Chapter 77: Esophageal Emergencies

Question 1

Normal length of oesophagus?

Answer 1

20-25cm

Question 2

The upper sphincter is composed primarily of the cricopharyngeus muscle, with a resting pressure of around ____

Answer 2

The upper sphincter is composed primarily of the cricopharyngeus muscle, with a resting pressure of around 100 mm Hg

Question 3

Three anatomic constrictions affect the adult esophagus

Answer 3

1. At the cricopharyngeus muscle (C6)
2. At the level of the aortic arch (T4)
3. At the gastroesophageal junction (T10 to T11)

Question 4

Five anatomic constrictions affect the pediatric esophagus

Answer 4

1. At the cricopharyngeus muscle (C6)
2. At the thoracic inlet (T1)
3. At the level of the aortic arch (T4)
4. At the tracheal bifurcation (T6)
5. At the gastroesophageal junction (T10 to T11)

Question 5

This can lead to massive upper GI bleeding

Answer 5

Variceal dilatation of the submucosal system

Question 6

Type of esophageal dysphagia that first with difficulty swallowing solids, then liquid

Answer 6

Mechanical or obstructive disease

Question 7

Is throat and chest pain with swallowing and usually signifies esophageal inflammation, infection, or erosion

Answer 7

Odynophagia

Question 8

What are the common cause of odynophagia

Answer 8

• Candida
• Herpesvirus
• Cytomegalovirus

Question 9

Primary cause of reflux?

Answer 9

Transient relaxation of the lower esophageal sphincter complex

Question 10

Type of esophageal dysphagia that has difficulty swallowing solids and liquid

Answer 10

Motility disorder

Question 11

Classic symptom of gastroesophageal reflux disease (GERD)

Answer 11

Heartburn

Question 12

A reasonable approach is to start treatment of GERD

Answer 12

Histamine-2 receptor antagonists, and if there is no improvement in 2 weeks, stop the current treatment and start a proton pump inhibitor

Question 13

Time needs not to lie down after eating so GERD will not develop

Answer 13

3 hours

Question 14

Risk factors for pill-induced esophageal injury include

Answer 14

Risk factors for pill-induced esophageal injury include swallowing position, fluid intake, capsule size, and patient age

Question 15

A chronic allergic- inflammatory condition in which eosinophils and other immune system cells infiltrate the esophagus and induce an inflammatory response, in response to foods, allergens, or acid reflux

Answer 15

Eosinophilic esophagitis

Question 16

Treatment for eosinophilic esophagitis

Answer 16

• Avoidance of allergens

- Oral liquid corticosteroids or inhaled corticosteroids

Question 17

Most common pathogen of infectious esophagitis

Answer 17

Candida

Question 18

Treatment for infectious esophagitis

Answer 18

Fluconazole 400mg/day for 2 weeks

Question 19

The most frequent cause of esophageal perforation

Answer 19

Iatrogenic perforation

Question 20

Is full-thickness perforation of the esophagus after a sudden rise in intraesophageal pressure

Answer 20

Boerhaave’s syndrome

Question 21

Most common site of perforation in boerhaave’s syndrome

Answer 21

Distal esophagus on the left posterolateral wall

Question 22

Caused by air in the mediastinum that is being moved by the beating heart, can sometimes be auscultated

Answer 22

Hammans’ crunch

Question 23

If CT is negative for esophageal rupture but clinical suspicion is still high, what is the next step?

Answer 23

If CT is negative for esophageal rupture but clinical suspicion is still high, flexible video esophagoscopy or esophagography, or both

Question 24

Age group most common seen swallowed foreign body

Answer 24

Children 18 to 48 months of age

Question 25

True or False

In children the impaction happen at distal while in adult is proximal

Answer 25

False

In children the impaction happen at proximal while in adult is distal

Question 26

Size usually dislodge at distal to the pylorus

Answer 26

> 2.5cm wide and >6cm long

Question 27

True or False
Coins in the esophagus generally present their circular face on anteroposterior films (coronal alignment), as opposed to coins in the trachea, which show that face on lateral films

Answer 27

True
Coins in the esophagus generally present their circular face on anteroposterior films (coronal alignment), as opposed to coins in the trachea, which show that face on lateral films

Question 28

Very high-yield test for esophageal foreign body

Answer 28

CT scan

Question 29

For distal esophageal objects, it is given and has been reported to relax the lower sphincter and allow passage of the object

Answer 29

Glucagon 1 to 2 mg/IV

Question 30

The food most commonly identified in food impaction

Answer 30

Meat

Question 31

In patient with food impaction, you can use proteolytic enzymes?

Answer 31

No. because it can cause mucosal injury

Question 32

True or False
Button batteries that have passed the esophagus can be managed expectantly, as long as follow-up in 24 hours can be ensured. Repeat films should be obtained at 48 hours to ensure that the cell has passed through the pylorus

Answer 32

True
Button batteries that have passed the esophagus can be managed expectantly, as long as follow-up in 24 hours can be ensured. Repeat films should be obtained at 48 hours to ensure that the cell has passed through the pylorus

Question 33

Most batteries pass completely through the body within?

Answer 33

48 - 72 hours

Question 34

American Society for Gastrointestinal Endoscopy guidelines recommend removal of sharp objects by endoscopy while they are in the ____

Answer 34

American Society for Gastrointestinal Endoscopy guidelines recommend removal of sharp objects by endoscopy while they are in the stomach or duodenum

Question 35

IF with sharp foreign body and intestinal perforation occurs, it is usually at the?

Answer 35

Ileocecal valve

Question 36

A favored packet is the ____, which may hold up to ____ of narcotic

Answer 36

A favored packet is the condom, which may hold up to 5 grams of narcotic