2 - Esophageal Disorders Flashcards
If you repeat the EGD for evaluation of BE and the results are unclear what should you do?
- double dose PPI and repeat EGD in 3-6 months
What is the criteria for screening for Barrett’s Esophagus?
- > 5 years GERD symptoms or weekly symptoms + 2 of the following:
- White males >50 yo
- Stomach obesity
- Smoking history
- Family history
What 3 medications are the most frequent causes of pill esophagitis?
- Tetracycline
- Multivitamins
- NSAIDs
This type of infectious esophagitis is most commonly seen in cancer patients with neutropenia.
a. HSV
b. Candidiasis
c. CMV
d. Bacterial
e. HPV
d. Bacterial
This type of diverticuli is commonly caused by traction from lung disease (TB).
- Midesophageal diverticuli
If Eosinophilic Esophagitis is not responsive to PPI what is the next treatment of choice?
steroids
Fluticasone, Budesonide, or PO predisone
What is the first line treatment for esophageal spasm?
- Nitrates
This type of diverticuli is often associated with achalasia.
- Epiphrenic diverticuli
Secondary Achalasia is associated with what type of cancer?
- lung cancer
* Anti-Hu (Antineuronal AB)
A “bird beak” appearance on esophagram is common in this disorder
- Achalasia
Barrett’s Esophagus occurs in what % of patients with GERD diagnosis?
10-15%
Rings and Webs usually don’t become symptomatic until the lumen is constricted to this size.
< 13 mm
A patient presents with dysphagia, halitosis and regurgitation. What type of diverticuli are you concerned for?
- Zenker’s Diverticuli
What is the treatment for an actively bleeding esophageal varices if we are unable to control bleeding.
- Transjugular intrahepatic portosystemic shunt (TIPS)
Peptic Strictures is primarily caused by what?
long standing gastric reflux
What is the treatment for infectious esophagitis d/t CMV?
- IV Gancyclovir
> 90% of patients with Barrett’s Esophagus dies from what?
- other causes NOT esophageal cancer
In this type of infectious esophagitis you may see ulcerations on EGD.
a. HSV
b. Candidiasis
c. CMV
d. Bacterial
e. HPV
c. CMV
What is the difference between Mallory Weiss Tears and Boerhaave’s syndrome?
- Boerhaave’s syndrome is a full thickness esophageal rupture
What is a Schatzki’s ring?
- Single ring at GE junction that is < 13 mm in diameter
This type of esophagitis is most commonly seen in children.
Eosinophilic Esophagitis
*localized allergic reaction
What is the primary treatment for achalasia?
- Botox
* Dilation also an option (90% relief with 3rd dilation)
What is Achalasia?
- gastric motility disorder d/t hypertensive LES with incomplete relaxation
How are peptic strictures treated?
- balloon dilation via EGD
A “cork-screw” like appearance on esophagram is consistent with this condition.
- Esophageal spasm
A biopsy with ____ eosinophils/HPF is necessary to diagnose Eosinophilic esophagitis.
> 15
What is the treatment for button battery ingestion if it is in this location:
a. esophagus
b. stomach
c. intestines
a. esophagus = immediate removal
b. stomach = wait 72 hr see if it passes before EGD
c. intestines = should pass within 7 days if not surgery?
A patient presents with thrush, odynophagia and dysphagia. What type of infectious esophagitis are you concerned for?
a. HSV
b. Candidiasis
c. CMV
d. Bacterial
e. HPV
b. Candidiasis
Severe odynophagia is associated with what type of infectious esophagitis?
a. HSV
b. Candidiasis
c. CMV
d. Bacterial
e. HPV
a. HSV
What % of patients who have esophageal varices has a Childs-Pughs score of C?
85%
What is the treatment for esophageal candidiasis if mild vs severe?
- mild = nystatin
- severe = fluconazole, Ampho B
What are Mallory Weiss Tears?
- mucosal tear of the esophagus d/t forceful vomiting
What is the procedure of choice for low or high grade BE?
- Endoscopic ablation
* also effective for T1a adenocarcinoma
Patient’s with Barrett’s Esophagus almost always have this second condition.
- Hiatal hernia
What is the classic sign of Mallory Weiss Tears?
- hematemesis
