Dysphagia, Odynophagia, Atypical Chest Pain Flashcards

Question

Flow chart: Approach to pt with Dysphagia

Answer 1

level of suprasternal notch

Answer 2

if it is **proximal** \*typically causes esophageal dysphagia

Answer 3

* structural problem: thin, diaphragm like membranes of squamous mucosa * congenital or acquired * acquired: eosinophilic esophagitis, Plummer Vision Syndrome * sx are intermittent (not progressive)

Answer 4

- rare disease characterized by: **angular chelitis** **glossitis** **symptomatic proximal esophageal webs** **koilonychia** **iron-deficiency anemia** (weakness and fatigue) - consider middle aged women

Answer 5

* Halitosis * Spontaneous regurgitation * Nocturnal Choking * Gurgling in the throat * Protrusion in the neck * Voice changes * Weight loss * Aspiration (--\> pneumonia/lung abscess)

Answer 6

* **False diverticula** involving herniation of the mucosa and submucosa through the muscular layer of the esophagus posteriorly between the cricopharyngeus muscle and the inferior pharyngeal constrictor muscles (at pharyngoesophageal junction) * Loss of elasticity of UES * Occurs in Killian’s triangle

Answer 7

- video esophagography _or_ Barium swallow \*due before EGD due to risk of perforation

Answer 8

* Dry eyes, dry mouth --\> oropharyngeal dysphagia * Vaginal dryness, tracheo-bronchial dryness * Increased incidence of oral infection (candida) * Dental caries * Parotid/major salivary gland enlargement * Keratoconjunctivitis sicca (foreign body sensation) \*Strong association with B cell non-Hodgkin lymphoma

Answer 9

* dx: lip biopsy, serology * Tx: supportive \* F\>M, mid 50s, post-menopausal

Answer 10

* **Topoisomerase I antibodies (Scle-70)** * involves **proximal extremities and trunk** * early and progressive **internal organ involvment** * **worse prognosis**

Answer 11

* **anti-centromere ABs** * **fingers, toes, face, distal extremities** * **Raynaud's** commonly precedes other sx * **CREST Syndrome** * Calcinosis cutis * Raynaud's (2⁰) * **Esophageal dysmotility !!!** * Sclerodactyly * Telangiectasia * **Good prognosis**

Answer 12

- atrophy of esophageal smooth m. - fibrosis of skin and visceral organs ---\> aperistalic esophagus - microangiopathy - progressive

Answer 13

* Gastrinoma with gastric acid hypersecretion (Zollinger-Ellison Syndrome) * Pill-induced esophagitis * Resistance to PPIs * Medical noncompliance

Answer 14

a. progressive b. lessens/improves because stricture acts as a barrier

Answer 15

a. **EGD** - differentiates b/t peptic stricture from stricture by esophageal carcinoma \*barium swallow _might_ be helpful b. **dilation** at time of EGD, long term **PPIs**, endoscopic **steroid injection** \*operative management is _rarely_ used

Answer 16

normal stratified squamous mucosa of distal esophagus ---\> specialized intestinal (metaplastic) columnar metaplasia \*risk factors: GERD, truncal obesity ==\> ***obese WMs \>50 who smoke*** pathoma: NKSS --\> nonciliated columnar with goblet cells

Answer 17

* chronic GERD * male * white * obese * hiatal hernia * age 50+

Answer 18

goblet and columnar cells

Answer 19

1. PPI 2. Endoscopic ablation 3. **Surgical resection** has high risk of morbidity and mortality ---\> **NOT recommended**

Answer 20

* structural problem: smooth, circumferential, thin mucosal structures, **distal** * **Intermittent** sx, not progressive \*associated with hiatal hernia

Answer 21

"Steakhouse Syndrome" = typically instigated by large, poorly chewed food bolus

Answer 22

- may pass on own with drinking extra liquids after regurgitation - if impacted ---\> extracted endoscopically

Answer 23

1. Dx: barium swallow (esophagogram) 2. Tx: dilation (bougie dilator) or small endoscopic electrosurgical incision; PPIs for heartburn

Answer 24

- propulsion problem - Loss of peristalsis (distal 2/3) and **failure** **of** deglutitive **LES relaxation** - **denervation of the esophagus** resulting primarily from **loss of nitric oxide-producing inhibitory neurons** (ganglion cells) in the myenteric plexus

Answer 25

1. Primary (Idiopathic) 1. loss of ganglion cells within the esophageal myenteric plexus 2. Secondary causes (Chagas’ disease or other) 1. Chagas’ disease (think Mexico, SE US...) 2. Other secondary causes: lymphoma, carcinoma, chronic idiopathic intestinal pseudoobstruction, ischemia, neurotropic viruses, drugs, toxins, radiation therapy, postvagotomy

Answer 26

- esophageal dysfunction that is indistinguishable from primary, idiopathic achalasia - should be considered in patients from **endemic regions** - **reduviid bug** that transmits the protozoan, **Trypanosoma cruzi** - **chronic phase** of the disease develops years after infection, and results from **destruction of autonomic ganglion cells** throughout the body including the heart, gut, urinary tract, and respiratory tract

Answer 27

Primary or metastatic tumors that invade the gastroesophageal junction

Answer 28

a. painless periorbital swelling; Achalasia b. narrowing of distal esophagus; Achalasia

Answer 29

**confirms diagnosis** - complete absence of normal peristalsis and incomplete LES relaxation with swallowing

Answer 30

bird beak esophagus - Achalasia

Answer 31

schatzki = distal web = mid to proximal

Answer 32

1. NSAIDs 2. potassium chloride pills 3. alendronate, risedronate (both for osteoporosis) 4. iron 5. antibiotics \*most likely to occur if pills are swallowed without water or while supine

Answer 33

- severe retrosternal chest pain - odynophagia - dysphagia \*begin several hours after taking a pill; can occur suddenly and persist for days

Answer 34

* *Candida albicans* * herpes simplex * CMV

Answer 35

odynophagia dysphagia substernal chest pain

Answer 36

eosinophil chemokine implicated in etiology of eosiniphilic esophagitis

Answer 37

eosiniphilic esophagitis will have more eosinophils

Answer 38

* Schatzki ring * peptic stricture * webs * esophagitis (Eosinophilic!) * achalasia * cancer

Answer 39

severe chest pain chest pressure dysphagia odynophagia sensation of choking neck or throat pain