Esophageal Disorders

Question 1

Hiatal Hernia Dx

Answer 1

endoscopy or barium studies.

Question 2

Hiatal Hernia Tx best initial therapy

Answer 2

is weight loss and PPIs.

Question 3

Hiatal Hernia Tx If symptoms persist

Answer 3

Qx: Nissen fundoplication

Question 4

Alarm symptoms indicating endoscopy include

Answer 4

Weight loss
Blood in stool (heme-positive stool)
Anemia

Question 5

Achalasia Dx “most accurate test

Answer 5

Manometry: failure of the lower esophageal sphincter to relax

Question 6

Achalasia Dx best initial tests

Answer 6

Barium esophagram: “bird’s beak”

Question 7

Achalasia Dx other tests

Answer 7

CXR: abnormal widening of the esophagus. BUT not sens-esp
endoscopy: normal mucosa AND rule out malignancy

Question 8

Achalasia Tx

Answer 8

no cure

1. • Pneumatic dilation:
2. • Surgical sectioning or myotomy (more effective & dangerous)
3. • Botulinum toxin injection c3-6m

Question 9

Esophageal Cancer Dx

Answer 9

Endoscopy**

Barium might be the “best initial test,” never deffinitive

Question 10

Esophageal Cancer Dx of extention

Answer 10

CT and MRI

Question 11

PET scan utility at EsophCA

Answer 11

1.- to determine the contents of anatomic lesions if you are not
certain whether they contain cancer.
2.- to determine
whether a cancer is resectable (local). or not, wide MT

Question 12

Esophageal Cancer Tx

Answer 12

Surgical resection*****

+ Chemotherapy and radiation

Question 13

Esophageal Cancer palliative Tx

Answer 13

Stent placement is used for lesions that cannot be resected. to improve dysphagia.

Question 14

Esophageal Spasm Dx

Answer 14

most accurate
test: manometry

Barium studies can show a corkscrew appearance

Question 15

Esophageal Spasm Tx

Answer 15

CCB and Nitrates
CCB sino TCAntd sino Sildenafil.
PPIs can help

Question 16

Eosinophilic Esophagitis Dx

Answer 16

Endoscopy shows multiple concentric rings

The most accurate diagnostic test is a biopsy finding eosinophils

Question 17

Eosinophilic Esophagitis 1Ln Tx

Answer 17

best initial therapy is PPIs and eliminating allergenic foods.

Question 18

Eosinophilic Esophagitis 2Ln Tx

Answer 18

swallowing steroid inhalers to allow the topical use of steroids

Question 19

Infectious Esophagitis Etiologic agents

Answer 19

• > 90% Candida in AIDS
• CMV
• Herpes

Question 20

Infectious Esophagitis once suspected, best first step management

Answer 20

Empiric therapy with fluconazole

Question 21

Infectious Esophagitis what to do if fluconazole didn’t work

Answer 21

Endoscopy

If Candidiasis confirmed-> IV amphotericin

Question 22

Infectious Esophagitis Dx diff

Answer 22

Endoscopy:
Large ulcerations=CMV
small ulcerations=HSV

Question 23

Infectious Esophagitis

CMV, HSV tx

Answer 23

CMV= ganciclovir or foscarnet
HSV= acyclovir

Question 24

Schatzki ring Cx Fx. And it is associated with what pathology?

Answer 24

acid reflux and intermittent dysphagia.

Asoc w hiatal hernia

Question 25

Schatzki ring Tx

Answer 25

pneumatic dilation in an endoscopic procedure

Question 26

Plummer-Vinson syndrome PAtho

Answer 26

``` PVSx=Esoph Web Asoc. iron deficiency anemia and can rarely transform into squamous cell cancer. The iron deficiency is not caused by blood loss. ```

Question 27

Plummer-Vinson syndrome Dx

Answer 27

barium studies: more proximal rings.

Question 28

Plummer-Vinson syndrome Tx

Answer 28

iron replacement at first, may solve the lesion. Then endoscopy + biopsy to r/o CA

Question 29

Zenker Diverticulum Cx Fx

Answer 29

dysphagia, severe halitosis, and regurgitation of food particles**.

Question 30

Zenker Diverticulum Dx

Answer 30

Barium

Question 31

Zenker Diverticulum Tx

Answer 31

Only Qx. No medical therapy. | Never NG tube or upper endoscopy. Danger!

Question 32

Scleroderma Cx Fx

Answer 32

Reflux + scleroderma/sclerosis

Question 33

Scleroderma Dx

Answer 33

Manometry: decreased | lower esophageal sphincter pressure

Question 34

Scleroderma Tx

Answer 34

PPIs as it would be for any person with reflux symptoms

Question 35

Manometry is the answer for

Answer 35

Achalasia Spasm Scleroderma

Question 36

Mallory-Weiss Tear Patho

Answer 36

upper gastrointestinal bleeding after | prolonged or severe vomiting or retching

Question 37

Mallory-Weiss Tear Cx Fx

Answer 37

Repeated retching is followed by hematemesis of bright red blood, or by black stool. No dysphagia.

Question 38

Mallory-Weiss Tear Tx

Answer 38

no specific therapy, | and it will resolve spontaneously.

Question 39

Mallory-Weiss Tear Tx Severe cases

Answer 39

injection of epinephrine to stop bleeding or the use of | electrocautery

Question 40

Boerhaave syndrome ?

Answer 40

full penetration of the esophagus

Question 41

Cannabinoid Hyperemesis Syndrome Dx. Also called cyclic vomitting Sx

Answer 41

Hx Cannabis + hot shower "better" | OJO this is not intox nor withdraw, just a gen especific reaction

Question 42

Cannabinoid Hyperemesis Syndrome Tx

Answer 42

antiemetics (such as ondansetron) or benzodiazepines (such as lorazepam). stop thc

Question 43

caustic esophagitis, cx fx

Answer 43

Larynx: hoarse. Stridor=urgent, may intubate Esoph:drooling!

Question 44

caustic esophagitis dx

Answer 44

endoscopy to asses damage

Question 45

caustic esophagitis tx

Answer 45

low severity= liquid diet high severity= NPO 72h, repeat EGD NEVER neutralize pH never induce emesis

Question 46

stricture path

Answer 46

GERD grade IV | 1/3 bottom of esoph

Question 47

esopho CA path

Answer 47

adenoCA caused by GERD, 1/3 bottom of esoph | SCC: caused by smoking and EtOH at upper 1/3

Question 48

stricture cx fx

Answer 48

Gerd-> dysphagia -> weight loss

Question 49

ESO CA cx fx

Answer 49

Gerd-> dysphagia -> weight loss

Question 50

stricture Dx

Answer 50

Barium shows: symmetric circunferencial loss of the lumen. | EGD Dx ro CA

Question 51

CA Dx

Answer 51

Barium shows: asymmetric loss of the lumen. EGD PET scan or PAN CT to stage/ seek for MT

Question 52

stricture Tx

Answer 52

PPI high dose | Dilation

Question 53

CA -tx

Answer 53

Chemo Radiation and Qx