GI - 3 Esophagus pt 4

Question 1

Dilated submucosal veins (in esophagus) due to portal hypertension, can result in major UGI bleed,

Answer 1

Esophageal varices

Question 2

What will confirm that bloody vomit is from an UGI bleed?

Answer 2

NG (nasogastric) tube

Question 3

How are varices treated?

Answer 3

banding

Question 4

Meds for Esophageal varices:

Answer 4

IV qinolong b/c of high risk of infection (peritonitis)

Octreotide, somatostatin, vasopressin - reduce portal pressure

Question 5

If medication treatment fails for esophageal varices, what can help stop the bleeding?

Answer 5

Balloon Tampanode (applies pressure)

Question 6

Signs and symptoms of Eosinophilic Esophagitis:

Answer 6

Dyaphagia for solid food, heartburn, vomiting, elevatead igE

Question 7

Diagnosis of Eosinophil Esophagitis

Answer 7

Barium swallow (for new patients complaining of dysphagia)

Question 8

Barium swallow shows multiple concentric rings and eosinophils in mucosa of proximal esophagus

Answer 8

That’s how you diagnose Eosinophil Esophagitis

Question 9

What are 2 types of Esophageal Cancer?

Answer 9

Squamous cell and Adenocarcinoma

Question 10

Barrett’s is associated with what?

Answer 10

Adenocarcinoma esophageal cancer

Question 11

Alcohol and tobacco are more associated with

Answer 11

Squamous cell esophageal cancer

Question 12

Symptoms of Esophageal cancer

Answer 12

Progrssive dysphagia (solids then even liquids)
Weight loss
Coughing with swallowing or pneumonia

Question 13

Why does Esophageal Cancer spread fast?

Answer 13

B/c there is no mucosa protecting the esophagus

Question 14

Diagnosis of Esophageal cancer

Answer 14

Barium Esophagram (new patient comes and complains ofdysphagia)
Upper endoscopy allows to biopsy area

Question 15

Anything beyond Stage IIIa is:

Answer 15

Too advanced for surgery to cure

Question 16

Idiopathic. Loss of peristalsis in distal 2/3 of esophagus. Impaired relaxation of LES, gradual onset of dysphagia for solids and liquids. Regurgitating undigested food hours later, coughing, aspiration, weight loss

Answer 16

Achalasia

Question 17

How is Achalasia diagnosed? (2 tests, 4 signs)

Answer 17

Barium Esophagram: Absent peristalsis, dilated esophagus, smooth symmetric beak appearance
CXR: Air fluid level in enlarged esophagus.

Question 18

How is Achalasia CONFIRMED?

Answer 18

Esophageal Manometry. The Barium is only suggestive. This actually confirms there isn’t peristalsis, there is incomplete relaxation of LES, and intraesophageal pressure > gastric pressure

Question 19

What is the treatment for Achalasia? (2)

Answer 19

1. Balloon Dilitation of LES
2. Laproscopic Myotomy (cut out and remove LES)
3. Botulinum toxin injection – reduces LES pressure (for ppl that can’t handle invasive procedures like 1&2

Question 20

Nonpropulsive/hyperdynamic/irritable contractions in esophagus. Chest pain, dysphagia (solids and liquids)

Answer 20

Diffuse Esophageal Spasm

Question 21

Barium Esophagram shows poor progression of bolus, disordered contraction

Answer 21

Diffuse Esophageal Spasm

Question 22

How is Diffuse Esophageal Spasm diagnosed?

Answer 22

Barium Esophagram shows poor progression of bolus, disordered contraction

Question 23

How is Diffuse Esophageal Spasm treated?

Answer 23

Anticholinergics (antispasmotics)

Question 24

Esophageal Manometry must be done to confirm:

Answer 24

Achalasia