Esophageal Disorders Flashcards
1
Q
What are the risk factors of esophagitis?
A
- pregnancy
- smoking
- obesity
- ETOH
- spicy foods
- meds (NSAIDs, beta blockers, calcium channel blockers)
2
Q
Medical term for painful swallowing?
A
odynophagia
3
Q
Esophagitis is most commonly caused by?
A
GERD
4
Q
What are the different causes of esophagitis?
A
PIECE
- pill-induced
- infectious
- eosinophilic
- caustic
- GERD
5
Q
What is the hallmark symptom of esophagitis?
A
Odynophagia!!
6
Q
What are the main causes of infectious esophagitis?
A
- candida
- CMV (cytomegalovirus)
- HSV (herpes simplex virus)
- HIV
7
Q
Endoscopy findings of candida esophagitis will show…
A
linear yellow-white plaques (oral thrush)
8
Q
Endoscopy findings of CMV esophagitis will show…
A
large superficial shallow ulcers
9
Q
Endoscopy findings of HSV esophagitis will show…
A
small, deep ulcers
10
Q
1st line tx for candida esophagitis?
A
PO Fluconazole
11
Q
1st line tx for CMV esophagitis?
A
val or ganciclovir (IV)
12
Q
1st line tx for HSV esophagitis?
A
acyclovir
13
Q
Eosinophilic esophagitis is most commonly associated with _____
A
atopic disease (allergies, asthma, eczema)
14
Q
What are the most common causes of pill-induced esophagitis?
A
- NSAIDs
- bisphosphonates
- beta blockers
- calcium channel blockers
- Abx (doxy, bactrum)
15
Q
What is the tx for pill-induced esophagitis?
A
drink pills with at least 4 ounces of water, avoid recumbency for at least 30-60 minutes of pill ingestion, remove pill all together, PPI until inflammation resolves.
16
Q
What is the pathophysiology of GERD?
A
weakened LES —> allows gastric acid reflux —-> produces esophagitis and mucosal injury
17
Q
What are the major complications of GERD?
A
- esophagitis
- esophageal stricture
- Barrett’s esophagus
- esophageal adenocarcinoma
18
Q
What is Barrett’s esophagus?
A
When the squamous cell epithelium of the esophagus is replaced by columnar (precancerous) cells from the cardia of the stomach. Columnar cells are used to the acidity.
19
Q
What are the “typical” symptoms of GERD?
A
- pyrosis (heartburn)– hallmark*
- worse when supine
- relieved with sitting and antacids
- regurgitation (sour taste in mouth)
20
Q
What are the “atypical” symptoms of GERD?
A
- hoarseness
- weight loss
- nocturnal asthma**
21
Q
What are considered the “alarming” symptoms of GERD?
A
- dysphagia
- odynophagia
- wight loss
- bleeding
**suspect malignancy or cancer!
22
Q
What is the first step in diagnosis/treatment of GERD?
A
Trial PPI and lifestyle modifications for 6 weeks!
ex. avoid recumbency for 3 hours after eating, decrease fat and ETOH intake, weight loss, smoking cessation, avoid food triggers
23
Q
What is the next step in management if PPI and lifestyle modification fails for GERD symptoms?
A
EGD with biopsy and manometry
24
Q
What is the BEST test for the evaluation of GERD, but is often not performed?
A
24 hour ambulatory pH monitoring
25
What is the hallmark sign for Barrett's esophagus?
pt has esophagitis s/sxs for years and then it gets better on its own (sign that squamous cells have switched to columnar cells)
26
What is the treatment/management for Barrett's (metaplasia) esophagus?
high dose PPIs bid and increase the frequency of EGDs and biopsies
27
What is Nissen Fundoplication and when is it considered for treatment?
It is when the stomach is wrapped around the LES, which creates a new sphincter. It is considered once metaplasia (Barrett's esophagus) is found.
28
What is the medical term for heartburn?
pyrosis
29
What is the pathophysiology of achalsia?
