Esophageal Disorders

Question 1

Barium esophagography is indicated in two esophageal problems - what?

Answer 1

1. Zenker diverticulum

2. Achalasia - BIRD’S BEAK!

Question 2

Hematemesis with recent history of lifting, retching, vomiting

Answer 2

Mallory Weiss syndrome

Question 3

What increases the risk of Mallory Weiss syndrome?

Answer 3

alcoholism

Question 4

What happens in Mallory Weiss syndrome?

Answer 4

tear at or below gastroesophageal junction

Question 5

What is Schatzke ring?

Answer 5

distal esophageal ring associated with hiatal hernia

Question 6

How is Schatzke ring treated?

Answer 6

dilation or incision

Question 7

Who gets infectious esophagitis and what is it?

Answer 7

immunocompromised

candida, CMV, Herpes

Question 8

What is fundoplication a treatment for?

Answer 8

GERD

Question 9

What happens in Barrett esophagus?

Answer 9

squamous epithelium turns into columnar with goblet cells

Question 10

When is upper endoscopy indicated for GERD?

Answer 10

if a PPI trial fails

Question 11

65 year old man complaining of halitosis, regurgitation, trouble swallowing, and a neck protrusion. He says it came on gradually. What test do you do and what is it?

Answer 11

barium esophagogram

Zenker diverticulum

Question 12

What is the treatment for Zenker diverticulum?

Answer 12

surgical diverticulectomy

Question 13

What causes esophageal varices?

Answer 13

PORTAL HYPERTENSION

Question 14

50% of patients with this get esophageal varices

Answer 14

cirrhosis

Question 15

How are esophageal varices diagnosed?

Answer 15

upper endoscopy

Question 16

These four things increase the risk of bleeding from esophageal varices:

Answer 16

1. BIG varices
2. red wale markings
3. BAD liver disease
4. STILL DRINKING

Question 17

If your patient is actively and dangerously bleeding out from esophageal varices, these are the first medications you give:

Answer 17

1. antibiotics
2. octreotide
3. vitamin K (if PT abnormal)
4. lactulose (if encephalopathy)

Question 18

After you have stabilized your esophageal varices bleeding patient, you will do these 2-3 procedures (the third one if the first two didn’t work):

Answer 18

1. endoscopy
2. balloon tube tamponade
3. TIPS (transvenous intrahepatic portosystemic shunts)

Question 19

Long-term, what four treatments may be considered for esophageal varices?

Answer 19

1. BB
2. band ligation
3. TIPS
4. liver transplant

Question 20

Patient is complaining of progressive dysphagia and regurgitation. What tests do you do and what is it?

Answer 20

ACHALASIA

1. barium esophagogram -> BIRD’S BEAK
2. confirm with esophageal manometry

Question 21

What are three possible treatments for achalasia?

Answer 21

1. botox
2. pneumatic dilation
3. myotomy

Question 22

What’s a common cause of Barrett Esophagus?

Answer 22

GERD with hiatal hernia

Question 23

Treatment for Barrett Esophagus?

Answer 23

long-term PPI once or twice daily

Question 24

Serious complication of Barrett Esophagus?

Answer 24

esophageal adenocarcinoma

–>surveillance includes endoscopy every 3-5yrs

Question 25

What test is mandatory for all peptic strictures?

Answer 25

endoscopy

–>differentiate peptic stricture from stricture by esophageal carcinoma

Question 26

Eosinophilic esophagitis caused by what?

Answer 26

food or environmental antigens stimulating an inflammatory response

Question 27

A history of what is present in over half of eosinophilic esophagitis pts?

Answer 27

allergies or atopic conditions (asthma, eczema, hay fever)

Question 28

What’s going on with Zenker diverticulum?

Answer 28

protrusion of pharyngeal mucosa at pharyngoesophageal junction

Question 29

Clinical findings of Zenker?

Answer 29

• dysphagia & regurgitation (develops over yrs)
• halitosis
• nocturnal choking
• gurgling in the throat
• protrusion in the neck

Question 30

The following “buzz words” are all associated with what?
nutcracker esophagus
corkscrew esophagus
rosary bead esophagus

Answer 30

esophageal spasm

Manometry key for diagnosis