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PBR: GI > Disorders of the Esophagus > Flashcards

Disorders of the Esophagus Flashcards

1
Q

How to 90% of tracheoesophageal abnormalities present?

A

Nearly 90% of tracheoesophageal abnormalities present as a blind, upper esophageal atresia with a fistula between a lower esophageal segment and the lower portion of the trachea, near the carina.

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2
Q

What prenatal clue hints at the presence of an esophageal abnormality in the infant?

A

~50% of infants with an esophageal abnormality have a history of polyhydramnios.

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3
Q

What does VACTERL stand for?

A

Vertebral anomalies, Anal atresia, Cardiac anomalies (PDA, ASD, VSD), TracheoEsophageal fistula, Renal anomalies (urethral atresia with hydronephrosis), and Limb anomalies (humeral hypoplasia, radial aplasia, hexadactyly, proximally placed thumb).

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4
Q

Create flashcards from Fig 10-1***

A

Fig 10-1***

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5
Q

At the bedside, how do you diagnose esophageal atresia with distal tracheoesophageal fistula?

A

Diagnose by trying to place a nasogastric tube into the stomach; the blind pouch of the esopagus prevents its passage, and an x-ray will show the NG coiled in the upper chest. ***Image 10-1

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6
Q

What is the recommended initial management of infants determined to have esophageal atresia with distal tracheoesophageal fistula?

A

Discontinue all oral feeds, place an OG into the blind pouch, and then connect it to continuous suction to manage oral secretions. Keep head elevated to 30° to prevent stomach contents from being refluxed into the trachea. Surgery should be performed as soon as cardiac evaluation rules out potential cardiac anomalies.

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7
Q

An infant with recently repaired tracheoesophageal fistula presents with tachypnea and a sepsis-like picture. What condition do you suspect?

A

The most common complication of TEF repair is leakage from the anastamosis site, which presents with tachypnea and a sepsis-like picture.

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8
Q

How would one differentiate between infants with esophageal atresia + TEF vs those with EA - TEF?

A

Infants with EA + TEF present with excessive oral secretions and gasseous distention of the entire GI tract on x-ray. Infants with EA - TEF present with excessive oral secretions and a flat, gassless abdomen on x-ray.

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9
Q

What is achalasia?

A

Achalasia is a disorder of the esophagus characterized by incomplete relaxation of the LES and a lack of normal esophageal peristalsis. It is a motor problem, not an anatomic problem.

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10
Q

Describe the typical appearance of barium swallow in patients with achalasia.

A

Barium swallow typically reveals a dilated esophagus that terminates in a beaklike manner due to persistent contraction of the LES. ***Image 10-2

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11
Q

What procedure is required for definitive diagnosis of achalasia?

A

Manometric examination is needed to confirm the diagnosis and demonstrates elevated resting LES pressure, incomplete relaxation of the sphincter, and aperistalsis of the smooth muscle portion of the body of the esophagus.

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12
Q

T/F: Achalasia in infancy can be due to a congenital disorder.

A

True. If achalasia presents in infancy or early childhood, it may be due to a congenital disorder.

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13
Q

When does achalasia typically present in children?

A

Achalasia is rare in children, but the mean age for presentation in children is 9 years of age.

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14
Q

What is the recommended treatment for achalasia?

A

Options include either graded pneumatic dilation, laparoscopic surgical myotomy with partial fundoplication, or botulinum toxin therapy.

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15
Q

Is GE reflux a normal process for infants?

A

Yes. Half of infants 0-3 months of age and 2/3 of infants 4-6 months of age vomit at least once daily.

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16
Q

How does one distinguish between physiologic regurgitation in an infant and GERD?

A

GERD can manifest as FTT due to inability to consume and maintain enough calories in the digestive tract for appropriate growth.

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17
Q

What conditions would an Upper GI series be able to diagnose?

A

Upper GI is good for diagnosing anatomic or motility problems, but should not be used to diagnose GERD since reflux can be seen in normal children.

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18
Q

What is the initial treatment for GERD in infants?

A

Food thickening and/or increasing the caloric content of food. If this is unsuccessful, do a trial of medical therapy.

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19
Q

What is the only method of definitively diagnosing esophagitis?

A

Upper endoscopy with biopsy of the esophagus.

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20
Q

How is GERD treated in children?

A

Treatment is initially aimed at dietary measures and positioning. Dietary measures include providing small meals while also avoiding carbonated beverages, high-fat foods, acidic foods, caffeine, and nicotine. If esophagitis is present, it should be treated with an antisecretory agent such as a PPI.

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21
Q

What is a long-term complication of severe, prolonged, untreated esophagitis?

A

Barrett esophagus, which is a premalignant condition characterized by the presence of intestinal metaplasia in the distal esophagus.

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22
Q

What are some long-term complications of long-term acid blockade?

A

Infants have increased rates of pneumonia and viral gastroenteritis. Children and adults have increased risk for GI infections, such as C. difficile.

23
Q

What is eosinohilic esophagitis?

A

It is a chronic inflammatory condition of the esophagus characterized by eosinophilic infiltration of the esophageal mucosa.

