OnlineMedEd: Surgery: General - "Esophagus"

Question 1

GERD is typically described as what kind of pain?

Answer 1

Retrosternal burning chest pain

Question 2

GERD improves with __________________.

Answer 2

sitting up and antacids

Question 3

Review the workup and diagnosis of GERD.

Answer 3

• First: clinical diagnosis; trial lifestyle management and PPIs for six weeks
• Second: for failure of initial therapy or alarm symptoms, do an EGD with biopsy

Question 4

When a patient develops metaplasia, you need to do what to their medicines?

Answer 4

Begin high-dose PPI

Question 5

Dysplasia in the esophagus should be managed with ______________.

Answer 5

ablation

Question 6

The first step in working up suspected achalasia is _______________. The follow-up text is ____________.

Answer 6

barium swallow; manometry

Question 7

___________ occurs in the proximal 1/3 of the esophagus and is related to smoking and hot beverage consumption.

Answer 7

Squamous cell carcinoma

Question 8

The first step in working up dysphagia is __________________.

Answer 8

barium swallow: look for symmetric narrowing (achalasia) or asymmetric narrowing (cancer)

Question 9

How does esophageal cancer typically present?

Answer 9

Progressive dysphasia (meaning first to solids then to liquids)

Question 10

How should you manage suspected Mallory-Weiss tears?

Answer 10

Like any other GI bleed: two large-bore IVs, IVF, type and cross, IV PPIs, and page GI for EGD

Question 11

Other than crepitus in the chest wall, what signs/symptoms do those with Boerhaave’s syndrome have?

Answer 11

Mediastinitis, which presents with fever, hypotension, tachycardia… sepsis

Question 12

If gastrograffin is safer for the mediastinum, then why don’t we always do that instead of barium?

Answer 12

Gastrograffin is more damaging to the lungs than barium, so for those