Clin - Dysphagia, Odynophagia, Atypical CP Flashcards
panacinar emphysema is associated with
alpha 1 antitrypsin deficiency
positive anti-Scl-70
diffuse scleroderma
corrugated ringed appearance of esophagus on EGD
eosinophilic esophagitis
risk of developing B cell non-Hodkin lymphoma
sjogren’s
what imaging is used to diagnose zenker diverticulum
barium esophagography
what imaging is used to diagnose achalasia
esophageal monometry
when to use esophageal pH monitoring
GERD patients with atypical sx
immune related bowel dz with ASCA antibodies
Crohn’s
herniation of mucosa in killian’s triangle
zenker’s diverticulum
uncoordinated esophageal contractions
diffuse esophageal spasm
rheumatologic dz with topoisomerase I antibodies
diffuse scleroderma
widened mediastinum on plain x-ray
aortic dissection
corkscrew appearance of esophagus on x-ray
diffuse esophageal spasm
iron deficiency anemia
plummer vinson syndrome
fecal occult blood test would be useful in looking for
colon cancer
iatrogenic causes of esophageal perforation
- nasogastric tube placement
- endoscopy
CXR with air in mediastinum and/or subcutaneous emphysema indicates what
esophageal perforation
tx for esophageal perforation
- NPO (nothing by mouth)
- parenteral antibiotics
- surgery
- endoscopic stenting
“gnawing, dull, aching, hunger-like” epigastric pain
PUD
diagnostic tests for PUD
- EGD w/ biopsy
- x-ray, CT, MRI
- CBC (anemia)
- Fecal and breath tests for H. pylori
purpose of EGD w/ biopsy in testing for PUD
excludes malignancy and can be used as treatment intervention of active bleeding
complications of ulcer located on posterior wall of duodenum or stomach
it may perforate into contiguous structures such as pancreas, liver, or biliary tree
- can cause pancreatitis
compare lower esophageal sphincter b/w nutcracker esophagus and diffuse esophageal spasm
nutcracker: relaxes normally, but has elevated pressure at baseline
DES: normal
compare diagnosis/tx b/w nutcracker esophagus and diffuse esophageal spasm
nutcracker: manometry, video fluoroscopy
DES: manometry, EDG, barium swallow
“rosary bead esophagus”
diffuse esophageal spasm
compare sx b/w nutcracker esophagus and diffuse esophageal spasm
both have intermittent (NOT progressive) dysphagia to solids and liquids and atypical chest pain
describe dysphagia in GERD
intermittent, NOT progressive
alarm features w/ GERD that require further evaluation
- weight loss
- persistent vomiting
- constant/severe pain
- palpable mass/adenopathy
- hematemesis
- melena
- anemia
hernia as a result of increased abd pressure from obesity, pregnancy, etc
sliding hiatal hernia
herniation into mediastinum and includes a visceral structure other than the gastric cardia, most commonly the colon
paraesophageal hernia
“upside down stomach”
paraesophageal hernia
dx and tx for hiatal hernias
barium x-ray
if symptoms –> surgical repair, otherwise nothing
inability to swallow liquids including their own saliva
foreign bodies and food impaction
globus pharygneus
sensation of lump lodged in throat with swallowing unaffected
describe dysphagia with esophageal webs
intermittent nOT progressive
where do schatzki rings and esophageal webs occur in the esophagus
rings: distal
webs: mid to proximal
diagnostic study for esophageal webs
barium swallow (esophagogram) - EDG can be done but is less sensitive
tx esophageal webs
dilatation (bougie dilator) or small endoscopic electrosurgical incision
- long term PPI if heartburn or needing repeat dilation
sx of plummer vinson syndrome
- angular chelitis (around mouth)
- glossitis
- symptomatic esophageal webs
- koilonychia (spoon nails)
- iron deficiency anemia
describe dysphagia in zenker’s diverticulum
gradual/insidious onset (years)
structural abnormality of zenker’s diverticulum
- herniation b/w cricopharyngeus m. and inferior pharyngeal constrictor m.