24
Q

What is the most common cause of dysphagia/food impaction in children?

A

Eosinophilic esophagitis, which accounts for 60-80% of cases.

25
Q

What disorder should you suspect if a child with a history of atopy presents with frequent odynophagia, dysphagia, or food boluses?

A

Eosinophilic esophagitis

26
Q

What is the diagnostic criteria for eosinophilic esophagitis?

A

Upper endoscopy with biopsy is required. Biopsy will reveal a large number of eosinophils (usually > 15/high power field).

27
Q

What is the standard treatment regimen for patients with eosinophilic esophagitis?

A

Treatment is often difficult, although most experts recommend high-dose acid suppression with a PPI, specific food elimination, or swallowed steroids (from a metered dose inhaler, but swallowed - not inhaled).

28
Q

Elimination of what dietary product improves symptoms in as many as 60% of patients with eosinophilic esophagitis?

A

Cow’s milk.

29
Q

Which children are at risk for having infection of the esophagus?

A

Immunocompromised children. Typically those at risk are children with HIV, diabetes mellitus, cancer, and long-term high-dose steroid usage.

30
Q

What are the three most common causes of esophageal infection?

A

Candida, CMV, and herpes simplex virus.

31
Q

What is the recommended treatment for esophageal infection with Candida?

A

Fluconazole

32
Q

What is the recommended treatment for esophageal infection with CMV?

A

Ganciclovir and/or foscarnet.

33
Q

What is the recommended treatment for esophageal infection with HSV?

A

Acyclovir.

34
Q

What are the (6) most common household products responsible for caustic ingestions?

A

Bleach, laundry detergents, bathroom cleansers, drain cleaners, oven cleaners, and swimming pool products.

35
Q

Why is the induction of emesis and the insertion of an NG tube no longer recommended in patients with caustic ingestions?

A

Emesis leads to further esophageal exposure to the agent, and placement of NG tubes can cause perforation of damaged areas.

36
Q

How long after ingestion of a caustic substance should upper endoscopy be performed?

A

Upper endoscopy is recommended 12-24 hours after the ingestion, but no later than 48 hours afterward due to increased risk of perforation.

37
Q

How are grade 1 esophageal burns characterized?

A

Grade 1 burns are only superficial and consist of mucosal edema or redness.

38
Q

How are grade 2 esophageal burns characterized?

A

Grade 2 burns extend into the submucosa and muscle layers. These lesions cause scarring and can result in stricture formation.

39
Q

How are grade 3 esophageal burns characterized?

A

Grade 3 burns extend through the esophagus and/or stomach and are associated with complete thickness burns and extensive necrosis.

40
Q

How are grade 4 esophageal burns characterized?

A

Perforation is classified as a Grade 4 burn and necessitates immediate consultation with a pediatric surgeon.

41
Q

Where are pills most likely to become stuck in patients with pill-induced esophagitis?

A

The most common location for the pill to become stuck is the midesophagus.

42
Q

What are the (5) most common pills that cause pill-induced esophagitis?

A

Tetracycline, doxycycline, aspirin, NSAIDs, and slow-release potassium.

43
Q

What is the recommended management of pill-induced esophagitis?

A

Symptoms generally resolve in 1-3 weeks. Agents to stop acid production may be helpful in severe cases, but, generally, no specific therapy is necessary. Advise the patient to swallow pills with water.

44
Q

What is the best way to determine if an ingested coin is in the esophagus?

A

Chest X-ray

45
Q

How can one differentiate between coins in the esophagus vs the trachea using chest x-ray?

A

On a PA projection, coins in the esophagus tend to to lie in the coronal plane (“face forward”), while coins in the trachea tend to lie in the sagittal plane (“on edge”). ***Images 10-3 and 10-4

46
Q

Make flashcards of Image 10-3 and 10-4.

A
47
Q

In what situation would endoscopic removal of a coin in the esophagus be appropriate?

A

Coins in the esophagus may be observed for 24 hours if the child is asymptomatic. If the child becomes symptomatic, or if the coin is still in the esophagus after 24 hours, endoscopic removal is required.

48
Q

Ingestion of which type of foreign body would require emergent endoscopic removal?

A

Button battery

49
Q

When does food impaction require intervention?

A

If the patient is in respiratory distress or can’t swallow secretions.

50
Q

Spontaneous esophageal perforation is rare but has increased frequency in patients with which two disorders?

A

Marfan and Ehlers-Danlos syndromes.

51
Q

What is the recommended diagnostic approach to patients suspected of having spontaneous esophageal perforation?

A

Plain film x-rays followed by instillation of a small amount of water-soluble contrast material. Do not perform endoscopy in these patients.

52
Q

What is the recommended treatment for esophageal perforation?

A

Treat surgically, and then begin antibiotics and parenteral feeds. Enteral feeds may be initiated by positioning the feeding tube past the healing perforation.

53
Q

What syndrome is characterized by achalasia, alacrima, and adrenal insufficiency?

A

Triple A syndrome, AKA Allgrove syndrome.

PBR: GI (14 decks)

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