Esophageal Disorders Flashcards
Barium esophagography is indicated in two esophageal problems - what?
- Zenker diverticulum
2. Achalasia - BIRD’S BEAK!
Hematemesis with recent history of lifting, retching, vomiting
Mallory Weiss syndrome
What increases the risk of Mallory Weiss syndrome?
alcoholism
What happens in Mallory Weiss syndrome?
tear at or below gastroesophageal junction
What is Schatzke ring?
distal esophageal ring associated with hiatal hernia
How is Schatzke ring treated?
dilation or incision
Who gets infectious esophagitis and what is it?
immunocompromised
candida, CMV, Herpes
What is fundoplication a treatment for?
GERD
What happens in Barrett esophagus?
squamous epithelium turns into columnar with goblet cells
When is upper endoscopy indicated for GERD?
if a PPI trial fails
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?
barium esophagogram
Zenker diverticulum
What is the treatment for Zenker diverticulum?
surgical diverticulectomy
What causes esophageal varices?
PORTAL HYPERTENSION
50% of patients with this get esophageal varices
cirrhosis
How are esophageal varices diagnosed?
upper endoscopy
These four things increase the risk of bleeding from esophageal varices:
- BIG varices
- red wale markings
- BAD liver disease
- STILL DRINKING
If your patient is actively and dangerously bleeding out from esophageal varices, these are the first medications you give:
- antibiotics
- octreotide
- vitamin K (if PT abnormal)
- lactulose (if encephalopathy)
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):
- endoscopy
- balloon tube tamponade
- TIPS (transvenous intrahepatic portosystemic shunts)
Long-term, what four treatments may be considered for esophageal varices?
- BB
- band ligation
- TIPS
- liver transplant
Patient is complaining of progressive dysphagia and regurgitation. What tests do you do and what is it?
ACHALASIA
- barium esophagogram -> BIRD’S BEAK
- confirm with esophageal manometry
What are three possible treatments for achalasia?
- botox
- pneumatic dilation
- myotomy
What’s a common cause of Barrett Esophagus?
GERD with hiatal hernia
Treatment for Barrett Esophagus?
long-term PPI once or twice daily
Serious complication of Barrett Esophagus?
esophageal adenocarcinoma
–>surveillance includes endoscopy every 3-5yrs
What test is mandatory for all peptic strictures?
endoscopy
–>differentiate peptic stricture from stricture by esophageal carcinoma
Eosinophilic esophagitis caused by what?
food or environmental antigens stimulating an inflammatory response
A history of what is present in over half of eosinophilic esophagitis pts?
allergies or atopic conditions (asthma, eczema, hay fever)
What’s going on with Zenker diverticulum?
protrusion of pharyngeal mucosa at pharyngoesophageal junction
Clinical findings of Zenker?
- dysphagia & regurgitation (develops over yrs)
- halitosis
- nocturnal choking
- gurgling in the throat
- protrusion in the neck
The following “buzz words” are all associated with what?
nutcracker esophagus
corkscrew esophagus
rosary bead esophagus
esophageal spasm
Manometry key for diagnosis
