OnlineMedEd: Gastroenterology - "Esophagus" Flashcards

1
Q

It’s helpful to categorize dysphagia into two groups: ________________.

A

motility (related to the failure of peristalsis) and mechanical obstruction (stricture)

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2
Q

What feature of the clinical history suggests a mechanical obstruction?

A

Progressive dysphagia that goes from solids to liquids

Motility dysphagia will present with dysphagia to solids and liquids at the same time.

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3
Q

Go through the three diagnostic steps of dysphagia.

A
  • First: barium swallow
  • Second: manometry for suspected motility issues
  • Third: endoscopy with biopsy
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4
Q

Those with achalasia will often complain of _____________.

A

feeling like food is stuck at the level of the sternum

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5
Q

List three treatment options for achalasia.

A
  • Botox
  • Myotomy
  • Dilation

Myotomy is the preferred treatment modality. Dilation carries a high risk of perforation. Botox doesn’t last.

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6
Q

Go through CREST syndrome.

A
  • Calcinosis
  • Raynaud’s
  • Esophageal dysmotility
  • Sclerodactyly
  • Telangiectasia
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7
Q

The esophageal dysmotility of CREST presents as _____________.

A

relentless GERD

The lower esophageal sphincter cannot contract in CREST syndrome.

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8
Q

CREST is associated with the anti-___________ antibody.

A

centromere

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9
Q

Systemic sclerosis is associated with the ______________ antibody.

A

anti-scl-70 (aka anti-topoisomerase)

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10
Q

What esophageal disorder presents like an MI?

A

Diffuse esophageal spasm

The esophagus contracts randomly, causing a crushing substernal chest pain that improves with NTG and CCBs.

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11
Q

How does diffuse esophageal spasm present on x-ray?

A

The barium collects into the random pockets (created by the spasms) that looks like a corkscrew.

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12
Q

The best treatments for DES are _____________.

A

CCB and NTG

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13
Q

____________ cause a syndrome familiarly referred to as “steakhouse dysphagia”.

A

Schatsky’s rings (strictures at the LES)

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14
Q

Plummer-Vinson syndrome causes _____________.

A

iron-deficiency anemia and esophageal webs

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15
Q

The esophageal webs in Plummer-Vinson syndrome can cause what worrisome outcome?

A

Esophageal cancer

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16
Q

In addition to halitosis, those with Zenker’s diverticulum will also have ____________.

A

episodes of coughing in which they regurgitate undigested food

17
Q

Explain the diagnostic schema for differentiating GERD strictures from esophageal cancer.

A
  • Both present in someone who’s had GERD for years as progressive dysphagia and weight loss.
  • Barium swallows will show a symmetric luminal obstruction in strictures and an asymmetric luminal obstruction in esophageal adenocarcinoma.
  • A biopsy can definitively differentiate the two.
18
Q

GERD strictures can be treated with ___________.

A

PPIs and dilation