EXAM #2: ESOPHAGEAL DISORDERS

Question 1

What is an alternate name for heartburn?

Answer 1

Pyrosis

Question 2

What is the definition of odynophagia?

Answer 2

Painful swallowing

vs. dysphagia that is non-painful difficulty with swallowing

Question 3

What is Globus hystericus?

Answer 3

Dysphagia that is relieved with swallowing

• Seen in OCD
• Seen in anxiety

Question 4

What is waterbrash?

Answer 4

Burped up acid into the esophagus causes an abnormal salivary reaction

Question 5

What is EGD?

Answer 5

Esophagogastroduodenoscopy

Question 6

What is the best test for visualizing the esophagus?

Answer 6

EGD

Question 7

What is endoscopic US?

Answer 7

Using a swallowed probe to get a US view of the esophagus

- Used to see structures just OUTSIDE of the esophagus

Question 8

What is esophageal manometry used for?

Answer 8

Observing contractility

Note that this often included with pH testing

Question 9

What is reflux testing?

Answer 9

A pH probe that measures the pH in the distal esophagus

Question 10

How do patients present with a hiatal hernia?

Answer 10

Complain of a fullness in the epigastrium + heartburn

Question 11

What is the most common symptom of a esophageal diverticula?

Answer 11

Putrid breath

Question 12

What is the hallmark sign of Achalasia on radiography?

Answer 12

Bird Beak sign

Question 13

What are the common presenting symptoms with Achalasia?

Answer 13

• Solid food dysphagia
• Weight loss
• Chest pain
• Foul breath

Question 14

What is the treatment for Achalasia?

Answer 14

Treatment is limited–this is incurable

Question 15

What can help an esophageal spasm?

Answer 15

NO and smooth muscle dilators

Question 16

What is eosinophilic esophagitis?

Answer 16

Recurrent dysphagia with food impaction

• Caused by eosinophilic dominant inflammation
• Allergic-type reaction

Question 17

What patient population is eosiniphilic esophagitis common in?

Answer 17

Young white males

Question 18

How does EGD appear in eosinophilic esophagitis?

Answer 18

Ringed esophagus

Question 19

What is the treatment for Eosinophilic Esophagitis?

Answer 19

1) PPI
2) Allergy avoidance
3) Inhaled glucocorticoids
4) Dilation

Question 20

What is the common presenting symptom of infectious esophagitis?

Answer 20

Odynophagia

Question 21

What are the common etiologies of Infectious Esophagitis?

Answer 21

1) C. albicans
2) CMV
3) HSV

Question 22

What clinical finding is common in Candida Esophagitis?

Answer 22

Oral Thrush

Question 23

What stain is used for identifying Candida Esophagitis?

Answer 23

Silver stain–pseudohyphae

Question 24

When do you perform an endoscopy BEFORE treatment in possible Candida Esophagitis?

Answer 24

No oral thrush but you suspect Candida Esophagitis

Question 25

What are the signs and symptoms of CMV esophagitis?

Answer 25

LAD, cough, and mono-like presentation

Question 26

How will the ulcers appear in CMV esophagitis?

Answer 26

Large serpigenous ulcers in mid-distal esophagus

Question 27

How will CMV esophagitis appear under the microscope?

Answer 27

Owl eye

Question 28

How is CMV esophagitis treated?

Answer 28

Gancyclovir

Question 29

What is the mnemonic to remember the features of HSV esophagitis?

Answer 29

hsV

• V= volcano ulcers
• V= very painful
• V= AcycloVir

Question 30

What is used to visualize HSV in the lab?

Answer 30

Tzanck smear

*Will show “Giant cell”

Question 31

What is the most common cause of an esophageal perforation?

Answer 31

Iatrogenic i.e. endoscopy

Question 32

What is radiation esophagitis?

Answer 32

Radiation induced “burning” of the esophagus

Question 33

What is a common cause of corrosive esophagitis?

Answer 33

Battery ingestion

Question 34

What patient populations is pill esophagitis most common in?

Answer 34

Elderly “polypharmacy” patients

Question 35

What is Scleroderma?

Answer 35

CREST Syndrome

- causes esophageal dysfunction

Question 36

What is Barrett’s Esophagus associated with?

Answer 36

Alcohol and tobacco use

Question 37

What is the treatment plan for low grade Barrett’s?

Answer 37

Surveillance every 2-3 years

Question 38

What is the treatment plan for intermedaite grade Barrett’s?

Answer 38

Survey every 6 months

Question 39

What should you do with high grade Barrett’s?

Answer 39

1) 2nd opinion

2) Surgery/laser