Esophagus 2

Question 1

Budd-Chiari syndrome is associated with what esophagus related condition?

Answer 1

esophageal varices

Question 2

explain how alcohol is related to esophageal varices?

Answer 2

alcohol abuse causes cirrhosis of the liver which leads to portal hypertension and then esophageal varices

the same is true for chronic viral hepatitis

Question 3

if a patient has esophageal varices what medication should be avoided as it can exacerbate bleeding?

Answer 3

NSAIDs

Question 4

esophageal varices are usually asymptomatic but they may present as what? how do you diagnosis these?

Answer 4

a painless upper GI bleed that is often painless and may be life treating
DX with endoscopy

Question 5

if a bleed from an esophageal varice is large what may a patient experience?

Answer 5

hypovolemic shock, orthostasis

Question 6

what does the bleeding from esophageal varices look like

Answer 6

“brisk” bleeding
bright red blood or coffee ground emesis
also have melon(black stools) or hematochezia

Question 7

treatment for esophageal varices

Answer 7

hemodynamic support (high volume fluid replacement) use of endoscopic vasopressors

emergent EGD (band ligation and sclerotherapy)

Question 8

prevention of esophageal varices

Answer 8

beta blockers( propanol)
no alcohol 
endoscopic band ligation

Question 9

GERD is due to an abnormality in what?

Answer 9

LES (Meds that directly irritate or decrease LES tone are a RF for development of GERD)

symptoms are then due to prolonged exposure to gastric acid

Question 10

common meds that may lead to GERD (8, should be easy)

Answer 10

antibiotics, bisphosphonate, iron, NSAIDS, anticholinergics, CCB, narcos, Benzos

Question 11

a patient comes in complaining of heart burn and you suspect GERD what are 5 other COMMON symptoms whey may experience

Answer 11

worsen after meals. worsen when lying down or bending over, some relief with antacids, regurgitation, dysphagia

Question 12

night time symptoms are increase when GERD becomes

Answer 12

more severe

Question 13

list the 6 alarm symptoms of GERD

Answer 13

anemia, loss of weight, anorexia, recent onset of progressive symptoms, melon or hematemesis, swallowing difficulties

Question 14

GERD diagnosis made with

heartburn + regurg of acid + what?

Answer 14

+ relief with antacids (cimetidine, ranitidine, famotidine)

Question 15

start a trail of what and for who long when you suspect GERD

Answer 15

PPI 4-8 weeks

Question 16

when would you use a endoscopy to rule in or rule out GERD

Answer 16

failure of PPI trial or alarm symptom 
more severe disease
age over 45 with new sx
long standing or recurrent sx 
nonresponse to therapy

Question 17

what is the Gold standard objective test for surgical planning in GERD

Answer 17

Ambulatory 24-hour pH monitoring

Question 18

PPI ending, when do we take them?

Answer 18

-prozole or -prazole

take daily prior to eating

Question 19

which surgery changes the anatomy so that the gastric fundus wrapped around esophagus for sphincter competence

Answer 19

nissen fundoplication

Question 20

barrett esophagus replaces squamous epithelium with

Answer 20

metaplastic column epithelium, associated with adenocarcinoma

Question 21

treatment of barrett esophagus

Answer 21

normalization of acid, decrease cell proliferation in BE

Treat with radiofrequency endoscopic ablation, monitor with Surveillance endoscopy

Question 22

most common benign tumor of the esophagus

Answer 22

leiomyoma

Question 23

clinical presentation a leiomyoma

Answer 23

usually asymptomatic may present with dsyphagia

Question 24

how do you know know if a leiomyoma benign or malignant

Answer 24

but be surgically removed

Question 25

which cancer is likely to be located mid portion of the esophagus and is associated making and common in asians and African Americans

Answer 25

squamous cells carcinoma esophageal cancer

Question 26

which cancer is likely to be located in the distal 1/3 of the esophagus and likely associated with chronic reflux obesity and white males

Answer 26

adenocarcinoma of the esophagus

Question 27

barret esophagus is associated with which Esophageal Cancer?

Answer 27

adenocarcinoma of the esophagus

Question 28

what risk factors are associated with BOTH squamous cells carcinoma esophageal cancer and adenocarcinoma of the esophagus

Answer 28

Smoking, caustic agents (nitrosamines, fungal toxins and carcinogens), and HPV

Question 29

chronic alcohol use is is associated with which Esophageal Cancer?

Answer 29

squamous cells carcinoma esophageal cancer

Question 30

what type of dysphagia is associated with esophageal cancer?

Answer 30

Progressive dysphagia with solid foods

Question 31

a patient comes in with complaints of weight loss occasional heartburn and vomiting and recurrent hoarseness
the patient has also had 2 episodes of apirtation pneumonia this year, what fo you suspect?

Answer 31

esophageal cancer

Question 32

you suspect esophageal cancer in a patient what test do you order initially and what lesions do you see?
what additional test is need to make a diagnosis?

Answer 32

best initial test is barium esophagogram with noted apple core lesions

then perform an endoscopy with biopsy to make diagnosis

Question 33

list 4 test used for staging in esophageal cancer

Answer 33

CT of chest and abdomen
Endoscopic ultrasound with guided FNA biopsy of lymph nodes
PET-CT
possible Bronchoscopy

Question 34

Esophageal Cancer treatment

Answer 34

surgical resection with radiation and or chemotherapy

Question 35

2 common Esophageal Cancer metastasis sites

Answer 35

stomach and colon