Clinic-Esophagitis

Question 1

the top ___ of the esophagus is skeletal muscle

Answer 1

one-third

Question 2

what three things come together to avoid esophageal reflux in a normal esophagus?

Answer 2

LES, crux of diaphragm, and angle of His

Question 3

what is primary peristalsis?

Answer 3

orderly contraction of smooth muscle to propagate food particles caudad, specifically associated with a swallow

Question 4

what innervates the LES?

Answer 4

vagal pre-ganglionic and sympathetic post-ganglionic neurons

Question 5

when does the LES relax?

Answer 5

with onset of swallow; intermittently and transiently all day to allow venting

Question 6

mucosal barrier defenses

Answer 6

tight junctions, enhanced bicarb production, transmembrane pumps (Na/H, Cl/bicarb), salivary bicarb to neutralize pH

Question 7

common sx of GERD

Answer 7

substernal chest burning, regurgitation/belching, dysphagia (SPECIFIC but not sensitive)

Question 8

atypical reflux sx

Answer 8

hoarseness, asthma, chronic cough, sinusitis, bronchitis, bronchiectasis, erosion of dental enamel

Question 9

RFs for GERD

Answer 9

male, increases with age, obesity, pregnancy, smoking, collagen vasc dz, alcohol use, hiatal hernia

Question 10

contributors to pathophys of GERD

Answer 10

loose LES, prolonged/too many tLESRs, poor peristalsis, decreased gastric emptying, weakened epithelial resistance (smoking, alcohol) – NOT BC TOO MUCH ACID

Question 11

major complications of GERD

Answer 11

erosive esophagitis, stricture formation, Barrett’s esophagus

Question 12

sx of erosive esophagitis secondary to GERD

Answer 12

chest pain, dysphagia, odynophagia

Question 13

strictures are composed of?

Answer 13

circular bands of scar tissue under the mucosa

Question 14

tx of stricture

Answer 14

dilatation

Question 15

Barrett’s esophagus occurs in ___% of ppl with GERD and increases the risk of ____

Answer 15

10%; adenocarcinoma

Question 16

the risk of cancer is a patient with Barrett’s esophagus is?

Answer 16

very low (less than 5%)

Question 17

what alarm symptoms trigger early investigation of GERD? What test is done?

Answer 17

weight loss, dysphagia, anemia, early satiety, bleeding; endoscopy or barium swallow

Question 18

what is the most common diagnostic test for GERD?

Answer 18

empiric therapy (endoscopy better for complications, but not GERD)

Question 19

what is the most accurate dx test for GERD?

Answer 19

24 hour pH probe (functional test for “functional” disease)

Question 20

best test to examine a pt with dysphagia

Answer 20

barium swallow

Question 21

what non-pharmacologic therapy should be tried first?

Answer 21

elevate head, stop smoking, stop drinking, reduce fat consumption, lose weight, avoid chocolate, caffeine, peppermint, citrus, tomato

Question 22

moderate esophagitis should be treated with _____, while severe disease may be healed using ______

Answer 22

H2 blockers; PPIs

Question 23

how do PPIs work?

Answer 23

irreversible blockage of H/K/ATPase (proton pump) = NO ACID production

Question 24

what is a possible surgical anti-reflux procedure?

Answer 24

Nissen = fix hernia and move LES down, strengthen stricture

Question 25

usual presentation with eosinophilic esophagitis

Answer 25

dysphagia

Question 26

endoscopy of eosinophilic esophagitis shows?

Answer 26

ringed esophagus

Question 27

dx of eosinophilic esophagitis

Answer 27

endoscopy with biopsy; biopsy shows eosinophils

Question 28

CMV esophagitis shows ____ ulcers, where as pill-induced esophagitis shows ____ ulcers

Answer 28

punched out; kissing