Esophagus

Question 0

Protection from esophagitis

Answer 0

• gravity
• LES
• esoph motility
• salivary flow
• gastric emptying
• tissue resistance

Question 1

GERD prevalence

Answer 1

10% pop

<10% have evidence of esophagitis

Question 2

Labs in GERD

Answer 2

• endoscopy in pts>45 w/ new onset, long standing, inc freq, tx failure
• severe: Ba swallow, esoph manometry, ambulatory 24h pH
• consider MI

Question 3

D/o of esoph motility

Answer 3

Neurogenic dysphagia, zenkers diverticulum, esophageal stenosis, achalasia, diffuse esophageal spasm, scleroderma

Question 4

Factors for dysmotility

Answer 4

Neurogenic, intrinsic or ext blockage, malfunction of esophageal peristalsis

Question 5

Neurologic dysphagia

Answer 5

Difficulty with solids and liquids. Caused by damage to BS or CN

Question 6

Zenkers diverticulum

Answer 6

Outpouching of posterior hypopharynx. –> regurg of un digested food hours after eating

Question 7

Esophageal stenosis

Answer 7

Dysphasia of solid food
Slow progression: benign (rings/web)
Fast progression: malignancy

Question 8

Achalasia

Answer 8

Global esophageal d/o
Dec peristalsis
Inc LES
Slow progressing dysphagia
Episodic regurg and angina
"Parrot-beaked" on Ba swallow
--dilated then tapered by obs

Question 9

Scleroderma

Answer 9

Eventually progresses to involve esophagus in most

Dec LES tone and peristalsis

Question 10

GERD tx

Answer 10

1st line: H2 blocker (higher dose than PUD)
1st line in mod-severe: PPI (most powerful GERD tx)

AVOID LES Pressure-decreasing drugs

Question 12

Drugs that DEC LES pressure

Answer 12

B-agonist, a-adrenergic antag., NO3s, CCB, anticholinergics, theophylline, morphine, meperidine, diazepam, barbiturates

AABBCcbD, MMNT

Question 13

How to tx esophageal strictures

Answer 13

Benign– manage by dilation

Malignant– manage by resection

Question 14

Esophageal neoplasms

Answer 14

SCC and adenocarcinoma – most CMN
Barrett’s esophagitis – AC in last 1/3
SCC– prox 2/3
Spread to mediastinum – CMN

Question 15

Esoph neoplasm causes

Answer 15

Related to chronic OH and smoke

Also, nitrosamines, fungal toxins, carcinogens, hot foods, mucosal abnormalities, poor oral hygiene, HPV

Question 16

Esoph neoplasm clinical

Answer 16

MAIN: INC dysphagia for solids and marked wt loss

Heartburn, vomiting, hoarseness

Question 17

Esoph neoplasm labs

Answer 17

BEST initial: biphasic Ba esophagram

to DX: endoscopy w/ brushings

Question 18

Esophageal tx

Answer 18

SURGICAL
Radiotherapy and adjunctive chemo
Prog: depends on stage, 4-60% 5y survival

Question 19

Mallory Weiss tear

Answer 19

Linear mucosal tear in esophagus
-USU at gastroesophageal jxn
Occurs w/ forceful vomiting –> hematemesis
Assoc w/ OH use – but consider in ALL UPPER GI BLEEDS
Est dx w/ endoscopy
Most resolve w/o tx, can do endoscopic injxn of epi or thermal coag

Question 20

Esophageal varices

Answer 20

Dilations of the veins – USU at distal end
Cause: portal HTN (MCC: cirrhosis), NSAIDs exacerbate this
Can be caused by Budd-Chiari syndrome –> thrombosis of portal vein

Question 21

Esophageal varices dx

Answer 21

USU clinical: pt w/ cirrhosis w/ hematemesis

Asx until bleed then can be life threatening

Question 22

Esophageal varices tx

Answer 22

high vol. fluid replacement, vasopressors, IMMED ctrl of bleeding
Endoscopic tx and pharm vasoconstriction (octreotide!)

Question 23

Esophageal varices mortality

Answer 23

30% with first bleed, 50% w/in 6wks