Gastroenterology Flashcards
___________ is a protrusion on the upper part of the stomach into the chest, generally caused by obesity weakening the diaphragm. It is associated with heartburn, chest pain, and dysphagia; symptoms can be indistinguishable from GERD.
Hiatal Hernia
How would you diagnose Hiatal Hernia?
Endoscopy or Barium Studies
This is the best initial therapy for Hiatal Hernia.
Weight loss and PPIs
These are alarm symptoms that indicates Endoscopy for Hiatal Hernia.
Weight loss
Blood in stool
Anemia
This is the inability of the lower esophageal sphincter (LES) to relax due to a loss of the nerve plexus within the lower esophagus. The etiology is not clear. There is aperistalsis of the esophageal body.
Achalasia
The patient is usually young (under 50), progressive dysphagia to both solids and liquids at the same time. There is no association with alcohol and tobacco use. What is the most likely diagnosis?
Achalasia
What is the most accurate test for Achalasia?
Manometry - will show a failure of the lower esophageal sphincter to relax
What will you see in the Barium esophagram of Achalasia?
“bird’s beak” as the esophagus comes down to a point
What are your treatment options for Achalasia?
Pneumatic dilation
Surgical sectioning or Myotomy
Botulinum toxic injection
Achalasia cannot be “cured”. Treatment is based on simple mechanical dilation of the esophagus
Patient is usually age 50 or older and presents with dysphagia first for solids, followed later (progressing) to dysphagia for liquids. It is associated with prolonged alcohol and tobacco use and more than 5-10 years of GERD symptoms. What is the most likely diagnosis?
Esophageal Cancer
How would you diagnose Esophageal Cancer?
Biopsy
How would you treat Esophageal Cancer?
Surgical Resection
Chemotherapy and radiation in addition to surgical removal
Stent placement for lesions that cannot be resected surgically to keep esophagus open for palliation and to improve dysphagia
What are the two forms of Esophageal Spasms?
Diffuse Esophageal Spasm (DES)
Nutcracker esophagus
How would esophageal spasm present?
- sudden onset of chest pain that is not related to exertion
- precipitated by drinking cold liquids
How can you distinguish DES and Nutcracker Esophagus?
Manometry
How would you treat esophageal spastic disorders?
Calcium Channel Blockers and Nitrates
A 43-year-old man recently diagnosed with AIDS comes to the emergency department with pain on swallowing that has become progressively worse over the last several weeks. There is no pain when not swallowing. His CD4 count is 43mm3. The patient is not currently taking any medications.
What is the most appropriate step in management?
a. Esophagram
b. Upper endocopy
c. Oral nystatin swish and swallow
d. Intravenous amphotericin
e. Oral fluconazole
E. The most commonly asked infectious esophagitis question is esophageal candidiasis in a person with AIDS.
This is associated with intermittent dysphagia. It is often from acid reflux and is associated with hiatal hernia. This is a type of scarring or tightening (also called peptic stricture) of the distal esophagus.
Schatzki Ring
How would you treat Schatzki Ring?
Pneumatic dilation in an endoscopic procedure
This presents as dysphagia and is associated with iron deficiency anemia and can rarely transform into squamous cell cancer. The IDA is not caused by blood loss. This is located more proximal.
Plummer-Vinson syndrome
How would you treat Plummer-Vinson syndrome?
Iron replacement
This is an outpocketing of the posterior pharyngeal constrictor muscles. There is dysphagia, halitosis, and regurgitation of food particles. Some patients suffer from aspiration pneumonia when the contents of the diverticulum end up in the lung. What is the most likely diagnosis?
Zenker diverticulum
How would you diagnose and treat Zenker diverticulum?
Barium Studies and Surgery Repair
What procedures are dangerous for people with Zenker diverticulum?
Nasogastric tube placement or upper endoscopy