Clincal- Esophageal Disorders Flashcards
What are the benefits of using upper endoscopy
-Direct visualization -Allows biopsy -Dilation of strictures
When is video esophagography used
Study of choice for oropharyngeal dysphagia
What is the first evaluation for esophageal dysphagia
Barium esophagography
What are the benefits of using barium esophagography aka barium swallow
-Differentiates mechanical lesions and motility disorders -more sensitive for detecting subtle esophageal narrowing due to rings, achalasia and proximal esophageal lesions
What is esophageal nanometry you used to asses
-Esophageal motility -to establish etiology of dysphagia in patients whom a mechanical obstructions cannot be found, especially if achalasia is suspected
What are the the differentials for a patients that presents with oropharyngeal dysphagia due to structural abnormalities
-Zenker diverticulum -Neoplasm -Cervical web
What is the differential in a patient that presents with oropharyngeal dysphagia due to a neurological propulsive issue
-Cerebral vascular accident -Parkinsons -ALS
What is the differential in a patient that present with esophageal dysphagia due to a propulsive abnormality
-Trouble with solids and liquids GERD with weak peristalsis
What is the differential in a patient that presents with esophageal dysphagia due to a structural abnormality, leading to intermittent dysphagia
Solid dysphagia Schatzki rings
What is the differential in a patient that presents with esophageal dysphagia due to a structural abnormality, leading to progressive dysphagia
-Solid dysphagia Neoplasms
What is the differential in a patient that presents with esophageal dysphagia due to a structural abnormality, leading to variable dysphagia
Solid dysphagia -Peptic strictures -eosinophilic esophagitis
What is the differential in a patient that presents with esophageal dysphagia due to a structural abnormality, leading to odynophagia
-Pill esophagitis -Infectious esophagitis
What is the state of performing initial diagnosis studies in typical GERD symptoms
Not warranted in patients with uncomplicated normal GERD cases
What are some of the alarm signals associated with GERD that constitute further workup and tests
-Dysphagia -odynophagia -hematemesis -Melena -weight loss -persistent vomiting
In the case of GERD, when should you run a upper endoscopy
-Persistent GERD despite treatment or the presence of alarm signals -Allows the detection of GERD complications
In the case of GERD, when should you run a Barium esophagography
-Should not be run to diagnose
When is a barium esophagography rarely run with GERD
In severe dysphagia in ordered prior to endoscopy to identify a peptic stricture
What should occur if GERD symptoms do not resolve after 3 months of treatment with PPI
Esophageal impedance pH testing
What does improvement of extraesophageal symptoms following PPI treatment show
Suggests but does not prove causation
What is the hallmark of scleroderma
Hardening and thickening of the skin (fibrosis), especially in African Americans
