Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

GI Board Review > Esophagus > Flashcards

Esophagus Flashcards

GERD, BE, H. pylori

1
Q

How do you manage extraesophageal reflux symptoms?

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

How do you manage new symptoms of GERD?

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How do you manage refractory GERD symptoms?

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How do you manage new symptoms of extraesophageal reflux?

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How do you manage non-cardiac chest pain?

A
  1. Cardiac evaluation

If reflux symptoms present, then PPI BID 8 to 12 weeks

If no reflux symptoms presents, then EGD or pH study

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Can GERD be diagnosed off layngoscopy findings alone?

A

no

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How do you manage GERD in pregnancy?

A
  1. lifestyle changes
  2. antacids, sucralfate
  3. H2 blockers or PPI (any except omeprazole)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How long do you continue PPI?

A
  1. stop PPI- GERD w/o erosive esophagitis or BE; patients whos symptoms resolved on PPI
  2. Indefinite treatment with PPI- LA grade C/D or BE
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

When should you use BRAVO vs impedence pH testing?

A

Is this GERD? - use any test OFF therapy to establish a diagnosis

This patient has GERD, why are they still symptomatic?- use impedance pH testing ON therapy because you can learn about non-acid reflux

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Does 2CM BE confirm a diagnosis of GERD?

A

No.
Endoscopic finidings of GERD are LA grade C/ D or BE >3cm
LA grade B only if symtoms of GERD and response to PPI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the symptom index (SI)?

A

reflux-related symptoms / total # of symptom episodes

> 50% is significant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the symptom sensitivity index (SSI)

A

of reflux-related symptoms / total # of reflux events

> 10% is significant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the symptom association probability

A

p value for the test

> 95% is significant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What enzyme metabolizes PPI?

A

CYP2C19

Rabeprazole is least dependent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Are all PPIs equivalent?
what is superior to PPI?

A

All are clinically equivalent at healing esophagitis

All are NOT equivalent in lowering acid pH
Rabeprazole > esomeprazole> omeprazole > lansoprazole > pantoprazole

vonoprazan is highly effective for treating LA Grade A and B esophagitis, so is lansoprazole, and healing rates at 8 weeks are 100% versus 99.2%, respectively.

In contrast, vonoprazan healing of LA Grade C and D

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the possible results of impedance pH study ON PP?

A
  1. inadequate acid suppression despite PPI
  2. non-acid reflux causes symptoms (hypersensitivity)
  3. normal pH study- functional, other condition (EOE, achalasia, gastroparesis, etc).
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are the types of anti-reflux surgery?

A

Lap fundoplication
Magnetic sphincter- especially if symptoms are regurgitation
Roux en-y if obese
TIF if regurgitation, not severe GERD

18
Q

Who gets screened for Barrett’s esophagus?

A

3 or more RF
-men, caucasion, >50years old, FDR with BE or EAC, smoker, obesity

19
Q

What should you do if you find salmon colored mucosa on routine EGD? What should the surveillance plan be?

A

biopsy if >1cm
at least 8 bites

surveillance
*ND BE <3cm - repeat 5 years
*ND BE>3cm- repeat 3 years
*Indefinite for dysplasia- 2nd pathologist review –> PPI BID and repeat EGD w/in 6 months –> if indefinite again the repeat in 1 year otherwise follow algorithm for path result

20
Q

How do you manage BE w/ LGD?

A

Surveillance or Ablation

  1. Surveillance - 6 months after diagnosis, 12 months after diagnosis, then every year
  2. Local resection + ablation until CEIM, then surveillance at 1 year, 3 years, and every 2 years
21
Q

How do you manage BE w/ HGD or cacinoma insitu

A

assuming T1a disease (limited to mucosa, T1b invades submucosa),

resection then ablation until CEIM

Surveillance at 3mo, 6mo, 12mo, then annually

22
Q

How do you manage Esophageal adenocarcinoma T1b disease?

A

endoscopic ablation/resection IF low risk features: well differentiated, <2cm, no LVI

otherwise surgical management

23
Q

Where do you biopsy for surveillance after CEIM for dysplasic BE?

A

at GEJ and distal 2 to 5cm of esophagus

24
Q

Esophageal lumen diameters for
1. dysphagia
2. modified diet
3. regular diet

A
  1. dysphagia = diam <13
  2. modified diet in diam 15mm
  3. regular diet 18mm diam
25
Q

How do you grade and manage caustic ingestions?

A

EGD within 48 hours

Zargar’s grading scale
0-normal
1- edema (liquid diet)
2a- friable and superficial erosions (liquid diet)
2b deep ulcers or circumfrential- NPO x 48 hours
3a scattered necrosis -NPO x 48 hours
3b extensive necrosis -NPO x 48 hours
4 perforation

26
Q

middle aged woman with proximal esophageal stricture refractory to PPI and dilation

A

Lichen planus

27
Q

Who needs to be screened for esophageal SCC?

A

h/o caustic injury (15 to 20 years later) - esp lye

h/o tylosis (start at age 30)
(leukoplakia, hyperkeratosis, and esophageal papillomas)

other associations that DON’T need screening

Plummer-Vinson syndrome (iron deficiency anemia and esophageal web formation)

Fanconi anemia (an inherited bone marrow failure syndrome)

systemic sclerosis.

achalasia

HPV

radiation

28
Q

How do you treat HIV-related esophageal ulcers

A

Steroids or thalidomide

29
Q

What condition is this?

A

Hiatal Hernia

30
Q
A

Barrett’s esophagus

31
Q
A

Barrett’s esophagus with dysplasia

32
Q
A

EOE

33
Q

what type of gastric polyps are these?

A

fundic gland (remove if >1cm)
hyperplastic (remove if >5mm)
adenomatous (remove any size)

34
Q

What is Plummer-Vinson syndrome?

A

triad of:
1. dysphagia
2. IDA
3. esophageal web
increased risk of esophageal squamous cell cancer

35
Q
A

glycogenic acanthosis

36
Q
A

Rumination syndrome

37
Q
A

The pull sign
specific for EOE
resolves after successful treatment

38
Q

Dysphagia after POEM or Lap heller. Esophogram shows this…

A

pseudodiverticulum at the myotomy site, or a blown out myotomy (BOM)

focal increase in luminal diameter in the distal esophagus on barium esophagram.

These patients typically have an adequate myotomy defined on HRM or do not respond to further LES-targeted therapy

treat with esophagectomy

39
Q

dysphagia
EGD shows this

A

Zenker’s diverticulum

40
Q

severe chest pain after eating

A

Boerhaave syndrome
if septic needs surgery
if not can consider conservative mgmt or even endoscopic stent

41
Q

How do you screen for esophageal SCC?

A

Lugol’s chromoendoscopy-
Esophageal mucosa with squamous dysplasia remains unstained compared to normal squamous epithelium on chromo

GI Board Review (15 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions