SM_137b: Clinical Features of GI Disorders

Question 1

Describe esophageal anatomy

Answer 1

Esophageal anatomy

Question 2

____ is discomfort / burning sensation behind the sternum

Answer 2

Heartburn is discomfort / burning sensation behind the sternum

(most common esophageal symptom)

Question 3

____ is effortless return of food or fluid into the pharynx without nausea or retching

Answer 3

Regurgitation is effortless return of food or fluid into the pharynx without nausea or retching

Question 4

____ is a feeling of food sticking / lodging in chest

Answer 4

Dysphagia is a feeling of food sticking / lodging in chest

Question 5

____ is pain caused / exacerbated by swallowing

Answer 5

Odynophagia is pain caused / exacerbated by swallowing

Question 6

____ is perception of a lump or fullness in the throat, felt even without swallowing

Answer 6

Globus is perception of a lump or fullness in the throat, felt even without swallowing

Question 7

____ is excessive salivation and a compensatory response to reflux

Answer 7

Water brash is excessive salivation and a compensatory response to reflux

Question 8

Describe transit related esophageal symptoms

Answer 8

Transit related esophageal symptoms

• Antegrade: food impaction, dysphagia
• Retrograde: regurgitation, aspiration

Question 9

Perception related esophageal symptoms include ____ caused by ____ and ____

Answer 9

Perception related esophageal symptoms include discomfort caused by chest pain / pressure and heartburn

Question 10

Structural abnormalities of esophagus often present with ____ and are diagnosed using ____

Answer 10

Structural abnormalities often present with dysphagia and are diagnosed with endoscopy

Question 11

Propulsive disorders of esophagus usually present as ____ and are diagnosed with ____

Answer 11

Propulsive disorders of esophagus usually present as dysphagia for solids / liquids / GERD and are diagnosed with functional esophageal tests

Question 12

Describe sensory abnormality etiology of esophageal symptoms

Answer 12

Sensory abnormality etiology of esophageal symptoms

• EGD negative
• Functional
• Nonspecific EMD
• Psychological

Question 13

____ is herniation of the viscera stomach into the mediastinum through the esophageal hiatus of the diaphragm

Answer 13

Hiatal hernia is herniation of the viscera stomach into the mediastinum through the esophageal hiatus of the diaphragm

Question 14

Type 1 hiatal hernia is a ____ and predisposes to ____

Answer 14

Type 1 hiatal hernia is a sliding hernia and predisposes to reflux

(95%)

Question 15

In Type 2,3, and 4 subtypes of paraesophageal hernia, herniation may also include ____

Answer 15

In Type 2,3, and 4 subtypes of paraesophageal hernia, herniation may also include visceral structural than gastric cardia

Question 16

Schatzki ring is ____

Answer 16

Schatzki ring is a lower esophageal mucosal ring

• Dysphagia when diameter < 13 mm
• Usually age > 40
• Some asymptomatic
• Treated with esophageal dilation

Question 17

____ is an esophageal web higher in the esophagus

Answer 17

Cervical web is an esophageal web higher in the esophagus

• Circumferential webs -> intermittent dysphagia
• Treated with dilation

Question 18

Plummer-Vinson syndrome occurs in ____ and presents with ____ and ____

Answer 18

Plummer-Vinson syndrome occurs in middle-aged females and presents with cervical web and iron deficiency

Question 19

Zenker’s diverticulum is ____ and ____

Answer 19

Zenker’s diverticulum is a sac-like outpoching of the mucosa and submucosa through Killian’s triangle and an area of weakness between transverse fibers of the cricopharyngeus and oblique fibers of the lower inferior constrictor

Question 20

Zenker’s diverticulum presents with ____, ____, ____, ____, and ____

Answer 20

Zenker’s diverticulum presents with pulmonary aspiration, halitosis, regurgitation, neck fullness, and gurgling in the throat