There is proximal loss of Auerbach's plexus, which normally produces nitric oxide to relax the smooth muscle of the LES. Without the nitric oxide, there is increased LES tone (can't relax) and lack of peristalsis.
30
What are the most common s/sxs of achalasia?
1. dysphagia to both solids and liquids***
2. weight loss
3. feeling of knot or ball of food stuck
31
What is the gold standard for diagnosing achalasia and what will it show?
Esophageal manometry!
Shows increased LES pressure > 40 mmHg and decreased peristalsis
32
What will a barium swallow show in a patient with achalasia?
Bird's beak appearance (LES narrowing) with proximal esophageal dilation and loss of peristalsis distally
33
What is the management options for achalasia?
```
Botulinum toxin injection for temporary relief
Nitrates
Calcium channel blockers
Dilation of LES
Myotomy (removal of the sphincter)
```
34
What is the etiology of diffuse esophageal spasm?
strong non-peristaltic esophageal contractions
35
What is the most common s/sx of esophageal spasm?
stabbing chest pain that gets better with nitrates and CCBs
Must rule out a MI!!!!
36
What diagnostic tests are indicated to diagnose esophageal spasm and what will they show?
1. Barium swallow (esophagram) ---> "corkscrew" esophagus
| 2. Manometry ---> shows the random contractions
37
What is the management of esophageal spasm?
Nitroglycerin tabs
| Calcium channel blockers
38
What is Zenker's diverticulum?
Pharyngeoesophageal pouch (outpouching) at the junction of the pharynx and esophagus
39
What muscle is weakened in Zenker's diverticulum causing a herniation?
Cricopharyngeus muscle
40
What is the hallmark symptom for Zenker's diverticulum?
Halitosis (bad breath)
41
What are the most common s/sxs of Zenker's diverticulum?
1. Halitosis**
2. progressive dysphagia
3. regurgitation of undigested food
4. feeling that there is a lump in their neck
42
What is the gold standard for diagnosing Zenker's diverticulum and what will it show?
Barium esophagram ---> collection of dye behind esophagus at pharyneoesophageal junction
43
What is the management of Zenker's diverticulum?
Diverticulectomy
observation if small and asymptomatic
44
What is nutcracker esophagus?
excessive contractions during peristalsis
45
What is the gold standard for the diagnosis of nutcracker esophagus and what will it show?
Manometry ---> increased pressure during peristalsis
| **EGD and esophagram will be normal!!
46
What is Boerhaave's syndrome?
A full thickness rupture of the distal esophagus
47
What are the most common causes of Boerhaave's syndrome?
1. repeated, forceful vomiting (ex. bulimia)
| 2. iatrogenic perforation during endoscopy
48
What are the most common s/sxs of Boerhaave's syndrome?
1. retrosternal chest p! that is worse with deep breathing and swallowing**
2. Hammond's crunch (crepitus on chest auscultation)
3. pneumomediastinum!
4. Hematemesis
49
What are the steps to diagnosing Boerhaave's syndrome?
1. gastrographin swallow (less irritating to mediastinum) ---> if negative then Barium swallow
50
How do you treat Boerhaave's syndrome?
Surgical emergency!!!!
51
What is a Mallory-Weiss tear?
Upper GI bleed due to superficial mucosal laceration at the gastroesophageal junction or gastric cardia
52
What is the most common cause of a Mallory-Weiss tear?
sudden rise in intragastric pressure from vomiting after ETOH binge or bulimic vomiting.
53
How will a Mallory-Weiss tear present?
hx of vomiting ----> hematemesis after an ETOH binge
54
What is the diagnostic test of choice for a Mallory-Weiss tear and what will it show?
upper endoscopy showing superficial mucosal erosions
55
What is the management options of a Mallory-Weiss tear?
No active bleed ---> supportive
| Active bleed ----> epinephrine injection, band ligation, type and cross for blood, hemo-clipping
56
What is an esophageal web?
thin membranes in the mid-upper esophagus that may be congenital or acquired
57
What is Plummer-Vinson Syndrome?
dysphagia + esophageal webs + iron deficiency anemia
58
Who does Plummer-Vinson Syndrome most commonly affect?
