GI

Question 1

What medications may cause or worsen sxs of GERD?

Answer 1

Some antibiotics (tetracyclines), bisphophonates, iron, NSAIDs, anticholinergics, calcium channel blockers, narcotics, benzodiazepines, and others.

Question 2

What is the (rare) complication of GERD?

Answer 2

Barrett’s Esophagitis (replacement of normal squamous epithelium with metaplastic columnar epithelium), which can predispose to malignancy

Question 3

What are the sxs of GERD?

Answer 3

heart burn that is generally worse after meals and when lying down, and relieved with antacids. Regurgitation and dysphagia may occur.

less common sxs: hoarseness, halitosis, cough, hiccuping, sore throat, laryngitis, and atypical chest pain

Question 4

When is endoscopy indicated for GERD?

Answer 4

more severe disease - confirm dx and assess for epithelial damage

if

Question 5

Tx for GERD?

Answer 5

1. Lifestyle modifications (stop smoking, avoid eating at bedtime, avoid large meals, avoid alcohol and foods that irritate like tomatoes, fried foods, caffeine, raising head of bed)
2. antacid for mild sxs
3. h2 blocker or PPI (omeprazole)

Question 6

What are some meds to avoid in GERD because they decrease lower esophageal sphincter pressure?

Answer 6

b-agonists
a-adrenergic antagonists
nitrates
CCBs
anti-cholinergics
theophylline
morphine
meperidine
diazepam
barbiturates

Question 7

Infectious esophagitis tends to occur in what patient population?

Answer 7

Immunocompromised

Question 8

What are causes of infectious esophagitis? How does it present?

Answer 8

fungal (candida), viral (CMV, HSV); other uncommon causes as well

odynophagia or dysphagia in immunocompromised
dx with endoscopy

Question 9

Esophageal dysmotility disorders causes?

Answer 9

Neurologic, intrinsic or external blockage, or malfunction of esophageal peristalsis

Question 10

what are some disorders of esophageal dysmotility?

Answer 10

neurogenic dysphagia, Zenker diverticulum, esophageal stenosis, achalasia, diffuse esophageal spasm, scleroderma

Question 11

What is the most common presenting symptom of esophageal dysmotility disorders?

Answer 11

Dysphagia.

Question 12

What is neurogenic dysphagia?

Answer 12

neurogenic: dysphagia with liquids and solids caused by injury or disease of brainstem or CN 9 or 10

Question 13

What is Zenker diverticulum?

Answer 13

outputting of posterior hypo pharynx that can cause regurgitation of undigested food and liquid into pharynx several hours after eating

Question 14

What is esophageal stenosis?

Answer 14

dysphagia with solid foods

slow progression of solid food indicates benign process whereas rapid progression indicates malignancy

Question 15

What is achalasia?

Answer 15

global esophageal motor disorder in which peristalsis is decreased and LES tone is increased, causing slowly progressive dysphagia with episodic regurgitation and chest pain

dx: barium swallow produces “parrot beak” (dilated esophagus tapering to the distal obstruction)

Question 16

What is diffuse esophageal spasm?

Answer 16

dysphagia or intermittent chest pain that may or may not be associated with eating

Question 17

What is scleroderma?

Answer 17

Hardening or tightening of skin and connective tissue

eventually involves esophagus in most patients, causing decreased sphincter tone and peristalsis, predisposing to sxs and complications of reflux

Question 18

Esophageal neoplasm types? Where might they spread?

Answer 18

Squamous cell carcinomas and adenocarcinomas most common
Barret is associated with adenocarcinomas in distal third of esophagus
SC lesions tend to occur in upper third

Common to spread to mediastinum since esophagus has no serosa

Question 19

Pt presents with progressive dysphagia for solid food associated with marked weight loss. Heartburn, vomiting, and hoarseness may occur. What is the major concern? How to dx and treat?

Answer 19

Esophageal cancer.

1. barium esophagram best initial test
2. endoscopy with brushings to diagnose
3. endoscopic sonography and CT for staging

Treat with surgery. May also do radiotherapy and adjunctive chemo with or without surgery.

Question 20

Risk factors for esophageal cancer?

Answer 20

Frequently related to cigarette smoking and chronic alcohol use; also exposure to caustic agents, hot foods, mucosal abnormalities, poor oral hygiene and HPV

Question 21

What is a mallory-weiss tear? What is it associated with?

Answer 21

Linear mucosal tear in esophagus, generally at gastroesophageal junction, that occurs with forceful vomiting or retching, causing hematemesis. 5-10% of upper GI bleeds.
Associated with alcohol use but consider for any upper GI bleed

Question 22

dx and tx of mallory-wiess tear?

Answer 22

endoscopy
most resolve without treatment; a PPI may be used if active bleed is resolved
endoscopic injection of epinephrine or thermal coagulation if bleeding doesn’t resolve

Question 23

What are esophageal varies and what causes them?

Answer 23

• Dilation of veins of esophagus, usually at distal end.
• Caused by portal hypertension (most commonly from cirrhosis either from alcohol abuse or from chronic viral hepatitis)
• Use of NSAIDs can exacerbate bleeding (hepatic vein obstruction)
• Budd-Chiari syndrome may cause thrombosis of portal vein, leading to esophageal varies