GI

Question 1

cause/ RFs of GERD

Answer 1

decreased LES pressure (< 10)
obesity, hiatal hernia, delayed gastric emptying, hypersensitivity

Question 2

s/s of GERD

Answer 2

heartburn, regurg, dyspepsia, cough

atypical- asthma, laryngitis, chronic cough

alarm- WL, dysphagia, odynophagia, iron def anemia

Question 3

Barrett’s esophagus risk factors

Answer 3

5+ yrs of GERD AND 3+:
1- > 50 yrs old
2- white
3- male
4- obesity
5- tobacco use
6- FHx of esophageal cancer

Question 4

GERD dx

Answer 4

clinical
pH monitoring- gold standard
upper endoscopy- alarm sx or Barrett RFs

Question 5

GERD tx

Answer 5

lifestyle
1 sx/ wk- antacids and H2 antagonists
2+ sx/ wk- daily PPIs 4-8 wks
atypical- BID PPIs
unresponsive- endoscopy and pH monitoring

Question 6

cause of barrett esophagus

Answer 6

squamous–> columnar epithelium

Question 7

Dx of barrett esophagus

Answer 7

endoscopy- orange gastric type epithelium > 1 cm from GEJ in tongue like projections

biopsy- confirmatory w/ columnar epithelium

Question 8

tx of Barrett’s esophagus

Answer 8

long term PPIs

Question 9

s/s of peptic stricture

Answer 9

progressive solid food dysphagia

Question 10

dx of peptic stricture

Answer 10

endoscopy w/ biopsy
(required to differentiate cancer)

Question 11

tx of peptic stricture

Answer 11

dilation and long term PPIs

Question 12

s/s of esophagitis

Answer 12

dysphagia
odynophagia
substernal CP

Question 13

infectious esophagitis pathogens and sx

Answer 13

candida- yellow/white plaques
HSV- small deep ulcers
CMV- large superficial ulcers

Question 14

tx of infectious esophagitis

Answer 14

candida- fluconazole
HSV- acyclovir if immunocompromised
CMV- ganciclovir

Question 15

dx of infectious esophagitis

Answer 15

endoscopy with biopsy

Question 16

cause and tx of reflux esophagitis

Answer 16

cause- GERD
Tx- long term PPIs

Question 17

diagnostics of eosinophilic esophagitis

Answer 17

EREFS
edema
concentric rings
exudates
furrows
strictures
biopsy def–> eosinophils

Question 18

tx of eosinophilic esophagitis

Answer 18

BID PPIs and topical steroids
other- food elimination, dilation, SQ dupilumab

Question 19

name 2 common agents that may lead to pill induced esophagitis

Answer 19

NSAIDs and bisphosphonates (alendronate)

Question 20

dx of pill induced esophagitis

Answer 20

endoscopy with small ulcers

Question 21

tx of pill induced esophagitis

Answer 21

stop offending agent
take pills with water and stay upright

Question 22

cause of caustic esophagitis

Answer 22

ingestion of acid or alkaline agent (bases are more severe)

Question 23

s/s of caustic esophagitis

Answer 23

oral burns (pain and drooling)
aspiration (stridor and wheezing)
voice changes

Question 24

dx of caustic esophagitis

Answer 24

endoscopy within 12-24 hrs