- loss of elasticity of UES
dx test for zenker’s diverticulum
video esophagography or barium swallow
tx for zenker’s diverticulum
surgery - upper myotomy or surgical diverticulectomy
dx test for sjogren’s
lip biopsy, serology
tx for sjogren’s
supportive
compare antibodies b/w diffuse scleroderma and limited scleroderma
diffuse: topoisomerase I antibodies (scl-70)
limited: anti-centromere antibodies
compare regions affected b/w diffuse scleroderma and limited scleroderma
diffuse: diffuse involvement including proximal extremities and trunk
limited: fingers, toes, face, distal extremities
compare prognoses b/w diffuse scleroderma and limited scleroderma
diffuse: worse prognosis than limited
CREST syndrome is associated with what scleroderma
limited
what is CREST syndrome
C: calcinosis cutis R: raynaud's E: esophageal dysmotility S: sclerodactyly T: telangectasia
describe dysphagia in scleroderma pts
progressive
hallmark of scleroderma
atrophy of esophageal smooth muscle
dx test for scleroderma
serology
tx for scleroderma
control sx and slow progression to improve quality of life and prolong survival
describe dysphagia with esophageal stricture
progressive, first with solids then with solids and liquids
describe how heartburn changes as esophageal stricture progresses
reflux and heartburn lessens/improves because the stricture acts as a barrier to reflux
diagnostic test for esophageal stricture
- barium swallow
2. endoscopy (EGD) w/ biopsy
tx for esophageal stricture
- dilation at the time of endoscopy
- long term therapy on PPI
- maybe steroids injected into stricture
diagnostic test for barretts esophagus
screening EGD w/ biopsy (case by case basis, depends on pt)
management/suveillance of barretts esophagus
surveillance endoscopy every 3-5 years, monitoring for adenocarcinoma
recommended tx in barretts esophagus pts w/ high grade dysplasia or intramucosal adenocarcinoma
endoscopic ablation
diagnostic test for esophageal squamous cell cancer
EGD w/ biopsy
tx esophageal squamous cell cancer
surgery (esophagectomy)
diagnostic test for esophageal adenocarcinoma
EGD w/ biopsy
tx esophageal adenocarcinoma
endoscopic therapy (ablation)
describe how barretts esophagus becomes adenocarcinoma
barrett metaplasia –> dysplasia –> adenocarcinoma
describe the dysphagia in esophageal ring
intermittent, NOT progressive
what esophageal structural dz is associated with hiatal hernia
esophageal ring
“steakhouse syndrome”
a large poorly chewed food bolus getting stuck in esophagus
- associated w/ esophageal rings
diagnostic test for esophageal ring
barium swallow (esophagogram)
tx for esophageal ring
dilatation (bougie dilator) or small endoscopic electrosurgical incision
- long term PPI if heartburn or needing repeat dilation
describe the dysphagia in achalasia
progressive
diagnostic test for achalasia
- barium esophagogram (bird’s beak sign)
- EGD
- esophageal manometry
- CXR
what does esophageal manometry show in an achalasia patient
- complete absence of normal peristalsis and incomplete lower esophageal sphincter relaxation w/ swallowing
- -> confirms diagnosis
sx of pill-induced esophagitis
- severe retrosternal CP
- odynophagia and dysphagia
diagnostic test for pill-induced esophagitis
endoscopy
tx for pill-induced esophagitis
healing occurs rapidly when offending agent is eliminated
preventative measures for pill-induced esophagitis
take pills with 4oz water and remain upright for 30 mins after ingestion
what history findings are associated w/ eosinophilic esophagitis
history of food bolus impaction
diagnostic test for eosinophilic esophagitis
EGD
“feline esophagus”
eosinophilic esophagitis
compare sx of eosinophilic esophagitis b/w adults and children
adults: dysphagia, pyrosis, poor med response, regurgitation
children: vomiting, difficulty feeding, dysphagia, failure to thrive
cause of caustic esophageal injury
accidental or deliberate ingestion of liquid or crystalline alkali (drain cleaners) or acid
sx of caustic esophageal injury
severe burning, varying degrees of chest pain, gagging, dysphagia, drooling
diagnostic test for caustic esophageal injury
laryngoscopy, chest and abd x-rays
complications of caustic esophageal injury
- pneumonitis
- perforation
- esophageal stricture
- increased risk of esophageal squamous carcinoma
tx for caustic esophageal injury
- ICU hospitalization
- nasogastric lavage
- oral antidotes
