Esophageal disorders

Question 1

what is the MC infectious cause of infectious esophagitis

Answer 1

candida

Question 2

classic sx all types of esophagitis

Answer 2

odynophagia
dysphagia
retrosternal chest pain

Question 3

in what population is eosinophilic esophagitis most common

Answer 3

white males between 30 and 40

Question 4

test of choice for any form of esophagitis

Answer 4

upper endoscopy

Question 5

what meds are most likely to cause pill-induced esophagitis

Answer 5

NSAIDs
bisphosphonates

Question 6

medical term for heartburn

Answer 6

pyrosis

Question 7

what is the most common cause of non cardiac chest pain in patients w a negative cardiac workup

Answer 7

GERD

Question 8

alarm features with GERD

Answer 8

dysphagia
odynophagia
anorexia
unexplained weight loss
evidence of GI bleed - occult blood in stool, melena, hematemesis, hematochezia, findings of IDA
persistent vomiting
age > 60
GI cancer in first degree relative

Question 9

if there are alarm sx present in patient w GERD, what test should you do

Answer 9

upper endoscopy

Question 10

what is the MC cause of esophagitis

Answer 10

GERD

Question 11

what is the MC type of esophageal cancer in the US

Answer 11

adenocarcinoma

Question 12

what is the MC type of esophageal cancer in the world

Answer 12

squamous cell

Question 13

what is not a risk factor for adenocarcinoma of the esophagus but IS a risk factor for squamous cell

Answer 13

alcohol

Question 14

most important risk factor for adenocarcinoma of esophagus

Answer 14

Barretts from GERD

Question 15

what may protect against esophageal CA

Answer 15

NSAIDs
Aspirin

Question 16

hallmark sx of esophageal CA

Answer 16

progressive dysphagia – starts w solids then liquids

Question 17

diagnosis of esophageal CA

Answer 17

upper endoscopy w biopsy

Question 18

where is adenocarcinoma of the esophagus MC found

Answer 18

distal esophagus and esophagogastric junction

Question 19

where is squamous cell CA of the esophagus MC found

Answer 19

mid to upper third of the esophagus

Question 20

what is used to diagnose achalasia

Answer 20

manometry

Question 21

what is used to diagnose achalasia if results from manometry are inconclusive

Answer 21

barium esophagram

Question 22

describe achalasia

Answer 22

idiopathic motility disorder characterized by impaired relaxation of the LES and loss of peristalsis in the distal two thirds (smooth muscle) of the esophagus

Question 23

pathophysiology of achalasia

Answer 23

idiopathic progressive degeneration and loss of ganglion cells in the myenteric (Auerbach’s) plexus in the esophageal wall

Question 24

treatment options for achalasia

Answer 24

pneumatic dilation, surgical myotomy, peroral endoscopy myotomy

botox injections or oral nitrates if failed other options or not good surgical candidates (nitrates are kinda a last resort)

Question 25

is Zenkers diverticulum a true or false diverticulum

Answer 25

false - only involves mucosa and submucosa

Question 26

where does zenkers diverticulum occur

Answer 26

Killians triangle - between cricophargyneal muscle and lower inferior pharyngeal constrictor muscle

Question 27

common sx zenkers diverticulum

Answer 27

dysphagia halitosis regurgitation cough feelings as if lump in neck

Question 28

how to diagnose zenkers

Answer 28

barium esophagram

Question 29

common symptoms of distal (diffuse) esophageal spasm

Answer 29

stabbing, nonexertional, non cardiac chest pain worse with hot or cold liquids or food intermittent dysphagia to both solids and liquids

Question 30

how to diagnose distal diffuse esophageal spasm

Answer 30

esophagram then manometry

Question 31

what will esophagram show for distal diffuse esophageal spasm

Answer 31

corkscrew or rosary bead appearance; severe non-peristaltic spastic contractions of the circular muscle in the esophageal wall

Question 32

are contractions coordinated or uncoordinated in distal diffuse esophageal spasm

Answer 32

uncoordinated

Question 33

treatment for distal diffuse esophageal spasm

Answer 33

CCB or nitrates if failed --> TCA if failed --> botox or pneumatic esophageal dilation

Question 34

what are some other names for hyper contractile esophagus

Answer 34

jackhammer nutcracker

Question 35

dx for hyper contractile esophagus

Answer 35

manometry - increased pressure during peristalsis > 180 mm Hg; or duration > 7.5 s

Question 36

tx hyper contractile esophagus

Answer 36

CCB, nitrates Botox, TCAs Myotomy if refractory

Question 37

what is an esophageal web

Answer 37

a noncircumferentialz thin membrane in the MID-UPPER esophagus

Question 38

what is plummer-vinson

Answer 38

dysphagia cervical esophageal web IDA

Question 39

what are ppl w Plummer-vinson at an increased risk of

Answer 39

squamous cell carcinoma

Question 40

sx of esophageal web

Answer 40

intermittent dysphagia to solids

Question 41

dx esophageal web

Answer 41

barium swallow

Question 42

tx esophageal web

Answer 42

endoscopic dilation

Question 43

what is an esophageal (schatzki) ring

Answer 43

circumferential membrane in the lower esophagus/squamocolumnar junction

Question 44

what other abnormality is seen in most patients w an esophageal (schatzki) ring

Answer 44

hiatal hernia

Question 45

sx and dx and tx for esophageal (schatzki) ring

Answer 45

same as for esophageal web say them!!!!