Clinical 1

Question 1

What test is done if exacerbated esophageal herpes simplex is suspected?

Answer 1

Vesicle barium swallow radiograph

Question 2

What will be present in exacerbated herpes simplex patients in their esophagus?

Answer 2

Cowdry body associated with viral odynophagia

Question 3

Patient has buringin with swallowing, uses an inhaler, immunosuppressed.

Answer 3

odynophagia secondary to candida infection (opportunisitic)

Question 4

Describe “steakhouse syndrome”

Answer 4

meat/food bolus gets caught trying to pass through shatzkis ring/ talking and eating at the same time, item too large and causes spasm of distal esophagus “characteristic over salivation:

Question 5

Where is the junction of squamous epithelium and columnar epithelium found in the esophagus

Answer 5

shatzkis ring “B ring”

Question 6

What should you suspect if an anemic female patient comes in with dysphagia?

Answer 6

Plummer vinson syndrome

formation of another ring just below the pharynx cauases teh symptoms

Question 7

What can an exacerbation of CMV cause?

Answer 7

Ulceration of the esophageal wall.

Question 8

Smooth benign tumor found in the esophageal wall?

Answer 8

Lyomyoma

Question 9

Likely cause of esophageal stricture?

Answer 9

Usally an ulceration like this is caused by taking pills without water, or not enough water

Question 10

What is the common etiology of boerhavve syndrome?

Answer 10

usualy in acute wretching episodes casuing a rupture of the esophageal wall, and subsequent effusion of the surrounding tissues/organs.

Surgical emergency

Question 11

what is a mallory-weiss tear?

Answer 11

Mucosal lacerations at the gastroesophageal junction due to vomiting, seen commonly in alcoholics/bulimics.

Question 12

What is the cause of achalasia?

Answer 12

degeneration of dorsal motor functions or degeneration of vagal nerve fibers, also possibly ganglion cells within esophageal wall.

Question 13

Describe the CCK octapeptide test?

Answer 13

In normal patients CCK will cause relaxation of the LES due to neural inhibition overcoming CCKs signal to constrict.

In achalasia patients, CCK will go unchecked by neural impulse, causing an acutal increase in constriction at the LES

Question 14

Describe the common radiographic finding in achalasia patients.

Answer 14

Bird’s beak sign. on barium swallow… shows no relaxation of the LES

Question 15

Treatments for achalasia

Answer 15

Nitrates
Ca++ channel blockers
Botox injections

Surgery (dilations/myotomy)

Question 16

In scleroderma patients what is a common complication/

Answer 16

Vascular obliteration causes fibrosis of the smooth muscles in teh LES causing weakness, poor gastric emptying

Question 17

How does one diagnose Eosinophilic Esophagitis?

Answer 17

Need 4 biopsies from 2 separate areas, need endoscopic confirmation w/ >15eosinophils/hpf, 8 Week trial of PPIs before dx can be valid

Adults: food impaction
Children: failure to thrive

Question 18

What are the endoscopic features of EoE/

Answer 18

Mucous Pallor
Furrows
Exudates
Stricture
Fixed Rings (trachealization)

Question 19

What are teh treatment options for patients with EoE

Answer 19

Steroids (Fluticasone, Budesonide) PO

Refractory patients receive systemic steroids.

Endoscopic Reassessment

Question 20

How are patients with EoE treated if they don’t respond to steroid treatment?

Answer 20

Dietary approach

Test for food allergies

Question 21

Discuss the various esophageal motility disorders.

Answer 21

Diffuse esophageal spasm
Nutcracker esophagus
Hypertensive LES (achalasia?)
Nonspecific disorders

sx/chest pain, dysphagia

Question 22

What is the most common non-cardiac esophageal cause of chest pain?

Answer 22

Nutcracker esophagus disorder

Question 23

What are common tests used to look at non-cardiac chest pain associated with the esophagus?

Answer 23

Acid perfusion (Bernstein test)

Endrophonium (Tensilon test)

Balloon Distention Test

Question 24

What is the most common gastrointestinal disease?

Answer 24

GERD

Question 25

Describe the grade of esophagitis in the following: one or more mucosal breaks no larger than 5 mm, none of which extends between the tops of two mucosal folds

Answer 25

LA Grade A

Question 26

Describe the grade of esophagitis in the following: one or more mucosal breaks more than 5mm long, none of which extend between the tops of the two mucosal folds

Answer 26

LA Grade B

Question 27

Describe the grade of esophagitis in the following: One or more mucosal breask that extend btween the tops of two or more mucosal folds but together involved less than 75% of the circumference of the esophagus

Answer 27

Grade C

Question 28

Describe the grade of esophagitis in the following: One or more mucosal breaks that involves at least 75% of the esophageal circumference

Answer 28

Grade D

Question 29

Describe some major causes of GERD.

Answer 29

Defective esophageal clearance (inneffective peristalsis, reduced secretions)

Decreased LES resistance (weak, hiatal hernia, reduced LES tone)

Disturbed LES function (innappropriate transient relaxation)

Overwhelmed LES (high abdominal pressure, delayed emptying)

Question 30

Describe Barrett’s Esophagus.

Answer 30

Columnarization of the squamous tissue in the esophagus, as a result of chronic gastric reflux.

Question 31

What is the reason for endoscopy use in the dx of GERD?

Answer 31

-R/O Barretts
-Diagnose grade of esophagitis (A-D)
Diagnose complications

Question 32

What is the BRAVO system?

Answer 32

A pill used to measure acidity in the GI tract. Can be used in the Dx/ of GERD by measuring acid exposure in the esophagus.

Question 33

With managed care organization patients what is the common step down drug for patients due to lower costs?

Answer 33

H2 blockers