SG Esophagus

Question 1

3 possible causes of GERD

Answer 1

1. Inappropriate transient lower esophageal relaxations
2. Floppy LES
3. Hiatal hernia

Question 2

Why do GERD pts get dysphagia?

Answer 2

Inflammation // erosive esophagitis
Ineffective esophageal motility
Less likely: peptic stricture, cancer

Question 3

Study for:

• Dysphagia
• Eval esophageal mucosa

Answer 3

Barium CXR

Endoscopy

Question 4

Mechanical or motor: dysphagia to solids and liquids

Answer 4

MOTOR

Question 5

Motor problem w/ dysphagia - what is the disease

Answer 5

Achalasia

• Dysphagia
• Regurg

Question 6

Achalasia patho

Answer 6

Lose inhibitory motor neurons in LES and neuronal drop out in body of esophagus
Net: hypertensive LES + aperistalsis body of esophagus

Question 7

Barium swallow results for achalasia

Answer 7

Bird’s beak w/ dilated esophagus behind it`

Question 8

Why perform endoscopy for achalasia

Answer 8

R/o pseudoachalasia
Small, infiltrating distal esophageal cancer or proximal gastric cancer can infiltrate the neuronal plexus of the LES
Mimics achalasia

Question 9

3 ways to treat achalasia

Answer 9

1. Smooth muscle relaxants - Ca CB
2. BoTox injection into LES
3. Balloon dilation or cut LES

Question 10

Treat nutcracker esophagus

Answer 10

1. Reassurance
2. SM relaxants - dysmotility
3. Pyschotropic agents - hypersensitivity

Question 11

Cancer vs peptic stricture on barium swallow

Answer 11

Cancer = irregular narrowing
Peptic = smooth, tapered narrowing of distal esophagus