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FUN MED SPRING 2018 > 3. Disorders Of The Esophagus II > Flashcards

3. Disorders Of The Esophagus II Flashcards

1
Q

When are primary peristaltic contractions initiated?

A

During swallowing.

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2
Q

When do secondary peristaltic contractions begin?

A

Circular esophageal muscles begin to contract WITHOUT swallowing.

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3
Q

What causes secondary peristaltic contractions?

A

Distension

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4
Q

What are key symptoms that might suggest chest pain is gastric instead of cardiac?

A

Prolonged pain, nonexertional, meal-related, improved with antacids, accompanied by heartburn, dysphagia, and regurgitation (usually still requires cardiac work up)

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5
Q

Which patients might require an esophageal manometry?

A

Dysphagia, odynophagia, intractable heartburn (work up for Nissen), non cardiac chest pain.

ANY PROBLEMS WITH SWALLOWING

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6
Q

Primary esophageal motility disorders.

A

Achalasia
Diffuse Esophageal Spasm
Nutcracker Esophagus
Hypertensive LES

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7
Q

Disorder of hypomotility.

A

Achalasia

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8
Q

Disorders of Hypermotility

A

DES
Hypertensive LES
Nutcracker Esophagus

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9
Q

Achalasia is a degeneration of ____ in the ____________plexus.

A

Ganglion cells.

Esophageal myenteric

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10
Q

Achalasia is a degeneration in innervation which leads to ________ and _____________

A

decreased to absent peristalsis

Poor LES relaxation

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11
Q

What kind of deformity might you find in achalasia?

A

“Sigmoid deformity”

LES becomes hypertrophied (it’s not relaxing)

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12
Q

What kind of infection might cause achalasia?

A

Human herpes simplex virus. 1 +genetic susceptibility

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13
Q

Type of dysphagia with achalasia

A

Solid and liquid

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14
Q

S and S of achalasia

A 
Dysphagia
Regurgitation
Chest pain
Heartburn
Weight loss-can’t maintain P.O. intake
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15
Q

Pt’s with achalasia are at a higher risk for_______,_______, and__________.

A

Bronchitis.

Pneumonia

Lung abscess

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16
Q

What kind of cancer is a complication of achalasia?

A

Esophageal squamous cell carcinoma-17x

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17
Q

Achalasia DDx

A

DES

Chagas

Pseudo achalasia

18
Q

Achalasia Diagnosis

A

Barium swallow

+/1 Esophageal Manometry

19
Q

What would you find in a barium swallow with a patient with achalasia?

A

Esophageal dilatation. Tapering at the gastroesophageal junction (beak.) Air-fluid level in the esophagus.

Sigmoid deformity (S curve) in advanced disease.

20
Q

What would you find in manometry in pt’s with achalasia?

A

increased LES pressure and absent peristalsis

21
Q

Can you reverse damage done by achalasia?

A

No

22
Q

What are we trying to do when treating achalasia?

A

Reduce LES pressure and improvement movement of stuff out of esophagus

23
Q

Pharm Tx. For achalasia

A

Nitrates or CCB before food

Botox into LES

Viagra

24
Q

Major complication of pneumatic dilatation.

A

Perforation

25
Q

Most common surgical tx. For achalasia

A

Heller myotonic-performed laparoscopically. (Cutting LES to allow food and secretions to easily pass into stomach)

Usually get a Nissen or Toupe wrap as well.

26
Q

Nissan: full or partial?

A

full

27
Q

A diagnosis of exclusion.

A

Diffuse Esophageal Spasm

28
Q

A patient presents with abnormal esophageal contractions even during normal swallowing.

A

Diffuse Esophageal Spasm-“crazy” spasm all the time.

29
Q

What is the diagnostic tool for DES?

A

Manometry

30
Q

What would you find in a barium swallow in DES?

A

“Corkscrew esophagus”

31
Q

The only controlled tx. for DES.

A

Anxiolytics-most effective

32
Q

Found in infectious esophagitis no matter the infection.

A

Odynophagia

33
Q

Most common types of causes of infectious esophagitis.

A

Candida albicans

Herpetic esophagitis-HSV1 or 2, varicella zoster, herpes zoster

Cytomegalovirus (CMV)

34
Q

Herpetic esophagitis tx

A

Acyclovir

35
Q

Candidiasis albicans infectious esophagitis tx

A

Antifungals( fluconazole)

36
Q

CMV Tx

A

Ganciclovir and foscarnet

37
Q

Endoscopic findings with EoE:

A

Edema

Esophageal rings

Longitudinally oriented furrows.

Punctuate exudate

38
Q

A pt. has been on a PPI for a few weeks and continues to have heartburn..ddx?

A

EoE

39
Q

Pediatric EoE Sx

A

Chest or abdominal pain

Nausea

Vomiting

Food aversion

40
Q

EoE complications

A

Esophageal stricture

Food impaction

Esophageal perforation

41
Q

Elimination diet for EoE

A

Milk, wheat, egg, soy, nuts, and seafood.

42
Q

Swallowed glucocorticoids is a tx for______

A

EoE

FUN MED SPRING 2018 (14 decks)

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