CHA 2 EXAM 2 GI WITH COMPLETE
SOLUTION
O What is esophageal cancer? - Cause unknown but strongly related to smoking, alcohol use, asbestos
exposure, and diets low in fruits, vegetables and vitamins
- Achalasia and barrett's esophagus
What is achalasia? - decrease function of lower esophagus
What is barrett's esophagus? - premalignant tissue changes seen with frequent esophageal irritation,
chronic reflux
Where are most malignant esophageal tumors found? - the middle or lower 1/3 of the esophagus
What is the prognosis of esophageal cancer? - Often poor due to it being diagnosed late
How do tumors of esophageal cancer look? - usually appear as ulcerated lesion and is quite advanced at
time of diagnosis.
What are signs and symptoms of esophageal cancer? - progressive dysphagia, choking, hoarseness with
higher tumor, weight loss, pain a late sign, severe regurgitation with bloody-flecked esophageal contents
with advanced disease.
What are complications of esophageal cancer? - Esophageal obstruction
Hemorrhage as tumor erodes through esophagus and into aorta
Fistula may form into trachea or lungs leading to pneumonia and hemorrhage
How is esophageal cancer diagnosed - Endoscopy; Barium Enema; CT or MRI
What is the treatment of esophageal cancer? - Usually treated with combination of surgery, chemo and
radiation
Surgical options:
Esophagectomy: Removal of all or part of esophagus; Dacron graft used to replace the resected part.
Esophagogastrectomy: Removal of part of esophagus and anastamosis of remaining portion to stomach.
, Esophagoenterostomy: Removal of part of esophagus and anastomosis of a segment of colon to the
remaining portion.
Maintaining nutrition very important for good outcome.
What is GERD? - Syndrome resulting in reflux of gastric contents into the esophagus
Can be from hiatal hernia or relaxation/weakness of lower esophageal sphincter
What are the symptoms of GERD? - Heartburn, sore throat, hoarseness, early satiety
Bloating, nausea and vomiting, regurgitaiton (effortless return of material from stomach to esophagus or
mouth), feeling of lump in throat, difficulty swallowing (dysphagia); some may suffer bronchospasm
What are complications of GERD? - Besides discomfort, scar tissue can form in esophagus leading to
strictures;
Esophageal metaplasia (Barrett's esophagus) can lead to cancer of esophagus,
Pulmonary complications (pneumonia)
What meds protect the mucosal lining? - Antacids (Magnesium oxide, calcium carbonate)
-Neutralizes stomach acid, protects the mucosa
-Give 1-3 hours after meals and at bedtime
What meds decrease or block hydrochloric acid (HCL) production? - H2 Receptors antagonists
(Famotidine, ranitidine)
Proton pump inhibitor:
Pantroprazole, esomeprazole
What is anti-ulcer medications? - Sulcrafate: coats mucosa for protection, give prior to meal
What does Bethanochol (urecholine) do? - Can increase LES pressure
Metoclopromide (reglan) - Increases stomach emptying
What is an important teaching topic for GERD? - •Avoid chocolate, peppermint, coffee, tea and milk
products
SOLUTION
O What is esophageal cancer? - Cause unknown but strongly related to smoking, alcohol use, asbestos
exposure, and diets low in fruits, vegetables and vitamins
- Achalasia and barrett's esophagus
What is achalasia? - decrease function of lower esophagus
What is barrett's esophagus? - premalignant tissue changes seen with frequent esophageal irritation,
chronic reflux
Where are most malignant esophageal tumors found? - the middle or lower 1/3 of the esophagus
What is the prognosis of esophageal cancer? - Often poor due to it being diagnosed late
How do tumors of esophageal cancer look? - usually appear as ulcerated lesion and is quite advanced at
time of diagnosis.
What are signs and symptoms of esophageal cancer? - progressive dysphagia, choking, hoarseness with
higher tumor, weight loss, pain a late sign, severe regurgitation with bloody-flecked esophageal contents
with advanced disease.
What are complications of esophageal cancer? - Esophageal obstruction
Hemorrhage as tumor erodes through esophagus and into aorta
Fistula may form into trachea or lungs leading to pneumonia and hemorrhage
How is esophageal cancer diagnosed - Endoscopy; Barium Enema; CT or MRI
What is the treatment of esophageal cancer? - Usually treated with combination of surgery, chemo and
radiation
Surgical options:
Esophagectomy: Removal of all or part of esophagus; Dacron graft used to replace the resected part.
Esophagogastrectomy: Removal of part of esophagus and anastamosis of remaining portion to stomach.
, Esophagoenterostomy: Removal of part of esophagus and anastomosis of a segment of colon to the
remaining portion.
Maintaining nutrition very important for good outcome.
What is GERD? - Syndrome resulting in reflux of gastric contents into the esophagus
Can be from hiatal hernia or relaxation/weakness of lower esophageal sphincter
What are the symptoms of GERD? - Heartburn, sore throat, hoarseness, early satiety
Bloating, nausea and vomiting, regurgitaiton (effortless return of material from stomach to esophagus or
mouth), feeling of lump in throat, difficulty swallowing (dysphagia); some may suffer bronchospasm
What are complications of GERD? - Besides discomfort, scar tissue can form in esophagus leading to
strictures;
Esophageal metaplasia (Barrett's esophagus) can lead to cancer of esophagus,
Pulmonary complications (pneumonia)
What meds protect the mucosal lining? - Antacids (Magnesium oxide, calcium carbonate)
-Neutralizes stomach acid, protects the mucosa
-Give 1-3 hours after meals and at bedtime
What meds decrease or block hydrochloric acid (HCL) production? - H2 Receptors antagonists
(Famotidine, ranitidine)
Proton pump inhibitor:
Pantroprazole, esomeprazole
What is anti-ulcer medications? - Sulcrafate: coats mucosa for protection, give prior to meal
What does Bethanochol (urecholine) do? - Can increase LES pressure
Metoclopromide (reglan) - Increases stomach emptying
What is an important teaching topic for GERD? - •Avoid chocolate, peppermint, coffee, tea and milk
products
