Disease of Upper GI/Stomach [7]

Question 1

Possible etiologies of obstructive disorders in the oropharyngeal area

Answer 1

Head + neck cancers
Zenker’s diverticulum
Radiation therapy (thyromegaly, fibrosis)

Question 2

Possible etiologies of propulsive motility disorders in the oropharyngeal area

Answer 2

Neurologic conditions
- stroke*
- ALS
- MS
- Parkinsons
Myasthenia gravis
Muscular dystrophy

Question 3

Possible etiologies of obstructive disorders in the esophageal area

Answer 3

Esophageal strictures
esophageal rings/schatzki's rings
EoE
Extrinsic compression
Esophageal cancer*

Question 4

Possible etiologies of propulsive motility disorders in the esophageal area

Answer 4

Achalasia*
Scleroderma*

Esophageal spasm “corkscrew eso”

Question 5

What test can you run for obstructive disorders in the oropharyngeal area

Answer 5

barium swallow

*can do this test for propulsive/motility disorders of the oropharyngeal area too

Question 6

What test can you run for obstructive disorders in the esophageal area

Answer 6

EGD (Esophagogastroduodenoscopy)

Esophagram

Question 7

Possible etiologies of propulsive motility disorders in the esophageal area

Answer 7

Esophagram
EGD (to exclude)
Esophageal manometry

Question 8

Possible etiologies of propulsive motility disorders in the oropharyngeal area

Answer 8

Barium swallow

*can do this test for obstructive disorders of the oropharyngeal area too

Question 9

Oropharyngeal dysfxn symptoms

Answer 9

1. oropharyngeal (transfer) dysphagia
2. nasal regurg
3. aspiration (solids/liquids)

Question 10

Esophageal dysfxn with propulsive/motility symptoms

Answer 10

dysphagia to BOTH solids and liquids

Chest pain

Question 11

Achalasia

Answer 11

"No relaxation" "A-chalasia"
Impaired relaxation of esophagus (LES)
- majority is IDIOPATHIC
- dmg to myenteric plexus
- Type I: Swallowing → no significant change in esophageal pressurization

dysphagia to both solids/liq, weight loss, regurg

Question 12

Esophageal dysfxn with obstructive symptoms

Answer 12

Dysphagia to solids (first) then liquid (much later)
Weight loss (ominous)
Heart burn

Question 13

Tx for achalasia

Answer 13

Endoscopic therapy

• GE junction botulinum toxin injxn → inhib of ACh release from nerve endings
• Pneumatic balloon dilation → tear LES muscle fibers
• POEM
• Surgical (hellar) myotomy

meds suck
(nitrates, CCB, sildenafil)

Question 14

Eosinophilic esophagitis EoE
(- obstructive disorders in the esophageal area)
What is it?
How is it dx?
Population affected?

Answer 14

chronic immune/antigen mediated esophageal disease

dx: dysphagia
eosinophilic infiltrate in esophagus
absence of other pot causes of esophageal eosinophilia

White male + assoc. with other allergic diseases

sx: dysphagia, acute food impaction, heartburn, food avoidance, non spec. in kids

Question 15

Tx for EoE

Answer 15

3 D’s
Drugs - steroids
Diet - 6 food elim
Dilation

Question 16

Causes of GERD

Answer 16

Inappropriate LES relaxation
Hiatal hernia
gastric/esophageal surgery
dysmotility or obstruction
ZE
Sjogern's
Scleroderma

Question 17

Barretts esophagus

• what is it
• tx?

Answer 17

Consequence of GERD with those at risk (White, male, fat, old)

• Metaplasia of esophageal squamous cells into columnar intestinal cells
• risk of dysplasia → adenocarcinoma

Tx: endoscopic treatment for high grade dysplasia and early esophageal adenocarcinomas
(ablation of Barretts tissue and resection of visible lesions )

Question 18

Esophageal cancer. which is more prevalent in US? World wide?

Answer 18

US: adenocarcinoma
World wide: Squamous

*note: adenocarcinoma is almost always in distal esophagus or gastric cardia

Question 19

Risk factors for esophageal SCC and Adenocarcinoma

Answer 19

SCC:
Old age, Alcohol/tobacco, caustic injuries
4M:1F
8AA:1 Cauc

Aden:
Old age, SMOKING, obesity, GERD, BARRETTS
8M:1F