79 - Esoph, stomach, duodenum

Question 1

Most common cause of dysphagia

Answer 1

Neuromuscular

- remainder lesion and inflammatory

Question 2

Nerves involved in swallowing

Answer 2

o Trigeminal
o Facial
o Glossopharyngeal
o Hypoglossal

Question 3

Tx of achalasia

Answer 3

Nitrates

CCB

Question 4

4 groups of FB ingestors

Answer 4

o Peds – 75% of cases
o Psych
o Esophageal disease
o Edentulous adults

Question 5

4 areas FBs get stuck

Answer 5

o Upper eso sphynctier
o Aortic arch
o Left mainstem bronch
o LES

Question 6

5 indications for urgent FB removal

Answer 6

o	Button batteries
o	Coins in proximal esophagus
o	Impacting ability to handle secretions
o	High grade
o	Possible long period of time

Question 7

Contraindication to foley FB removal technique

Answer 7

o Not for >1 week
o Non-smooth objects
o Perf

Question 8

Delayed complications of esoph FB

Answer 8

o Perf
o Fistula
o Strictures
o Exsanguination

Question 9

3 indications for scope of FB in stomach

Answer 9

o >5cm long or 2.5cm wide
o Sharp and pointed
o Possible for >3-4 weeks

Question 10

3 common causes of esoph perf

Answer 10

o Vomit
o Childbirth
o Cough

Question 11

Clinical triad of esoph perf

Answer 11

o Subcut emphysema
o CP
o Vomiting

Question 12

Xray signs of esoph perf

Answer 12

o Pneumomediastinum
o Sub cut emphysema
o Mediastinal widening
o Pulmonary infiltrates

Question 13

MGMT of esoph perf

Answer 13

• IV tazo and vanco
• NPO
• Early surgery consult

Question 14

RFs for lower LES tone

Answer 14

o	Meds
o	Chocolate
o	Caffeine	
o	Fatty meals
o	Dysmotility
o	Pregnancy

Question 15

RF for infectious GERD

Answer 15

• Mostly immunocompromised
• May be due to inhaled steroids
• Candida
• HIV
• CMV

Question 16

Only lifestyle for GERD with evidence

Answer 16

raising head of bed

Question 17

Meds for GERD

Answer 17

o	PPI more effective than H2 blockers
o	H2 for mild to moderate
o	Refractory cases may need sucralfate
- Mucosal protectant
o	Prokinetic agents

Question 18

NSAIDS with greatest risk for gastritis

Answer 18

indmethacin
naproxen
diclfenac
ibuprofen

Question 19

Substances that damage mucosal barrier

Answer 19

bile
smoking
EtOH
steroids
H pylori
NSAIDS
pancreatic secretions
stress

Question 20

MGMT of h pylori

Answer 20

Triple

• clarithro
• amoxil
• PPI

Quadruple

• bismuth
• flagyl
• tetracycline
• PPI

Question 21

what is gastric volvulus

Answer 21

stomach rotates on self

Question 22

mgmt gastric volvulus

Answer 22

• attempt to pass NG
• possible endoscopy
• if not OR