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Disorders of the Esophagus High Yield Flashcards

1
Q

Two types of dysphagia

A
  • Oropharyngeal
  • Esophageal
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2
Q

2 MC Symptoms of GERD

A
  • Heartburn
  • Regurgitation
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3
Q

3 Dysfunctions of the GEJ that cause GERD

A
  1. Transient LES relaxation
  2. Anatomic disruption of GEJ
  3. Hypotensive LES
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4
Q

Typical symptom of GERD

A

Heartburn

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5
Q

Besides heartburn, what else can occur in GERD?

A

Extraesophageal or atypical manifestations

Asthma
Chronic cough
Chronic laryngitis
Sore throat
Non-cardiac chest pain
Sleep disturbances

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6
Q

When do we do further studies on someone with GERD?

A
  • Only if they have alarm symptoms
  • Only if they fail empiric PPIs
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7
Q

What imaging modality is best to observe GERD?

A

EGD

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8
Q

What kind of patient almost always has an associated hiatal hernia?

A

90% of Barrett’s patients

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9
Q

Which hiatal hernia type is worse?

A

Sliding

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10
Q

MC Risk factors for hiatal hernia

A
  • Age > 50
  • Obesity
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11
Q

What endoscopic finding is diagnostic of Barrett’s?

A

Biopsy of salmon colored gastric type epithelium

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12
Q

Tx of low-grade Barrett’s

A
  1. Resect
  2. EGD 6mo
  3. Annual EGD
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13
Q

Tx of high-grade Barrett’s

A
  1. Resect
  2. Immediate EGD
  3. 3,6,12 mo EGD
  4. Annually for 5 years, then q3-5years
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14
Q

Tx of mild, intermittent GERD

A
  1. Lifestyle modifications
  2. Antacids or H2RA
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15
Q

Tx of failed H2RA therapy or severe GERD?

A

PPIs

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16
Q

Who gets long-term PPI therapy?

A
  1. Severe erosive esophagitis
  2. Barrett’s
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17
Q

Best surgery for GERD

A

Surgical fundoplication laparoscopically

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18
Q

3 groups that can get surgical fundoplication

A
  1. Extraesophageal manifestations of GERD
  2. Severe reflux and refuse lifelong PPI
  3. Large hiatal hernias despite PPI
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19
Q

When is gastric bypass better than surgical fundoplication

A

Obese GERD patients

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20
Q

Who can use a LINX procedure

A

Hiatal hernias < 3cm

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21
Q

What epithelial type is esophageal cancer due to Barrett’s?

A

Adenocarcinoma

MC type of esophageal cancer

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22
Q

Where are most esophageal cancers located?

A

Distal 3rd

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23
Q

Top two modifiable risk factors that contribute to Squamous cell carcinoma?

A
  • Alcohol
  • Tobacco
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24
Q

What esophageal cancer type is more common in blacks vs whites and where does it occur in the esophagus?

A

Squamous cell carcinoma in the MIDDLE esophagus

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25
Q

What is the common symptom of esophageal cancer?

A

Significant weight loss

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26
Q

How to diagnose esophageal cancer?

A

EGD with biopsy

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27
Q

Treatment of curable eso cancer

A

Surgery +/- chemoradiation

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28
Q

Treatment of INcurable eso cancer

A

Chemo/chemoradiation, local therapy for obstructions.

29
Q

Two most important predictors of POOR survival in eso cancer

A
  1. Adjacent mediastinal spread
  2. Lymph node involvement
30
Q

What is the suspected cause of Zenker’s

A

Loss of elasticity of UPPER esophageal sphincter

31
Q

What two things are associated with most Zenker’s patients?

