Clinical-Esophageal Disorders 2 Flashcards
What is Zenker Diverticulum
Faisal diverticulum involving herniation between the cricopharyngeaus muscle and the inferior pharyngeal constrictor muscles
What area does Zenker diverticulum occur and what is the method used for diagnosis
Killian’s triangle and found using a Barium swallow
What are the symptoms of a peptic stricture
Gradual development of solid food dysphagia with reduction of heartburn (stricture acts as a barrier)
What is the diagnosis used for peptic strictures
Endoscopy with biopsy in all cases
What is the common patient demographics in the case of squamous cell carcinoma
Older than 50, African American males, who drinks, smokes, and lots hot beverages
What are the drugs that commonly cause pill esophagitis
NSAIDs, potassium chloride pills, alendronate, risedronate, antibiotics
What are the most common pathogens leading to infectious esophagitis
Candida albicans, herpes simplex, CMV
What is the pathogenesis of large, shallow, superficial ulcerations in the esophagus
CMV
What is the pathogenesis of small, multiple deep ulcerations in the esophagus
Herpes Simplex
What is the pathogenesis of diffuse, linear, yellow-white plaques and the esophagus mucosa
Candida
In the case of patients with caustic esophageal injury (usually doe to direct ingestion) what is the first initial examination
-Circulatory status and airway patency, laryngoscopy for mucosal assessment
What should not be administered in patients with caustic esophageal injury
-Nasogastric lovage or oral antibiotics
What is the state of surveillence in a patient after caustic esophageal injury
15-20 years after due to increased risk adenocarcinoma
In the case of eosinophilic esophagitis, what is the cause and what is the setoff usually
Food or environmental allergens cause and stimulate and inflammatory response
In patients of eiosinophilic esophagitis, what previous conditions tend to be present in 50% of patients
- Asthma
- Eczema
- Hay fever
What are complications seen with eosinophilic esophagitis
-*Food impaction can cause long history of dysphagia
What are the diagnostic findings in the physical and lab tests
-Increased IgE along with multiple concentric rings
What are the findings of the endoscopy in eosinophilic esophagitis
White exudate or papules, red furrows, concentric rings, and strictures
What is the treatment of eosinophilic esophagitis
Corticosteroids
How are esophageal webs best visualized
Barium esophagigram
How are the majority of esophageal webs treated
Passage of bougie dilators
What condition is almost always associated with esophageal rings, aka Schatzki rings
Hiatal hernias
What is the characteristics of esophageal rings
Dysphagia is intermittent and not progressive
What is likely to cause symptoms in esophageal rings
Large poorly chewed food, usually like beefsteak
What is the treatment for esophageal rings
Bougie dilators
As the size of Zenker diverticulum enlarge, what are some characteristic sings that may appear
- Bad breath (halitosis)
- spontaneous regurgitation of undirected food
- Nocturnal choking
What are the complications of Zenker diverticulum
Pneumonia
Bronchiectsis
Lung abcess
What is the best diagnostic tool for Zenker diverticulum
Video esophageography
What is the diagnostic finding during upper endoscopy
“Feline esophagus”
-multiple esophageal rings treating a curragated appearance looking like a trachea
What are the complication associated with eosinophilic esophagitis
Esophageal perforation
What is the most common cause of GIB due to portal hypertension
Esophageal varices
What is a crucial initial management of esophageal varices
Fluids, blood products, and taken to the ICU
What blood products can be given to patients with esophageal varices
FFP or fresh frozen plasma, vitamin K
Which antibiotics are given to patients with bleeds/ esophageal varices
3 gen cephalosporins, or flouroquinolones
What is the short term agents given to esophageal varices to reduce rebleeding
Nonselective beta blockers
What is the long term treatment of esophageal varices to prevent rebleeding
Band ligation
During active esophageal varices bleeding, what is done for the airway
Endotracheal tube to prevent aspiration
What is the emergent treatment for esophageal varices bleeding
Banding (the endoscopy of choice)
What are Minnesota or Sengstaken-blakemore tubes used to treat
Esophageal varices, and is a form of ballon tube, and only in cases where the bleeding can not be controlled (temporary fix)
What is transvenous intrahepatic portosystemic shunts used to treat
Aka TIPS, and for lowering risk of rebleeding, but does not lower mortality. Reserved for those patients with 2 or more epidsodes of bleeding that have not responded to treatment
What is the cause of achalasia
Loss of relaxation of the lower esophageal sphincter due to loss of NO production as there is the loss of the myenteric plexus
What is used to confirm the diagnosis of achalasia and what is the finding
Esophageal manometry and will have the complete absence of normal peristalsis and incomplete lower esophageal sphincter relaxation with swallowing
What is occurring during Boerhhave’s syndrome
Spontaneous transmural rupture at the GE junction due to belching or vomiting
What is the diagnostic tool used for Boerhaave’s syndrome
CT of chest and detecting air in the mediastinum
What is the treatment for Boerhaave’s syndrome
NGT suction
What are the three signs of pneumomediastinum
- SubQ emphysema
- Hamman’s sign
- Dyspnea
What is SubQ emphysema and where is it heard in pneumomediastium
Air trapped under the skin, usually heard in the neck or precordial area
What is Hamman’s sign and what condition is it associated with
-heard during pneumomediastinum
Crunching, rasping sound, synchronous with the heartbeat and heard over the precordium during systole and in the decubitus position (on their side)
How can Mallory Weiss tear be treated locally and quickly
Epinephrine
