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2.1) My Cards > 1.1 MTB Step 3 - Esophageal Disorders (Dysphagia) > Flashcards

1.1 MTB Step 3 - Esophageal Disorders (Dysphagia) Flashcards

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1
Q

INTRODUCTION

In general, what (2) Clinical Manifestations do Esophageal Disorders with ANY degree of Anatomic Damage leading to Narrowing result in?

A
  1. Dysphagia
  2. Weight Loss

ALL forms of Dysphagia can lead to Weight Loss

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2
Q

INTRODUCTION

  1. If Dysphagia is present and you do NOT know the diagnosis, what Test should you perform first?
  2. If Dysphagia is present and in the Stomach, what Test should you do first?
A
  1. Barium Study
  2. Endoscopy
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3
Q

INTRODUCTION

What are the ONLY (2) Esophageal Disorders for which Endoscopy is indispensable in the Diagnosis?

A
  1. Cancer
  2. Barrett Esophagus - precancerous histologic change.

Biopsy necessary to Diagnose both of these

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4
Q

INTRODUCTION

What is the Difference between Dysphagia and Odynophagia?

A

Dysphagia - Difficulty Swallowing

Odynophagia - Painful Swallowing (suggest Infectious process, such as HIV, HSV, Candida, CMV)

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5
Q

DYSPHAGIA

ACHALASIA

How does Achalasia typically present?

A
  1. Young
  2. Nonsmoker
  3. Progressive Dysphagia to both Solids & Liquids at the same time.
  4. Regurgitation & Aspiration of food.
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6
Q

DYSPHAGIA

ACHALASIA

  1. Which (2) Diagnostic Tests are equivalent as the Best INITIAL Tests for Achalasia?
  2. What is the Most ACCURATE Test for Achalasia?
A
  1. Barium Swallow or Chest X-Ray (CXR)
  2. Esophageal Manometry - shows Absence of normal Esophageal Peristalsis and abnormally High pressure at the Lower Esophageal Sphincter (LES) due to failure to relax (no mucosal abnormality).
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7
Q

DYSPHAGIA

ACHALASIA

Why would an Endoscopy be performed in a patient with Achalasia, and what would it show?

A

Endoscopy is done to Exclude Malignancy NOT to diagnose Achalasia.

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8
Q

DYSPHAGIA

ACHALASIA

  1. What is the Best INITIAL Therapy for Achalasia?
  2. What is the Next Best Therapy for Achalasia if the initial therapy is unsuccessful?
  3. What Therapy is used when the patient Refuses the first 2 therapies?
A
  1. Surgical Myotomy
  2. Pneumatic Dilation
  3. Botulinum Toxin injection
    • ​​toxin Inhibits the release of Acetylcholine at the Neuromusclular Junction (NMJ)
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9
Q

DYSPHAGIA

ESOPHAGEAL CANCER

What are (4) Common Presenting Signs/Symptoms for Esophageal Cancer?

A
  1. Dysphagia:
    • to Solids first
    • to Liquids later
  2. Heme-positive Stool or Anemia
  3. Age > 50
  4. Smokers and Alcohol drinkers
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10
Q

DYSPHAGIA

ESOPHAGEAL CANCER

  1. What is the Best INITIAL Diagnostic Test for Esophageal Cancer?
  2. Which Diagnostic Test should be used if the initial test is not one of the choices?
A
  1. Endoscopy
  2. Barium Swallow

Manometry will not be useful since cancer can only be diagnosed with a Biopsy.

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11
Q

DYSPHAGIA

ESOPHAGEAL CANCER

  1. What is the Best INITIAL Therapy for Esophageal Cancer?
  2. What Therapy should Follow the initial therapy?
  3. What Therapy should be added for Obstruction?
A
  1. Surgical Resection - if there are NO local or distant metastases.
  2. 5-Fluorouracil (5-FU) Chemotherapy
  3. Palliative Stenting
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12
Q

DYSPHAGIA

RINGS & WEBS

What are (2) Common Causes of Rings & Webs (a.k.a. peptic strictures)?

A
  1. Repetitive exposure of the Esophagus to Acid
  2. Sclerosing Agents for variceal bleeding (this is why variceal banding is a superior procedure)
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13
Q

DYSPHAGIA

RINGS & WEBS

What is the Best Diagnostic Test for Rings & Webs (a.k.a. peptic strictures)?

A

Barium Study

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14
Q

DYSPHAGIA

RINGS & WEBS

What are the (3) Types of Rings & Webs (a.k.a. peptic strictures)?

A
  1. Plummer-Vinson Syndrome
  2. Schatzki Ring
  3. Peptic Stricture
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15
Q

DYSPHAGIA

RINGS & WEBS

  1. What is Plummer-Vinson Syndrome?
  2. How is Plummer-Vinson Syndrome Treated?
A
  1. Plummer-Vinson Syndrome is a Proximal Stricture found in association with Iron Deficiency Anemia and is more common in Middle-aged Women.
  2. Iron Replacement
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16
Q

DYSPHAGIA

RINGS & WEBS

  1. What is a Schatzki Ring?
  2. What is the Best INITIAL Treatment for a Schatzki Ring?
A
  1. Schatzki Ring is a Distal Ring of the Esophagus that presents with Intermittent Symptoms of Dysphagia
  2. Pneumatic Dilation
17
Q

DYSPHAGIA

RINGS & WEBS

  1. What is the cause of a Peptic Stricture?
  2. What is the Treatment for a Peptic Stricture?
A
  1. Peptic Stricture results from Acid Reflux
  2. Pneumatic Dilation
18
Q

DYSPHAGIA

ZENKER DIVERTICULUM

What is a Typical Presentation for Zenker Diverticulum?

A

Dysphagia

with

Horribly Bad Breath

19
Q

DYSPHAGIA

ZENKER DIVERTICULUM

What is the Cause of Zenker Diverticulum and its symptoms?

A

Rotting Food in the back of the Esophagus from Dilation of the Posterior Pharyngeal Constrictor Muscles

20
Q

DYSPHAGIA

ZENKER DIVERTICULUM

  1. What is the Best Diagnostic Test for Zenker Diverticulum?
  2. What is the Best Therapy for Zenker Diverticulum?
A
  1. Barium Study
  2. Surgical Resection
21
Q

DYSPHAGIA

SPASTIC DISORDERS

What are (2) Common Presenting Signs/Symptoms for Diffuse Esophageal Spasm (a.k.a. Nutcracker Esophagus)?

A
  1. Severe Chest Pain typically AFTER drinking a cold beverage.
  2. NO risk factors for ischemic heart disease

Always Pain but NOT always dysphagia

22
Q

DYSPHAGIA

SPASTIC DISORDERS

What are the (2) Best Therapies for Spastic Disorders?

A
  1. Calcium Channel Blockers (CCBs)
  2. Nitrates

Same treatment as for Prinzmetal Angina/Coronary Vasospasm)

23
Q

DYSPHAGIA

SCLERODERMA (PROGRESSIVE SYSTEMIC SCLEROSIS)

  1. How does Scleroderma present?
  2. What is the Treatment for Scleroderma?
A
  1. Scleroderma presents as Symptoms of Reflux
  2. Treat with Proton Pump Inhibitors (PPIs)
24
Q

DYSPHAGIA

SPASTIC DISORDERS

Even though Esophageal Disorders can mimic Prinzmetal Variant Angina (sudden, severe pain not related to exercise) what difference should you look for on exam to distinguish the two?

A
  • Prinzmetal Variant Angina will give you ST-segment Elevation and an Abnormality on Stimulation of the Coronary Arteries.
  • Esophageal Spasm will not do the above.

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