A
  • Hiatal hernia
  • Reflux
32
Q

What unique symptoms suggest Zenker’s

A
  • Halitosis
  • Nocturnal choking
  • Protrusion of neck
33
Q

Diagnosis of Zenker’s

A

Barium swallow

34
Q

Tx of Zenker’s

A

Myotomy of obstruction and excision of diverticulum

35
Q

What is achalasia

A

Distal narrowing of esophagus (LES)

36
Q

S/S of achalasia

A
  • Gradual onset of dysphagia for solid foods and liquids
  • Specific manuevers to eat properly
37
Q

Diagnose achalasia

A
  • Esophageal manometry (#1)
38
Q

Barium swallow result for achalasia

A

Symmetric bird’s beak tapering of the distal esophagus

39
Q

Tx of achalasia

A
  1. Pneumatic dilation (#1)
  2. Botox
  3. Heller myotomy

Botox and nitrates for non-surgical candidates

40
Q

Diagnostic finding for diffuse esophageal spasms

A

Corkscrew esophagus with barium swallow

41
Q

Tx of DES

A
  • CCBs (Dilt)
  • TCA
  • SL NTG
  • Sildenafil
  • Botox
42
Q

Non-pharm tx of scleroderma

A
  • Eat upright
  • Drink liquids when swallowing solids
43
Q

Pharm tx of scleroderma

A
  1. PPI
  2. Metoclopramide
44
Q

Strong predisposing factor for mallory-weiss tears

A

Alcoholics

45
Q

What is the most common historical finding in mallory weiss patients?

A

Lifting, straining, retching, vomiting

46
Q

Diagnose mallory weiss tear

A

EGD with 0.4-0.5cm linear tear near GEJ or below

47
Q

What makes someone more likely to keep bleeding from a mallory weiss tear

A

Portal HTN

48
Q

Initial management of mallory-weiss tear

A

Fluids + transfusions

49
Q

Management of continued bleeding in mallory weiss tears

A
  • Epi
  • Cautery
  • Compression
  • Angiographic arterial embolization for last resort
  • PPIs
50
Q

Where are webs MC found

A

Upper to mid esophagus

51
Q

Where are rings MC found

A

Distal esophagus

52
Q

Tx of a single ring or web

A

Dilators or incision

53
Q

MCC of esophageal varices

A

Portal HTN

54
Q

MCC of portal HTN

55
Q

Bleeding risk factors for esophageal varices

A
  1. Large > 5cm
  2. Red wale markings
  3. High child’s score (liver severity)
  4. Active alcohol abuse
56
Q

Initial management of esophageal varices

A
  1. Acute resucitation via fluids and transfusions.
  2. NG tube
  3. Supplemental O2
57
Q

4 mainstays of esophageal varices besides stabilizing them

A
  1. IV rocephin
  2. Octreotide
  3. Vit K
  4. Lactulose (prevent ammonia buildup)
58
Q

When is emergent endoscopy and banding indicated in esophageal varices treatment?

A

AFTER they are hemodynamically stable

59
Q

How to prevent recurrent bleeding of esophageal varices

A

BBs and variceal band ligation

Propranolol

60
Q

What kind of patients should be screened for esophageal varices and what do they give?

A
  • Anyone w/ cirrhosis
  • BBs reduce first-time risk
61
Q

When to refer for esophageal varices?

A
  • Upper GI bleeding and suspected varices
  • Cirrhosis patients
62
Q

When to admit for varices?

A

Acute upper GI bleed and suspected cirrhosis => ICU

63
Q

Last resort treatments for varices

A
  • Balloon tamponades
  • TIPS
64
Q

MC risk factor to get infective esophagitis

A

Immunosuppressed

65
Q

3 MC pathogens that cause infective esophagitis

A
  • Candida
  • HSV
  • CMV
66
Q

What pathogen can cause infective esophagitis in normal ppl

67
Q

Diagnose infective esophagitis

A

EGD w/ biopsy and brushings

68
Q

Tx of infective esophagitis

A
  1. CMV: antiretrovirals
  2. Candidal: systemic fluconazole
  3. HSV: Oral acyclovir
69
Q

What does esophageal manometry test?

A

Motility testing

GI (17 decks)

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