Esophagus 1

Question 1

the UES controls what

Answer 1

food entry into he esophagus

Question 2

the LES prevents

Answer 2

reflux of gastric contents

relaxed during swallowing and under pressure at rest `

Question 3

common infectious etiologies of esophagitis

Answer 3

fungal: candida
viral: CMV, HSV

Question 4

patient demographics of esophagitis

Answer 4

immunosuppressed

Question 5

patients with esophagitis present with Odynophagia, dysphagia, and possible fever and lymphadenopathy, which is the most significant symptom?

Answer 5

Odynophagia

Question 6

esophagitis caused by CMV endoscopy shows

Answer 6

1 to several larger and deeper ulcers that are in a linear or longitudinal distribution

Question 7

esophagitis caused by HSV endoscopy shows

Answer 7

multiple small shallow ulcers more clusters look “volcano-like” due to being well circumscribed

Question 8

esophagitis caused by candida endoscopy shows

Answer 8

linear yellow white plaques that appear adherent to the esophagus

Question 9

if someone comes in with esophagitis what should you test them for

Answer 9

HIV, if negative look for other underlying causes of immunodeficiency

Question 10

definitive diagnosis for esophagitis

Answer 10

when getting an endoscope gather brushings and get at cytology or culture

Question 11

treatment for esophagitis due to candida

Answer 11

fluconazole or ketoconazole

Question 12

treatment for esophagitis due to HSV

Answer 12

acyclovir

Question 13

treatment for esophagitis due to CMV

Answer 13

IV gancilovir or foscarnet

Question 14

ingestion of household cleaners or bleach may lead to what

Answer 14

corrosive esophagitis

Question 15

on endoscopy you see ulceration, necrosis and perforation in patches that extends from oropharynx to stomach, what is this?

Answer 15

corrosive esophagitis

Question 16

2 complications of corrosive esophagitis

Answer 16

Healing may lead to fibrosis and stricture formation (dilate if present)
Increased risk of squamous cell carcinoma

Question 17

corrosive esophagitis additional information

Answer 17

perforation may occur
obtain a CXRAY and CBC
patients abdomen will be rigid and they will often be unstable

Question 18

a patient reports with retrosternal chest pain and odynophagia after taking doxy for a recent infection, what is a possible diagnosis?

Answer 18

medication induced esophagitis

Question 19

3 common meds leading to medication induced esophagitis

Answer 19

NSAIDS, Bisphosphonates, Doxy

Question 20

chronic injury without treatment of medication induced esophagitis may lead what 3 complications

Answer 20

severe esophagitis with stricture
hemorrhage
perforation

Question 21

treatment for medication induced esophagitis

Answer 21

removal of medication, allow time to resolve, educate patient to take medication with enough fluid to clear medication

Question 22

Brain stem dz or CN disease, CVA, Parkinson’s, myasthenia gravis, botulism, muscular dystrophy, polymyositis are causes of what type of esophageal dysmotility?

Answer 22

neurogenic

Question 23

clinical symptoms of neurogenic esophageal dysmotility?

Answer 23

Dysphaisa, with possible olodyphasia

trouble with BOTH Liquids and solids

Question 24

a patient comes in complaining of emesis consisting of liquids and undigested foods what do you suspect?

Answer 24

zenker’s diverticulum

Question 25

where is the pouch located in zenker’s diverticulum

Answer 25

in the posterior hypopharynx above UES

Question 26

a patient has trouble swallowing solids and not liquids on endoscopy you note webbing, what do you suspect?

Answer 26

esophageal stenosis

Question 27

3 types of esophageal stenosis

Answer 27

webs rings and malignancy

Question 28

esophageal manometry and barium esophagram may be used for visualization of what on zenker’s diverticulum

Answer 28

posterior pouch

Question 29

Schatzki’s ring is a mechanical disorder that may be caused by GERD or congenital/devlopmental deformity may present with what 3 things?

Answer 29

Episodic dysphagia to solids (webs described as intermittent)
Large food boluses may become impacted
Abrupt onset of sub-sternal discomfort

Question 30

Plummer- Vinson syndrome is associated with what?

Answer 30

esophageal webs

also difficulty swallowing, iron-deficiency anemia

Question 31

Dilated esophagus tapering to distal obstruction the gives a parrot beak appearance on esophagus is related to what condition?

Answer 31

achalasia

Question 32

which dysmotility disorder may mimic a heart attack and therefore must be ruled out?

Answer 32

diffuse spasm of the esophagus

Question 33

patient presents with chest pain and difficulty swallowing after a stressful day at work, pain is radiating to arm and jaw, after ruling our a heart attack you perform a barium esophagram? you diagnosis your patient with a diffuse spasm, what did you see on the esophagram?

Answer 33

a corkscrew esophagus

Question 34

a diffuse spasm may also be cause by drinking what?

Answer 34

cold liquids

Question 35

how do you treat a diffuse spasm

Answer 35

smooth muscle relaxants
NTG: before meals and at bedtime
Isosorbide denigrate before meals
nifedipine before before meals

these may drop BP, warn patients

Question 36

esophageal dysmotility is associated with what rheumatoid disorder from exam 2?

Answer 36

scleroderma - CREST syndrome

Question 37

in what two ways does CREST syndrome lead to esophageal dysmotility?

Answer 37

1) atrophy and fibrous replacement of smooth muscle in distal esophagus
2) weakness of contraction in the lower esophagus and incompetence of LES

Question 38

which imaging study allows you to directly see abnormalities and allow for biopsy

Answer 38

endoscopy

Question 39

which imaging study can show structural and motor problems

Answer 39

barium swallow

Question 40

esophageal manometry allows what two things?

Answer 40

1) assess strength and coordination of peristalsis

2) Assesses pressures of LES

Question 41

aspiration pneumonia is common in which esophageal dysmotility?

Answer 41

neurogenic

Question 42

what is the test of initial investigation for esophageal dysmotility?

Answer 42

barium esophargram (barium swallow), endoscopy then allows for treatment

Question 43

a linear tear in the mucosa of the esophagus usually near the GE junction is refereed to as

Answer 43

a mallory Weiss tear and causes 10% of paper GI bleed

Question 44

a 10 week pregnant patient comes in stating that she vomits multiple times a day but is concerned because this morning started to notice blood in the vomit however she is in no pain, what do you suspect?

Answer 44

a Mallory Weiss tear

Question 45

a 23 year old female comes in a day after her birthday reporting that she blacked out while celebrating the night before, she states that her friends noticed blood in her vomit the night before, you suspect a a Mallory Weiss tear, how do you diagnosis and treat this patient?

Answer 45

dx- endoscopy
treatment- may resolve on its own, possible injection of epinephrine if bleeding persist, additionally might try thermal coagulation or surgery if the bleed is severe (arterial)