Esophageal Disease Flashcards
A pt presents with heartburn which predominantly occurs after eating. He complains of epigastric pain and occasional hoarseness. What 4 diagnostic tests could you perform on this pt based on his most likely diagnosis?
GERD
- EGD - if alarm sx, look for Barrett’s
- pH monitoring - GOLD STANDARD, pH
A pt presents with heartburn at night and after eating, a cough, and difficulty swallowing. On exam you notice some dental damage. What treatment options do you recommend for this pt?
GERD
Lifestyle: weight loss, diet changes, avoid NSAIDS, NPO 3 hrs before lying down, no chocolate/onion/pepper/EtOH/peppermint/garlic/carbonation/coffee/fried or fatty food
Meds: Antacids, H2 blockers (-tidine), PPIs (-prazole), sucralfate, reglan
Nissen Fundoplication
A pt presents with signs & symptoms of GERD. What is the best medical management for them?
PPIs
A 45 yo obese, white male presents for his annual physical. He has had GERD for the past 10 year but has not wanted to take meds for it. What disease are you worried this pt might develop? What are the 3 types of this Dz?
Barrett’s Esophagitis
- Non-Dysplastic
- Low-Grade Dysplasia
- High-Grade Dysplasia
A pt presents with a history of chronic, mild GERD. Since he is a white, 50 yo male with a BMI of 35, what should you consider screening for? How would you diagnose this?
Barrett’s Esophagitis
Dx w/ BIOPSY only
Endoscopic biopsy - 4 quad biopsies 2 cm apart
Confirm w/ expert pathologist
Your pt has been diagnosed with low-grade dysplasia Barrett’s. What treatment options should you recommend this pt?
Antisecretory therapy (PPIs, H2 blockers)
Surgery
Ablation
Chemoprevention
What is the most common complication of Barrett’s?
Esophageal CA (20-30X risk of adenocarcinoma)
What is the use of PPIs in treating Barrett’s?
Symptom control Heals the esophagus Decreases reflux Decreases dysplasia risk NO change in CA risk
A 22 yo male presents with dysphagia, FB sensation, and heartburn. You suspect GERD, but because of his unusual age, what other condition should you be concerned about? How would you test for it?
Eosinophilic Esophagitis
Biopsy (gold standard)
EGD
A 19 yo male presents with sx of GERD. EGD showed inflammation & fibrosis, and biopsy showed eosinophil invasion into the esophageal mucosa. What Tx options should you recommend?
Eosinophilic Esophagitis Topical steroids Allergy testing/elimination diet Tx reflux (PPIs) Fluticasone inhaler Endoscopic dilation
A pt presents complaining of difficulty swallowing. He has only noticed it with solids, but it is usually accompanied by the feeling of food being stuck in his throat. He occasionally has regurg. What might you suspect based on his Hx? What diagnostics should you order?
Esophageal stricture
EGD b/c he has dysphagia
Barium swallow
Biopsy to R/O CA
A pt presents with dysphagia of solids. EGD shows esophageal web and Schatzki’s ring. What treatment do you recommend?
Esophageal stricture Dilation Esophageal stinting PPIs Repeat EGD when symptomatic (after Tx)
A pt presents with difficulty swallowing. She notes that it occurs both with eating and drinking, and that she experiences regurg and chest pain. What treatment do you recommend for the most likely Dx?
Achalasia Balloon dilation Botulinum toxin Surgery (Meds NOT effective)
A pt presents with dysphagia of liquids and solids. What tests should you perform?
Ba swallow - “bird’s beak appearance”
Manometry - show hypertensive LES
What should you take into consideration when treating dysmotility?
Location, nature, & severity
A 60 yo pt presents with complaints of difficulty swallowing followed by regurg of undigested food hours later when he lays down. What disease are you worried about? What complications are associated with this disease?
Zenker’s Diverticulum
Complications: non-absorption of medications
A pt presents with dysphagia followed later by regurg of undigested food. There seems to be a positional component, since the regurg usually occurs when she lies down or leans forward. What treatment should you consider for this pt?
Zenker’s Diverticulum
Open surgery
ENT endoscopy