Caucasian females 30-60 years!
59
What is Schatzki ring?
mucosa lower esophageal constrictions at squamocolumnar junction
60
Schatzki ring is most commonly associated with _____.
hiatal hernia
61
What is the clinical manifestations of esophageal webs and rings?
infrequent large caliber foods getting stuck
| "steakhouse dysphagia"
62
What is the diagnostic test of choice for esophageal webs and rings?
Barium swallow revealing a narrowed lumen (webs)
63
What is the management of esophageal webs and rings?
endoscopic dilation of the area
screen for CA with EGD and bx
64
What is an esophageal varice?
Dilation of the gastroesophageal submucosal veins
65
Esophageal varices are a complication of _______.
portal vein hypertension
66
What is the most common risk factor for esophageal varices?
Cirrhosis!! (90% of pts with cirrhosis will develop esophageal varices)
67
___% of esophageal varices re-bleed within the 1st year of the initial bleed.
70% (1/3rd of them are fatal)
68
What is the diagnostic test of choice for esophageal varices?
Upper endoscopy showing enlarged veins + red wale markings and cherry red spots (increased risk of bleed)
69
What is the management of an acute active bleeding varices?
1. stabilize with 2 large bore IV lines, IV fluids
2. +/- blood transfusion
3. Endoscopic ligation is tx of choice!!!
4. Octreotide is drug of choice
70
What is the drug of choice during an acute active bleeding varice and what is its MOA?
Octreotide ---> somatostatin analog that causes vasoconstriction of portal venous flow, so reduces bleeding
71
What is the 2nd line txs of an active bleeding varice?
1. Baloon tamponade (when endoscopic or pharm intervention fails or fast bleeds!) ---> Increased risk of perforation, ulceration, or aspiration pneumonia
2. Surgical decompression with TIPS (shunt) ----> indicated if other txs fail
72
What is the management to prevent re-bleeding of esophageal varices?
1. Non-selevtive beta-blockers (ex. propranolol, nadolol) ---> reduces portal venous pressure. NOT USED in ACUTE bleeds
2. Isosorbide ---> long-acting nitrate (vasodilator)
73
What is a hiatal hernia?
Protrusion of the upper portion of the stomach into the chest cavity due to diaphragm tear or weakness
74
What is a type I hiatal hernia?
"sliding hernia" ---> GE junction and stomach slide into mediastinum (95% of hiatal hernias!)
75
What is the management of a type I hiatal hernia?
treat as GERD
76
What is a type II hiatal hernia?
"rolling hernia" ---> fundus of stomach protrudes through diaphragm with GE junction remaining in anatomical location
77
What is the management of a type II hiatal hernia?
Surgical repair to avoid complications
78
What is the most common risk factor of squamous cells neoplasm of the esophagus?
tobacco/ETOH
79
Squamous cell esophageal neoplasm affects the _____ 1/3rd of the esophagus.
Upper
80
Adenocarcinoma of the esophagus is usually a complication of _____.
GERD/Barrett's esophagus
81
Adenocarcinoma of the esophagus affects the _____ 1/3rd of the esophagus.
Lower
82
There is an increased incidence in squamous cell esophageal neoplasms in ______.
African Americans
83
What are the most common clinical manifestations of esophageal neoplasms?
1. progressive dysphagia
2. weight loss
3. chest pain
4. odynophagia
84
Patients with squamous cell of the esophagus often present with _____.
Hypercalcemia
85
What is the diagnostic test of choice for esophageal neoplasms?
Upper endoscopy with biopsy
86
What is the management of esophageal neoplasms?
Esophageal resection, staging, chemo
87
Esophageal cancer most commonly spreads to the _____.
Mediastinum
88
Endoscopy screenings should be performed in patients with Barrett's every _____ years.
3-5
