atypical CP

Question 1

what are some life-threatening GI causes of CP

Answer 1

Boerhave syndrome + iatrogenic esophageal rupture

Question 2

describe the clinical presentation, causes, diagnostic methods and treatment of .. esophageal perforation

Answer 2

1. clin present with respiratory distress and retrosternal CP
2. cause = iatrogenic (post-trauma of fb swallowed) or spontaneous (forceful retching, EtOH, Boerhaves)
3. dx= CXR w air in mediastinum and subQ emphysema, CT chest with water soluble contrast
4. trx= NPO, parenteral abx, surgery, endoscope stenting

Question 3

describe the clinical presentation, diagnostic methods of .. pneumomediastinum

Answer 3

1. clin present= dyspnea,
2. dx= subQ emphysema in neck and precordial area, air OUTSIDE mediastinum on CXR, Hamman’s sign (crunching in over precordium in beat with heart, heard best in left lateral decubitus position)

Question 4

describe the clinical presentation, causes, diagnostic methods and treatment of ..
PUD

Answer 4

1. clin present= DU in 30-55 yo, GU 55-70 yo
   hunger like pain, happens for weeks at a time with long intervals between
   coffee ground emesis, hematemesis, melena, hyperactive BS, local epigastric pain with palpation,
2. cause = [acid+pepsin] > [mucus+HCO3-], H. Pylori
3. dx= EGD w biopsy, imaging showing free air under diaphragm, CBC, nasogastric lavage, fecal-breath test, urea breath test
4. trx= acid suppression= PPI/H2 blocker (via IV if GI bleeding), surgery, eradicate h pylori
   stop smoking+ NSAID use, dietary restriction

Question 5

at least 14 days before doing a fecal-breath test to confirm eradication of _____, stop ___ use as they can cause a false ____

Answer 5

H pylori
PPI
negative

Question 6

what are the two main types of esophageal dysmotility

differentiate etiology, LES function, sx, diagnostics, and trx

Answer 6

nutcracker syndrom =
hypertensive peristalsis, with high amplitude and long duration of contractions, associated with anxiety and depression
-LES has increased P at baseline
-sx= dysphagia to solids and liquids, atypical CP, intermittently but NOT progressive
-dx w manometry
-trx= nitrates (isosorbide dinitrates, nifedipine, address mental health

diffuse esophageal spasm= normal contractions that are NOT coordinated, either primary or secondary to GERD, stress, DM, EtOH, neuropathy, etc

• LES tone is normal
• same sx
• dx with manomatry, EGD, barium swallow
• same trx

Question 7

describe the histologic changes seen with uncontrolled GERD

Answer 7

erosive esophagitis with bleeding, friable esophagus

Question 8

describe the clinical presentation,possible complications, diagnostic methods and treatment of .. GERD

Answer 8

1. clin present= ineffective motility, NONprogressive dysphagia with weak peristalsis,
2. complications= LPR, stricture, barrett’s–>adenocarcinoma
3. dx= ambulatory 24-48 hr esophageal pH recording, EGD if have alarm sx
   ALARM SX= weight loss, persistent vomiting–>dehydration, severe/constant pain, dysphagia, odynophagia, mass, hematemesis, melena, anemia
4. trx= lifestyle changes, acid suppression with PPI>H2 blocker, eradicate H. Pylori if needed
   if uncomplicated, trx with 6 week trial of omeprazole/famotidine

Question 9

what are the two types of hiatal hernia

how do you diagnose and treat?

Answer 9

1. sliding hiatal hernia

Question 10

describe the risk factors, sx, and trx of foreign body/food impaction

Answer 10

risk factors= schatzki ring, peptic stricture, webs, esophagitis, achalasia,

sx= sever chest pressure, dysphagia, odynophagia, choking, neck pain, retching+V, increased salivation (foaming at the mouth bc they can’t swallow their saliva)

trx: most pass spontaenously, others can be managed endoscopically