Diseases of the Esophagus

Question 1

Define pyrosis

Answer 1

Hearburn

Substernal burning sensation

Question 2

Differentiate mechanical obstructions and motility disorders in relation to esophageal dysphagia

Answer 2

Mech = solids

Motility = both bad

Question 3

What four things ca cause GERD

Answer 3

Dysfunction of LES

Hiatal Hernia

Abnormal esophageal clearance

Delayed gastric emptying

Question 4

What is the Z-line?

Answer 4

Squamo columnar junction of the esophagus

Question 5

GERDis one of the three most common causes of what?

Answer 5

Chronic cough

Question 6

What symptom may suggest advanced disease with GERD

Answer 6

Dysphagia

Question 7

How do we work up GERD?

Answer 7

Typically we tx symptomatically unless there are alarm signs (dys/odynophagia, weight loss, fever stuff)

If alarm signs present or emperic tx fail –> EGD or possible LES manometry and pH

Question 8

Describe GERD lifestyle mods?

Answer 8

Lifestyle mods - No spicy, acid, tobacco. Dont lay flat. Exercise ETC..

Question 9

Describe OTC antacids and H2 receptor antagonists

Answer 9

OTC - Tums, Rolaids = Rapid, short duration

H2 - Cimetidine, Ranitidine, Famotidine. Onset = 30m, Dur= 8 hours take before meals

Question 10

Describe PPIs

Answer 10

Omeprazole (Prazole drugs)

Once daily dosing 30 minutes before b-fast

Question 11

Describe Tx algorithm for GERD patients

Answer 11

All = lifestyle

Mild/intermittent - PRN OTC or H2

“Troublesome” - Once daily PPI

Persist x 4 weeks once daily PPI = BID PPI

Persit w/ BID PPI = EGD referral.

***All w/ alarm = get EGD

Question 12

When can a GERD patient stop PPI?

Answer 12

If asymptomatic after 8-12 weeks.

Will prob relapse… need lowest therapuetic dose

Question 13

If a GERD patinet is completely refractory to medical treatment or has a severe manifestation, what can be done?

Answer 13

Nissen Fundoplication.

Wrap stomach around esophgus to reinforce the LES

Question 14

2 complications of GERD include Barret esophagus and Peptic stricture. Describe these.

Answer 14

Barret - Squam –> Columnar w/ goblet. Prolonged caustic exposure. Can cause decrease in GERD symptoms. Your gonna get an adenocarcinoma

PEPTIC Stricture (5%) - Narrowing of lumen at GEJ. Progressive solid dysphagia. Dilate it.

Question 15

Infectious esophagitis is mainly caused by what? What are two other notable causes?

Answer 15

Candida Albicans

CMV and herpes

Question 16

Infectious esophagitis is typically found in what kind of patients? What do we do for them?

Answer 16

Immunocompromised, dysphagia, odynophagia**, maybe chest pain

Diagnose w/ EGD with biopsy

But… can tx emperically, Use fluconazole x 5 days… if nothing –> EGD

Question 17

Pill induced esophagits is what?

Answer 17

Any pill making your throat hurt because the pill mechanically disturbed it

Question 18

Describe pathology behind Eosinophilic esophagitis

Answer 18

Infiltration of eosinophils into the esophagus as a inflamm response to allergen.

Leads to progressive dysphagia and narrowing of the lumen

Question 19

How do eosinophilic esophagitis patients present. What should we do?

Answer 19

Dysphagia to solids, Heartburn.

Ask about hx asthma, allergies, atopic derm.
EGD w/ mucosal biopsy (eosinophils)
*Empiric PPI BID x 2 months
Refer to Allergist
Swallow fluticosone

Question 20

Describe esophageal rings and webs

Answer 20

Webs - Thin membranes of squamous epi, many asymptomatic. Can cause GERD, usually mid to high

Ring - Schatzki, circumferential mucosal structure, distal, sim to webs, assoc w/ *Hiatal hernia

Question 21

How do we diagnose webs and rings? How do we Tx?

Answer 21

Barium swallow

Endoscopic dilation *if symptomatic

Question 22

An esophageal carcinoma is a ______ form of cancer that primarily affects ______ (3/1). Can be squamous or adenocarcinoma and present ______ w/ advanced disease

Answer 22

Rare
Men
Late

Question 23

How will esophageal carcinoma patient present? What to we do?

Answer 23

Progressive solid food dysphagia, odynophagia, **unexplained weight loss, Body aches and pains

Barium swallow –> EGD because barium doesnt show shit. See cancer –> cancer tx.

Question 24

Esophageal carcinoma is a super safe cancer right?

Answer 24

No. <20% 5-year survival.

Question 25

What is Boerhaave syndrome? What are our common findings?

Answer 25

Complete rupture of esophagus

Shock, **Pneumomediastinum ….. Also look at Sub-Q emphysema of chest

Question 26

What is a Mallory-Weiss Tear? What do we do about it?

Answer 26

Mucosal tear at GEJ (vomit,alchoholism)

Pt presents w/ hematemesis (Acute Upper GI bleed)

**Stabilize pt.
Upper Endoscopy w/ epi, cautery, endoclip

Question 27

What causes esophageal varices?

Answer 27

Dilated submucosal veins due to portal hypertension (50% w/ cirrhosis)

**high mort due to severe UGIB

Question 28

How do we Tx Esophageal varices (rupture esp)

Answer 28

Emergent = Hemostasis and stabilization

Follow on -

Propranolol, Variceal band ligation, octreotide

Question 29

Differentiate presenting symptoms of achalasia and other esophageal issues

Answer 29

Progressive dysphagia to SOLIDS AND LIQUIDS**

Question 30

How do we diagnose Achalasia?

Answer 30

Barium swallow –> bird

EGD and manometry confirms

Question 31

What causes an esophageal dysfunction that mimics achalasia but is more rapid in onset?

Answer 31

Chagas disease - T. Cruzi in mexico and s/c america

Question 32

How does Achalasia get treated

Answer 32

Botulinum toxin in LES
Pneumatic dilation
Surgery

Question 33

Sup with Zenker’s?

Answer 33

Pharyngeal pouch. Food sticking, breath smells, regurg undigested.

Barium swallow.