
Term
| sx of diffuse esophageal spasm: |
|
Definition
1. substernal CP
2. Dysphagia w pain |
|
|
Term
| manometry findings in diffues esophageal spasm: |
|
Definition
| normal pressure unless it is done during the spasm episode |
|
|
Term
| barium x-ray appearance of esophageal spasm: |
|
Definition
|
|
Term
|
Definition
1. trial of sm m relaxants
2. trial of antidepressants
3. relaxation exercises, therapy |
|
|
Term
| 3 indications for upper endoscopy: |
|
Definition
1. eval for reflux-induced esophageal injury
2. Sx not responding to tx
3. sx are chronic &/or refractory to tx |
|
|
Term
| what is the first test used in dx dysphagia: |
|
Definition
|
|
Term
| which two suspected disorders indicate manometry: |
|
Definition
| achalasia & esophageal spasm |
|
|
Term
| 5 categories of esophageal disorders: |
|
Definition
1. dysphagia
2. heartburn
3. odynophagia
4. hematemesis
5. noncardiac CP |
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