Esophagus/stomach/duodenum

Question 1

List 4 narrowings of esophagus

Answer 1

1. upper esophageal sphincter (cricopharyngeus muscle)
2. aortic arch
3. left mainstem bronchis
4. diaphragmatic hiatus (LES)

Question 2

List 8 esophageal abnormalities that may result in obstruction?

Answer 2

Intrinsic

• Schatzki’s ring
• Esophageal web
• Carcinoma
• Peptic stricture
• Zenker diverticulum

Extrinsic

• Congenital abnormalities of the aortic arch or subclavian artery
• Bronchogenic carcinoma
• Thyroid mass (goiter or carcinoma)

Question 3

List 5 indications for endoscopic removal of esophageal FBs.

Answer 3

1. significant distress
2. button batteries
3. sharp
4. coins (proximal)
5. impaired handling of secretions
6. failure of other measures
7. contraindication to other measures

Question 4

List 3 indications for FB removal from the stomach.

Answer 4

• Long > 5cm
• Wide > 2.5cm diameter (is toothbrush, spoon)
• Sharp and pointed FBs (toothpicks, bones)
• Other objects that remain in the stomach for 3 – 4 weeks (or same intestinal location for >1 week)

Question 5

List 8 causes of esophageal perforation?

Answer 5

Traumatic

• Boerhaave’s
• FB aspiration
• caustic
• blunt/penetrating injury

Medical
-carcinoma
-severe esophagitis
-
Iatrogenic
-EGD
-dilation
-sclerotherapy
-NG tube
-ET tube
-Combitube

Question 6

List CXR findings of esophageal perforation.

Answer 6

1. Subcutaneous emphysema
   
   2. Mediastinal widening
   3. Pleural effusion
   4. Pulmonary infiltrate

90% will be abnormal

Question 7

How do you investigate for an esophageal perforation?

Answer 7

• Penetrating trauma: Gastrograffin esophagram + endoscopy
• Non-traumatic:
  o Start with gastrograffin esophagram (False negative 10%)
  o If negative:Barium swallow or CT chest

Question 8

List 7 causes of esophagitis.

Answer 8

nfectious esophagitis
	o Candidal
	o Viral – HSV, CMV
	o Bacterial
	o Mycobacterial
	o Fungal – PJP
-Parasitic – Trypanosoma cruzi, Cryptosporidium

Non-infectious causes:

• GERD
• Pill esophagitis
• Caustic ingestion
• Sclerotherapy
• Radiation
• Eosinophilic esophagitis

Question 9

List 8 common culprits of medication-induced esophagitis:

Answer 9

• Tetracyclines
• Antivirals
• Aspirin
• NSAIDs
  -KCl
• Quinidine
• Ferrous sulfate
• Alprenolol
• Aledronate
  Pamidronate

Question 10

List 8 complications of GERD.

Answer 10

Esophageal

• Esophagitis
• Erosions, ulcers, scarring
• Strictures
• Barrett’s esophagus
• Adenocarcinoma

Extraesophageal

• Asthma
• Chronic persistent cough
• Laryngeal stenosis
• Tracheal stenosis
• ?Subglottic stenosis in the intubated patient
• Hoarsenss
• Dysphonia
• Laryngitis
• Globus sensation
• Gingivitis, halitosis, dental problems

Question 11

List 8 causes of gastritis/gastropathy.

Answer 11

• Helicobacter pylori (most common)
• Supperative bacterial gastritis
• ASA
• NSAIDs
• Potassium
• Ethanol
• Corrosives
• Hypovolemia and hypotension
• Radiation
• Autoimmune reactions
• Crohn’s disease
• Sarcoidosis

Question 12

List suggested treatment regimes for Helicobacter pylori.

Answer 12

Triple therapy: Clarithromycin + (amoxicillin OR metronidazole) + PPI x 2 wks

Question 13

List the 4 major esophageal motility disorders.

Answer 13

• Achalasia
• Diffuse esophageal spasm
• Hypercontractile esophagus (“nutcracker esophagus”)
• Nonspecific motor disorder