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GI
Thiruvengadam-Dysphagia, Esophageal Cancer, Gastric Cancer
| Question | Answer |
|---|---|
| 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
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