Esophageal disorders

Question 0

Therapeutic use of EGD

Answer 0

Tx (banding/sclerotherapy) of esophageal varices.
Injection therapy
Application of cautery to tissues
Removal of ingested foreign bodies
Tamponade of bleeding esohageal varices with a balloon

Question 1

Double contrast upper GI

Answer 1

Baking-soda crystals (similar to Alka-Seltzer) to produce gas. Better visualization of mucosal layer.

Question 2

Solid food dysphagia

Answer 2

Mechanical obstruction

• Lower esophageal ring (Schatzki’s ring)
• Zenker’s diverticulum
• Stricture
• Carcinoma

Question 3

Liquid Dysphagia

Answer 3

usually Neuromuscular disorder

• Diffuse spasm
• Scleroderma
• Achalasia
• Advanced carcinoma

Question 4

Zenker’s diverticulum

Answer 4

tx: endoscopic stapling

Question 5

Dx of Esophageal strictures

Answer 5

Identify etiology by Xray and Endoscopy
Confirm by Endoscopy and Tissue Biopsy
Manometry can be diagnostic when dysmotility is suspected as the primary process
CT scan and Endoscopic U/S aids in the staging of malignant stricture

Question 6

GERD

Answer 6

24 hour Esophageal pH monitoring is the GOLD STANDARD

Preferred method: trial of acid supression therapy with a H2 blocker or PPI for 3-4 weeks.

Question 7

GERD tx

Answer 7

Phase1: Lyfestyle modification. Antacids-4x/day. H2 receptor blockers.
Phase2: H2 receptor blockers. PPI.
Phase3: PPI or high dose H2 blocker or plus promotility drugs (metoclopramide).
Phase4: surgical intervention (Laparoscopic Nissen fundoplication [1st line for paraesophageal hernia])- inadequate response to medical treatment for a period of 6months.

Question 8

Esophageal achalasia

Answer 8

tx;
Medical- Nitrates, Calcium channel blockers, Beta agonists, Anticholinergic
Pneumatic dilatation of esophagus
Surgical myotomy- Heller procedure

Question 9

Candida esophagitis

Answer 9

Amphotericin B (severe)
Fluconazole
Itraconazole

Question 10

HSV Esophagitis

Answer 10

Acyclovir
Famciclovir
Valaciclovir

Question 11

CMV Esophagitis

Answer 11

Ganciclovir

Foscarnet

Question 12

HIV Esophagitis

Answer 12

Steroids

Question 13

Chemotherapy

Answer 13

Cisplatin
5-fluorouracil (5-FU)
Paclitaxel
Anthracyclines

Question 14

Esohagectomy for cancer

Answer 14

two techniques

1: Trans-hiatal (THE) abdominal and cervical incision with blunt mediastinal dissection through the esophageal hiatus.
2: Trans-thoracic (TTE) abdominal and right thoracic incision.

Question 15

Tx of Variceal hemorrhage

Answer 15

• Endoscopic variceal ligation (EVL)- fewer complication than EST
• Endoscopic sclerotherapy (EST)