Esophageal Disorders Flashcards
What is pyrosis?
Heartburn
What is dysphagia?
Food sticking
What is globus sensation?
Globus hystericus
What is waterbrush?
Excessive salivation secondary to vagal reflex triggered by acidification
What is the best test for diagnosing esophageal problems?
Endoscopy
What is esophageal manometry?
Testing for contractility
What are the three things that endoscopic ultrasound particularly good for?
- Stage esoph CA
- Evaluate dysplasia
- Assess submucosal lesions
What is involved in reflux testing?
Wear a monitor that detects contractility (manometry) and pH
What are the two types of hiatal hernias?
Sliding (common) and paraesophageal
What are the ssx of hiatal hernias?
Reflux and feeling of fullness
What is plummer-vinson syndrome?
Esophageal webs + anemia
What are the classic ssx of esophageal diverticula?
Halitosis
What is a traction diverticulum? Zenker?
traction = mid-esophageal Zenger = between cricohyoid/cricothyroid
What is the treatment for esophageal varices?
IVF and some other drugs
What are the ssx of achalasia?
Solid food dysphagia with weight loss and chest pain
“Bird’s beak” appearance on barium swallow = ?
Achalasia
What is the pathophysiology of achalasia?
Increased LES pressure
Proximal dilatation and lack of peristalsis
What is the treatment for achalasia?
Incurable, but surgical resection
The risk for what disease is increased with achalasia?
esophageal SCC
Who usually gets eosinophilic esophagitis?
young white males
What is the etiology of eosinophilic esophagitis?
Immunologic vs Ag sensitization
What are the ssx of eosinophilic esophagitis?
Recurrent attacks of dysphagia with food impaction
What is the endoscopic findings with eosinophilic esophagitis?
Rings
What is the treatment for eosinophilic esophagitis?
PPIs, avoid allergens, inhaled steroids
What are the ssx of infectious esophagitis?
Odynophagia
wwo oral lesions
Infectious esophagitis is usually secondary to what?
- immunosuppression
- immunosuppression from chronic inflammation
- HIV/AIDs
What is the treatment for candidal esophagitis patients?
Fluconazole or nystatin
What are the histological findings of candida esophagitis?
Pseudohyphae in silver staining
What is the treatment for oral candidiasis for HIV pts?
Swish and swallow fluconazole/nystatin
What are the ssx of CMV esophagitis?
LAD
Cough
Mono-like presentation
What is the virus that causes CMV?
HHV5
What are the EGD findings with CMV esophagitis?
Large, serpiginous ulcers in the mid-distal areas
What are the histological findings of CMV?
Owl=eye findings
What is the treatment for CMV esophagitis?
Ganciclovir or foscarnet
What is the painful infectious cause of esophagitis?
herpetic esophagitis
What is the treatment for herpetic esophagitis?
acyclovir
What are the histological findings of HSV?
Giant cells
HHV3 = ?
Varicella
What is the smear that tests for HSV?
Tzanck smear
Mallory weiss tears are usually caused by what? Presentation?
Alcoholics or bulimics
Coughing and painful hematemesis
What are the ssx of esophageal varicies?
Painless hematemesis
What is the risk of having mallory-weiss tears?
Perforation
What causes radiation esophagitis?
Fibrosis of esophagus to other structures
What is the usual cause of corrosive esophagitis?
Alkali or acidic material ingestion
What are the complications associated with alkali/acidic esophagitis?
FB and food impaction
What is the treatment for alkali/acidic esophagitis?
EGD + glucagon
In whom is pill esophagitis common? Why?
Elderly–lower secretions, more pills
What is the treatment for pill esophagitis?
fluids
What is the autoimmune disease that can cause esophageal disease? Ssx?
Scleroderma
Hypotensive LES, absent esophageal peristalsis
What is CREST syndrome?
Idiopathic Autoimmune disease associated with anticentromere antibodies. Features include:
Calcinosis Raynaud's phenomenon *Esophageal Dysmotility* Sclerodactyly Telangiectasia
What disease can Barrett’s esophagus progress to?
Adenocarcinoma
What are the gross findings with Barrett’s esophagus?
Bright red/pink esophagus
What is the most common esophageal CA in the US? World?
US = adenoCA World = SCC
What are the appropriate next steps for treating low grade Barrett’s esophagus? Intermediate? High grade?
Low = follow with 2-3 years Intermediate = 1 6 months High = 2nd pathology/surgery
What is the risk of progression (per year) with high grade dysplasia in Barrett’s esophagus?
40%
What are the two risk factors for getting Barrett’s esophagus?
EtOH
Smoking
Hot tea = ?
SCC