clinical esophageal disorders

Question 1

schatzki ring

Answer 1

lower esophageal mucosal ring, can cause dysphagia.

Higher in esophagus, associated w/ plummer-vinson

Question 2

common pathophys of GERD

Answer 2

exaggeration of transient LES relaxation reflex (LES hypotension), impaired salivation, impaired peristaltic emptying

Question 3

GERD rx

Answer 3

PPI/H2RA blockers, nissen fundoplication, modify eating habits and foods (fats, EtOH, mint, tomato, caffeine)

Question 4

presentation of EoE in adults? in kids?

Answer 4

male, fibrostenotic features (concentric rings, strictures), food impaction and dysphagia, reflux symptoms.
refractory reflux symptoms, vomitting, growth problems, edeam, exudates, furrowing.
Both often have hx of atopy and link to FOOD ALLERGIES

Question 5

therapy for EoE?

Answer 5

topical fluticasone. Six food elimination diet (milk, wheat, soy, egg, nut, mariscos)

Question 6

cause of achalasia? characteristics?

Answer 6

loss of myenteric plexus possibly from Chagas infection.. High LES pressure and uncoordinated SM peristalsis.

Question 7

presentation and diagnosis of achalasia

Answer 7

intolerance of solids and liquids, dysphagia, regurgitation, wt loss, aspiration pneumonia. Manometry and barium swallow (bird-beak)

Question 8

complications of achalasia

Answer 8

sq cell carcinoma

Question 9

three achalasia treatments

Answer 9

botox, pneumatic dilation, heller myotomy

Question 10

diffuse esophageal spasm: two kinds, appearance on barium swallow, treatments

Answer 10

distal and nutcracker. corkscrew esophagus. Nitrates, CCBs, botox, anxiolytics

Question 11

three types of infectious esophagitis and their appearance on scope

Answer 11

candida: white pseudomembrane; HSV-1: punched out ulcers; CMV: linear (serpingous) ulcers