Clincal- Esophageal Disorders

Question 1

What are the benefits of using upper endoscopy

Answer 1

-Direct visualization -Allows biopsy -Dilation of strictures

Question 2

When is video esophagography used

Answer 2

Study of choice for oropharyngeal dysphagia

Question 3

What is the first evaluation for esophageal dysphagia

Answer 3

Barium esophagography

Question 4

What are the benefits of using barium esophagography aka barium swallow

Answer 4

-Differentiates mechanical lesions and motility disorders -more sensitive for detecting subtle esophageal narrowing due to rings, achalasia and proximal esophageal lesions

Question 5

What is esophageal nanometry you used to asses

Answer 5

-Esophageal motility -to establish etiology of dysphagia in patients whom a mechanical obstructions cannot be found, especially if achalasia is suspected

Question 6

What are the the differentials for a patients that presents with oropharyngeal dysphagia due to structural abnormalities

Answer 6

-Zenker diverticulum -Neoplasm -Cervical web

Question 7

What is the differential in a patient that presents with oropharyngeal dysphagia due to a neurological propulsive issue

Answer 7

-Cerebral vascular accident -Parkinsons -ALS

Question 8

What is the differential in a patient that present with esophageal dysphagia due to a propulsive abnormality

Answer 8

-Trouble with solids and liquids GERD with weak peristalsis

Question 9

What is the differential in a patient that presents with esophageal dysphagia due to a structural abnormality, leading to intermittent dysphagia

Answer 9

Solid dysphagia Schatzki rings

Question 10

What is the differential in a patient that presents with esophageal dysphagia due to a structural abnormality, leading to progressive dysphagia

Answer 10

-Solid dysphagia Neoplasms

Question 11

What is the differential in a patient that presents with esophageal dysphagia due to a structural abnormality, leading to variable dysphagia

Answer 11

Solid dysphagia -Peptic strictures -eosinophilic esophagitis

Question 12

What is the differential in a patient that presents with esophageal dysphagia due to a structural abnormality, leading to odynophagia

Answer 12

-Pill esophagitis -Infectious esophagitis

Question 13

What is the state of performing initial diagnosis studies in typical GERD symptoms

Answer 13

Not warranted in patients with uncomplicated normal GERD cases

Question 14

What are some of the alarm signals associated with GERD that constitute further workup and tests

Answer 14

-Dysphagia -odynophagia -hematemesis -Melena -weight loss -persistent vomiting

Question 15

In the case of GERD, when should you run a upper endoscopy

Answer 15

-Persistent GERD despite treatment or the presence of alarm signals -Allows the detection of GERD complications

Question 16

In the case of GERD, when should you run a Barium esophagography

Answer 16

-Should not be run to diagnose

Question 17

When is a barium esophagography rarely run with GERD

Answer 17

In severe dysphagia in ordered prior to endoscopy to identify a peptic stricture

Question 18

What should occur if GERD symptoms do not resolve after 3 months of treatment with PPI

Answer 18

Esophageal impedance pH testing

Question 19

What does improvement of extraesophageal symptoms following PPI treatment show

Answer 19

Suggests but does not prove causation

Question 20

What is the hallmark of scleroderma

Answer 20

Hardening and thickening of the skin (fibrosis), especially in African Americans