Esophageal disorders (DeMonaco)

Question 1

Hallmark sign of esophageal disorder

Answer 1

Regurgitation

other signs: ptyalism (drooling), repeated/painful swallowing, failure to thrive (thin, emactiated), coughing or dyspnea due to asp pneumonia

Question 2

How to tell regurg versus v+

Answer 2

V+ = active
- is an active, coordinated process (with brain // vomit centers, contraction of abdominal muscles)
- presence of bile = 100% v+

Regurg = passive
- lack of abdominal muscle contraction (is more passive)
- lack of bile (but this does not indicate that it is 100% regurg)

timing in assocation w/ eating ≠ a differentiating factor, nor is shape

Question 3

3 most common esophageal diseases // differentials for hx of regurgitation:

Answer 3

1. Esophagitis
2. Esophageal obstruction
3. Megaesophagus

other: GERD

Question 4

How is esophagitis treated?

Answer 4

• drugs that reduce gastric acid secretion (PPIs like pantoprazole or omeprazole)
• drugs that tighten LES and promote gastric emptying (metoclopramide – vagal stimulation)
• drugs that protect esophageal mucosa (sucralfate)

Question 5

Etiologies of intraluminal versus extraluminal esophageal obstruction “Choke”

Answer 5

Question 6

Consequences of choke (esophageal obstruction)

Answer 6

• esophagitis (esp. if present chronically)
• esophageal perforation
• stricture
• pneumonia

Question 7

Megaesophagus
- definition
- etiologies

Answer 7

• persistently dilated esophagus, usually diffuse
• etiologies: 1º idiopathic; 2º to endocrinopathies, myopathies, neuropathies, esophagitis

Question 8

Possible esophageal consequence of anesthesia?

Answer 8

under anesthesia, reflux of stomach contents into esophagus can occur –> esophagitis +/- stricture

stricture tx = balloon dilation of the stricture