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gastroenterology > Esophageal Disorders & Neoplasms > Flashcards

Esophageal Disorders & Neoplasms Flashcards

1
Q

the loss of peristalsis in the distal 2/3 of the esophagus and impaired relaxation of the LES

A

achalasia

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2
Q

a patient presents with steady worsening of dysphagia over months to years that started with solid foods and has progressed to liquids. they have substernal fullness/pain after eating and regurg while eating and for several hours after a meal. Dx?

A

achalasia

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3
Q

what symptom warrants an upper endoscopy in a patient with achalasia?

A

dysphagia

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4
Q

what would definitively diagnose a patient with achalasia?

A

esophageal manometry

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5
Q

what would an esophageal manometry show if a patient has achalasia? (2)

A

absence of normal peristalsis
incomplete LES relaxation with swallowing

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6
Q

what diagnostic may show food or fluid in the esophagus of a patient with achalsia?

A

chest xray

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7
Q

what is the finding in a patient with achalasia if we do a barium swallow?

A

bird’s beak tapering of the distal esophagus

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8
Q

what is the treatment of achalasia in low risk surgical patients? (2)

A

pneumatic balloon dilation
surgical myotomy

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9
Q

what is the treatment of achalasia in high risk surgical patients?

A

botox injections

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10
Q

narrowing of the esophagus with scar tissue, most commonly as a result of esophageal injury

A

esophageal stricture

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11
Q

what is the most common risk factor for esophageal stricture?

A

chronic gastric reflux

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12
Q

a patient presents with chronic heartburn with sudden improvement and worsening dysphagia of solid foods only. Dx? Tx (2)?

A

esophageal stricture

dilation
PPI post-dilation

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13
Q

what is the diagnostic of choice of an esophageal stricture?

A

upper endoscopy

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14
Q

what can be used before an endoscopy to limit the risk of perforation?

A

barium swallow

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15
Q

what treatment can be used for refractory esophageal strictures during a 2nd dilation to reduce reoccurrence?

A

local steroid injections

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16
Q

what treatment can be used if patients to continue to experience refractory strictures post steroid injection?

A

temporary plastic stent placement

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17
Q

a non-full thickness esophageal laceration or tear

A

mallory-weiss esophageal tear

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18
Q

what is the most common cause of mallory-weiss esophageal tear?

A

retching/vomiting

19
Q

a patient presents with vomiting (hematemesis, coffee-ground, blood), abdominal/chest/back discomfort. Dx?

A

mallory-weiss esophageal tear

20
Q

what symptom will be present in a patient with mallory-weiss esophageal tear if bleeding has been present for 12-72 hours?

A

black, tarry stools

21
Q

what is the gold standard diagnostic for mallory-weiss esophageal tear?

A

endoscopy

22
Q

what is the treatment for mallory-weiss esophageal tear?

A

resolves spontaneously

23
Q

what is the treatment for mallory-weiss esophageal tear if bleeding does not spontaneously resolve of if clinically significant?

A

endoscopic intervention

24
Q

what is the management for a patient with mallory-weiss esophageal tear that is actively bleeding and hemodynamically unstable? (2)

A

hospitalize
observe for 48 hours

25
Q

when do mallory-weiss esophageal tears usually heal?

A

within 48-72 hours

26
Q

when is rebleeding of a mallory-weiss esophageal tear most likely to reoccur?

A

within first 48 hours

27
Q

mucosa of the pharynx protrudes posteriorly through an inherently weak area at the pharyngoesophageal junction.

A

zenker diverticulum

28
Q

what is the natural area of weakness called in zenker diverticulum?

A

killian triangle

29
Q

what is the etiology of zenker diverticulum?

A

chronic increased pressure on an already weak area

30
Q

a patient presents with worsening dysphagia with coughing/choking sensation, halitosis, and regurgitation of food. Dx?

A

zenker diverticulum

31
Q

what is the 1st line of study for zenker diverticulum?

A

barium swallow

32
Q

what allows for a definitive diagnosis and treatment of zenker diverticulum?

A

upper endoscopy

33
Q

what is the treatment of choice for zenker diverticulum?

A

flexible endoscopic myotomy + diverticulectomy

34
Q

what are the 2 histological types of esophageal neoplasms?

A

squamous cell carcinoma
adenocarcinoma

35
Q

what are the 2 most common risk factors for squamous cell carcinoma of the esophagus?

A

chronic alcohol
tobacco

36
Q

what are the 2 most common risk factors for adenocarcinoma of the esophagus?

A

chronic gastric reflux
barrett esophagus

37
Q

what is the most common esophageal neoplasm?

A

adenocarcinoma

38
Q

a patient presents with solid food dysphagia that has been progressively worsening over weeks to months, has odynophagia, weight loss, neck mass, and hoarse voice. Dx?

A

esophageal neoplasm

39
Q

what will be present in a patient’s test if they have esophageal neoplasm?

A

+ fecal occult blood

40
Q

what gives the definitive diagnosis for esophageal neoplasm?

A

upper endoscopy + biopsy

41
Q

what is recommended to evaluate complex lesions suspected in esophageal neoplasms?

A

barium swallow

42
Q

what is the treatment for non-metastatic, localized tumors in the esophagus?

A

radiation + chemotherapy
+/- surgery

43
Q

what is the treatment for distant metastasis from the esophagus?

A

palliative therapy

gastroenterology (26 decks)

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