Esophageal Disorders Flashcards by Stewart Stinton

Most common cause of infectious esophagitis

Candida

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Transmural rupture of the distal esophagus due to straining or vomiting is known as …

Boerhaave syndrome

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Risk factors for esophageal adenocarcinoma

White male

GERD/Barrett’s esophagus

Obesity

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This class of GERD medications can develop tachyphylaxis within 2-6 weeks

Histamine 2 receptor antagonists (famotidine/pepcid)

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Premature, rapid contractions of the distal esophagus are suggestive of this condition

Diffuse/Distal esophageal spasm

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After noting esophageal cancer on endoscopy, what is the next test?

CT of chest and abdomen to assess extent of disease and look for metastases

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This medication is known to cause esophagitis

Minocycline

(tetracycline antibiotic used for acne)

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Purpose of barium swallow in diagnosing esophageal disorders

Can identify subtle narrowings and motility disorders

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Two common symptoms with achalasia

Slowly progressive dysphagia

Regurgitation

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Purpose of metoclopramide in treatment of GERD

Prokinetic agent - enhance gastric clearance

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A rosary bead or corkscrew appearance on barium swallow is suggestive of this condition

Diffuse/distal esophageal spasm

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Esophageal cancer diagnosis methods

Barium swallow will show obstruction but won’t tell you the cause

X-ray may show irregular borders/sharp angles

Endoscopy best test, shows nodules protruding into lumen

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Best initial diagnostic test in a patient complaining of chronic GERD

Endoscopy

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This diagnostic test is often performed first in diffuse/distal esophageal spasm

Endoscopy

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Gold standard test for esophageal motility disorder diagnosis

Esophageal manometry

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Most common esophageal foreign body objects

Kids: coins

Adults: meat/other food

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Treatments for infectious esophagitis

Mild = clotrimazole

Severe = fluconazole or amphotericin B

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Test for tracking acid levels throughout a day

Ambulatory 24-hour esophageal pH monitoring

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Most common type of esophageal cancer

Squamous cell carcinoma

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Which type of esophageal cancer is more common in white men?

Adenocarcinoma

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Most common age range for esophageal foreign bodies

6 months to 3 years

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90% of patients with this autoimmune condition

Scleroderma

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Form of calcium supplementation to use in patient on chronic PPI

Calcium citrate

(doesn’t require acid for absorption)

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Two main medications to know for nutcracker esophagus

Nitrates, calcium channel blockers

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Which esophageal disorders will have slowly progressive difficulty swallowing?

Benign lesions Achalasia

Raised white plaques seen in the throat that resemble cottage cheese is suggestive of ...

Infectious candida esophagitis

How to differentiate diffuse/distal esophageal spasm from nutcracker esophagus?

Both are non-progressive, disordered spasm of esophagus DES: Esophagus contracts *too early* Nutcracker: contracts on time, but *too forcefully*

Risks associated with PPI use

Clostridium difficile (no acid in stomach to stop proliferation) Magnesium malabsorption (leads to neuromuscular excitability initially and long QT/torsades if severe) Fractures (need acid to absorb calcium) Dietary B12 malabsorption

Degeneration of the inhibitory neurons impairing relaxation of the esophagus causing a slowly progressive dysphagia is known as ...

Achalasia

Two most common symptoms in diffuse/distal esophageal spasm

Dysphagia and chest pain

Initial diagnostic test for new onset GERD

PPI trial

A patient complaining of GERD who failed a PPI trial and with negative endoscopy should get this test to identify a possible motility disorder cause of reflux

Manometry

Three diagnostic studies for achalasia

Endoscopy - usually done initially Esophageal manometry - gold standard Barium swallow - dilated esophagus ending in bird's beak

Symptoms of GERD

Uncomfortable, burning sensation often radiating up throat

Causes of nutcracker esophagus

Excessive excitatory neuronal activity/smooth muscle hypertrophy

Best procedures for achalasia treatment

Pneumatic dilation therapy Surgical myotomy (cuts lower esophageal sphincter) Botulinum injection into lower esophageal sphincter

Important method to manage cessation of PPIs

Must taper (50% each week) if patient has been on PPI for more than 6 months

Gold standard diagnostic test for diffuse/distal esophageal spasm

Esophageal manometry

If a patient with GERD fails BID H2RA therapy/has erosive esophagitis/has severe GERD, start these drugs

PPIs

Diagnosis method for Barrett's esophagus

Endoscopy with biopsy

Describe benign esophageal stricture causes

Like scar tissue in the esophagus (Can be caused by ingesting foreign bodies, history of candida, radiation to chest for cancer)

Difference between dysphagia and odynophagia

Dysphagia = difficulty swallowing Odynophagia = pain/discomfort swallowing

This stomach condition sometimes co-occurs with GERD

Hiatal hernia

Mechanism of action of PPI drugs

Inhibition of hydrogen potassium ATPase pump

Which esophageal disorders will have rapidly progressive difficulty swallowing?

Malignant lesions

Medications for achalasia

Nitrates and calcium channel blockers (although surgery or dilation procedures work better)

This condition is also called "hypercontractile esophagus"

Nutcracker esophagus

Which esophageal cancer is more likely in black or asian men?

Squamous cell carcinoma

Best treatment for infrequent GERD

Antacids (Tums)

Treatment for Boerhaave syndrome

Surgical debridement - (emergency)

Most common patient to get infectious esophagitis

Immunocompromised (HIV/AIDS)

A bird's beak barium swallow is suggestive of this condition

Achalasia

Three best lifestyle modifications for GERD treatment

Elevate head of bed 4-8 inches Avoid food 2-3 hours before bed Dietary modification

Odd folds of the mucosa at the distal esophagus that cause non-progressive dysphagia (mostly with solid foods) is called ...

Schatzki rings

Risk factors for esophageal squamous cell carcinoma

Black male Smoking and alcoholism Preserved foods, hot foods/drinks, achalasia

Medications for diffuse/distal esophageal spasm

Nitrates, calcium channel blockers, sildenafil

Diagnosis methods for Boerhaave syndrome

Chest/neck x-ray may show perforation CT if x-ray fails to find it (don't give barium swallow, it will leak out)

Which esophageal disorder presents with intermittent, non-progressive episodes?

Schatzki ring

This esophageal is relieved by antacids and eliminated by PPIs

GERD

Which is more sensitive for identifying subtle mucosal lesions of the esophagus, barium swallow or endoscopy?

Endoscopy