Section 1: Esophageal Disorders & Epigastric Pain Flashcards
General presentation of esopgageal disorders
- Dysphagia
- Weight loss
- Dysphagia + Unknown diagnosis. What is the initial test
- Barium study
Difference between dysphagia and odonophagia and the implications of both
Dysphagia (difficulty swallowing) is different from odynophagia (painful swallowing)
Odynophagia suggests an infectious process, such as HIV, HSV, or Candida.
Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 5674-5675). . Kindle Edition.
Clinical presentation of achalasia
- Young nonsmoker
- Dysphagia to both solids and liquids at the same time
- Regurgitation of food particles
- Aspiration of previously eaten material that is regurgitated and falls into the lungs
Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 5677-5681). . Kindle Edition.
Achalasia:
- Best initial test
- Most accurate test
- Barium swallow
- Esophageal manometer
Endoscopy is not necessary to diagnose achalasia; it is done to exclude malignancy. Manometry would show absence of normal esophageal peristalsis. Achalasia presents with abnormally high pressure at the lower esophageal sphincter, since it involves a failure of the gastroesophageal sphincter to relax. There is no mucosal abnormality.
Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 5685-5687). . Kindle Edition.
Achalasia:
Best initial Rx
** Surgical myotomy**
Pneumatic dilation (if surgical myotomy fails)
Botilinium toxin injection for those who refuse surgery
Clinical presentation of esophageal cancer
- Dysphagia: Solids first, then liquids
- Heme-positive blood or anemia
- Usually, >50years
- Smokers
- Alcohol use
Diagnosis:
- Dysphagia + Weight loss
- Dysphagia + Weight loss + Heme positive stool/anemia
- Esophageal pathology
- Cancer
Esophageal cancer:
Best initial diagnosis
Endoscopy
Rx of esophageal cancer
Surgery + 5-fluorouracil based chemotherapy
Best initial test for esophageal ring or web
Barium study
Rx of seophageal ring/web
- Plummer-Vinson Syndrome
- Schatzki’s ring (peptic stricture)
- Peptic stricture from acid reflux
- Iron replacement
- Pneumatic dilation
- Pneumatic dilation
Clinical features of Zenker’s diverticulum
- Dysphagia
- Horrible bad breath
Zenker’s diverticulum:
- Best initial test
- Best initial Rx
- Barium study
- Surgical resection
To avoid perforation, do not do endoscopy or place an NG tube with Zenker’s diverticulum
True or False:
Diffuse esophageal spasm = Nutcracker esophagus
True
- Most accurate test for esophageal spastic dissorders
- Rx of esophageal spastic disorders
- Manometry
Barium study may show cockscrew pattern but only during episode of spasm
- CCBs and nitrates