Lecture 14 - Clinical Approach to Esophagus Flashcards
When inserting an NG tube, use _____ to make sure the tube is correctly placed.
X-ray
For patients with Dysphagia, it’s important to determine which kinds of foods cannot be swallowed.
If Solids can’t be swallowed –> usually _____ lesion.
If Liquids can’t be swallowed –> typically ______/______ problem.
Mechanical
Contractile/Muscular
Eosinophilic esophagitis is characterized by > _____ eosinophils per HPF, esophagitis that is still present ____ months after PPI treatment, and/or when secondary causes are ruled out. Treating these patients with oral Steroids (so immunosuppressed) increases their risk for ________ esophagitis.
> 15 Eosinophils per HPF
2 months
Candidal
Treatment for CMV is usually _______, while treatment for HSV is usually ________ or _______.
Ganicyclovir
Valacyclovir
Acyclovir
________ (for osteoporosis), NSAIDs, and Fe are the common meds that cause Esophagitis.
Bisphophonates
Esophageal Webs come in 2 varieties:
______ _____ Syndrome –> characterized by Spoon-shaped fingernails, _______ stomatitis, Iron-deficiency anemia, and 10% risk of _____ ____ Carcinoma.
Howel-Evans Syndrome –> characterized by ________ of palms and soles of feet. 95% of these patients develop ____ ____ Carcinoma by age 65.
Plummer Vinson Syndrome
Angular Stomatits
Squamous Cell Carcinoma
Hyperkeratosis
Squamous Cell Carcinoma
Shatzki ring presents as intermittent, non-progressive ______. It’s a thin mucosal membrane with a smooth concentric contour that protrudes into the ______ of the esophagus.
Dysphagia
Lumen
Are men or women at higher risk for deveoping esophageal strictures?
Treatment of strictures involves progressive ______ of the esophagus using dilators in succession or a balloon.
Men
Widening
Squamous cell Carcinoma of the esophagus usually occurs in the ____ to ____ decades of life and in the _____ and _____ portions of the esophagus. Which race is at highest risk?
How does Adenocarcinoma of the esophagus compare?
6th to 7th
Upper and Mid
Adenocarcinoma usually occurs at the GE junction, white males are at higher risk, obesity IS a risk factor but alcoholism is NOT.
Stage 0-1 for esophageal cancer –> contained at site of origin
Stage II - III –> invades into ______ _____ OR ____ ____ involvement.
Stage IV –> mets
T –> tumor spread
N –> Lymph nodes
M –> mets
Muscularis Propria OR Lymph Node involvement
Stage 0 - I –> treated by resection and/or _______ dynamic therapy.
Stage II - III –> treated with Sugery, Chemo, or Radiation.
Stage IV –> palliation and/or ____ stents.
Photodynamic Therapy
Metallic stents
Treatment of acute hemorrhage from esophageal Varices can include ______ tamponade, ______ (SST analogue) drip, Vasopressin (which causes vasoconstriction), ______ which shunts portal circulation to systemic circulation, or injection of 2-octyl cyanoacrylate which ______ the varices.
Baloo tamponade
Octreotide
TIPS
Coagulates
For Varices > 5mm, _____ ____ are used to lower bp. The most commonly used are Propranolol, Nadolol, and ________.
Beta-blockers
Carvedilol
For Diffuse esophageal spasm (so hyperactivity), patients will present with ______ squeezing chest pain and possibly dysphagia. You MUST rule out _____ etiology, and you can confirm diagnosis with a _____ swallow which may show “_____” shape to the esophagus. These patients should be treated with ____ ____ blockers and/or ______ injections.
Substernal
Cardiac
Barium
Corkscrew
Ca++ Channel blockers
Botox
Scleroderma involves the esophagus in up to 80% of cases. While there is normal peristalsis above the ____ ____, it results in ______ (hypo or hypermotility?) and _______ incompetence –> how does this differ from Achalasia?
Aortic Arch
Hypomotility
LES
In Achalasia, the LES cannot relax normally, while in Scleroerma it relaxes too much.
