Esophageal Disorders & Neoplasms Flashcards
the loss of peristalsis in the distal 2/3 of the esophagus and impaired relaxation of the LES
achalasia
a patient presents with steady worsening of dysphagia over months to years that started with solid foods and has progressed to liquids. they have substernal fullness/pain after eating and regurg while eating and for several hours after a meal. Dx?
achalasia
what symptom warrants an upper endoscopy in a patient with achalasia?
dysphagia
what would definitively diagnose a patient with achalasia?
esophageal manometry
what would an esophageal manometry show if a patient has achalasia? (2)
absence of normal peristalsis
incomplete LES relaxation with swallowing
what diagnostic may show food or fluid in the esophagus of a patient with achalsia?
chest xray
what is the finding in a patient with achalasia if we do a barium swallow?
bird’s beak tapering of the distal esophagus
what is the treatment of achalasia in low risk surgical patients? (2)
pneumatic balloon dilation
surgical myotomy
what is the treatment of achalasia in high risk surgical patients?
botox injections
narrowing of the esophagus with scar tissue, most commonly as a result of esophageal injury
esophageal stricture
what is the most common risk factor for esophageal stricture?
chronic gastric reflux
a patient presents with chronic heartburn with sudden improvement and worsening dysphagia of solid foods only. Dx? Tx (2)?
esophageal stricture
dilation
PPI post-dilation
what is the diagnostic of choice of an esophageal stricture?
upper endoscopy
what can be used before an endoscopy to limit the risk of perforation?
barium swallow
what treatment can be used for refractory esophageal strictures during a 2nd dilation to reduce reoccurrence?
local steroid injections
what treatment can be used if patients to continue to experience refractory strictures post steroid injection?
temporary plastic stent placement
a non-full thickness esophageal laceration or tear
mallory-weiss esophageal tear
what is the most common cause of mallory-weiss esophageal tear?
retching/vomiting
a patient presents with vomiting (hematemesis, coffee-ground, blood), abdominal/chest/back discomfort. Dx?
mallory-weiss esophageal tear
what symptom will be present in a patient with mallory-weiss esophageal tear if bleeding has been present for 12-72 hours?
black, tarry stools
what is the gold standard diagnostic for mallory-weiss esophageal tear?
endoscopy
what is the treatment for mallory-weiss esophageal tear?
resolves spontaneously
what is the treatment for mallory-weiss esophageal tear if bleeding does not spontaneously resolve of if clinically significant?
endoscopic intervention
what is the management for a patient with mallory-weiss esophageal tear that is actively bleeding and hemodynamically unstable? (2)
hospitalize
observe for 48 hours
when do mallory-weiss esophageal tears usually heal?
within 48-72 hours
when is rebleeding of a mallory-weiss esophageal tear most likely to reoccur?
within first 48 hours
mucosa of the pharynx protrudes posteriorly through an inherently weak area at the pharyngoesophageal junction.
zenker diverticulum
what is the natural area of weakness called in zenker diverticulum?
killian triangle
what is the etiology of zenker diverticulum?
chronic increased pressure on an already weak area
a patient presents with worsening dysphagia with coughing/choking sensation, halitosis, and regurgitation of food. Dx?
zenker diverticulum
what is the 1st line of study for zenker diverticulum?
barium swallow
what allows for a definitive diagnosis and treatment of zenker diverticulum?
upper endoscopy
what is the treatment of choice for zenker diverticulum?
flexible endoscopic myotomy + diverticulectomy
what are the 2 histological types of esophageal neoplasms?
squamous cell carcinoma
adenocarcinoma
what are the 2 most common risk factors for squamous cell carcinoma of the esophagus?
chronic alcohol
tobacco
what are the 2 most common risk factors for adenocarcinoma of the esophagus?
chronic gastric reflux
barrett esophagus
what is the most common esophageal neoplasm?
adenocarcinoma
a patient presents with solid food dysphagia that has been progressively worsening over weeks to months, has odynophagia, weight loss, neck mass, and hoarse voice. Dx?
esophageal neoplasm
what will be present in a patient’s test if they have esophageal neoplasm?
+ fecal occult blood
what gives the definitive diagnosis for esophageal neoplasm?
upper endoscopy + biopsy
what is recommended to evaluate complex lesions suspected in esophageal neoplasms?
barium swallow
what is the treatment for non-metastatic, localized tumors in the esophagus?
radiation + chemotherapy
+/- surgery
what is the treatment for distant metastasis from the esophagus?
palliative therapy