Question 21

____ diverticulum occurs in the midportion of the esophagus and presents with regurgitation and dysphagia

Answer 21

Traction diverticulum occurs in the midportion of the esophagus and presents with regurgitation and dysphagia

Question 22

Epiphrenic diverticulum occurs above ____, is usually associated with ____, and presents with ____ and ____

Answer 22

Epiphrenic diverticulum occurs above the lower esophageal sphincter, is usually associated with motility disorders like achalasia, and presents with regurgitation and dysphagia

Question 23

Endoscopic findings of GERD include ____ and ____

Answer 23

Endoscopic findings of GERD include erythema and erosions

Question 24

Describe pathophysiology of GERD

Answer 24

GERD pathophysiology

• Transient lower esophageal sphincter relaxations
• Lower esophageal sphincter hypotension
• Anatomic distortion of the esophagogastric junction
• Impaired salivation
• Impaired peristaltic emptying

Question 25

Describe factors that worsen GERD

Answer 25

Factors that worsen GERD * Obesity * Pregnancy * Gastric hypersecretory states * Delayed gastric emptying * Disruption of esophageal peristalsis * Overeating -\> gastric distension

Question 26

GERD can be \_\_\_\_, \_\_\_\_, or \_\_\_\_

Answer 26

GERD can be non-erosive GERD, extra-esophageal GERD, or esophagitis

Question 27

Describe GERD histology

Answer 27

GERD histology

Question 28

Barrett's esophagus is when \_\_\_\_

Answer 28

Barrett's esophagus is when metaplastic columnar epithelium that predisposes to cancer development replaces the stratified squamous epithelium that normally lines the distal esophagus

Question 29

Treatment for non-erosive GERD includes ____ such as ____ or \_\_\_\_

Answer 29

Treatment for non-erosive GERD includes pharmacotherapy to decrease acid secretion such as PPI or H2RA blcockers

Question 30

Treatment for GERD esophagitis includes \_\_\_\_, \_\_\_\_, \_\_\_\_, and \_\_\_\_

Answer 30

Treatment for GERD esophagitis includes weight reduction, avoidance of foods, and eating modification (lifestyle modification)

Question 31

Treatment for extra-esophageal GERD is \_\_\_\_

Answer 31

Treatment for extra-esophageal GERD is surgery

Question 32

Reflux testing includes ____ or \_\_\_\_

Answer 32

Reflux testing includes ambulatory 24-48h esophageal pH recording or intraluminal impedance * Intraluminal impedance: detects any reflux events, both acid and non-acid

Question 33

Eosinophilic esophagitis is ____ with symptoms related to \_\_\_\_

Answer 33

Eosinophilic esophagitis is a chronic immune-mediated food-antigen driven disease with symptoms related to esophageal dysfunction * ≥1 biopsy specimens must show eosinophil-predominant inflammation * Isolated to esophagus

Question 34

Eosinophilic esophagitis endoscopy findings include \_\_\_\_, \_\_\_\_, \_\_\_\_, and \_\_\_\_

Answer 34

Eosinophilic esophagitis endoscopy findings include rings, furrows, exudates, and food impaction

Question 35

Gold standard for eosinophilic esophagitis is \_\_\_\_

Answer 35

Gold standard for eosinophilic esophagitis is esophageal biopsy * Superficial layering * Eosinophilic microabscess * Spongiosis * Epithelial hyperplasia * Degranulation * Lamina propria fibrosis

Question 36

Treatment for eosinophilic esophagitis are \_\_\_\_, \_\_\_\_, and \_\_\_\_

Answer 36

Treatment for eosinophilic esophagitis are drugs, diet, and dilation * Medical therapy: swallowed topical steroids, swallowed viscous budesonide * Dietary therapy: empiric elimination / six food elimination diet * Endoscopic therapy: esophageal dilation

Question 37

Suspect ____ in adults with dysphagia and diagnosis requires esopagogastroduodenoscopy and biopsy

Answer 37

Suspect eosinophilic esophagitis in adults with dysphagia and diagnosis requires esopagogastroduodenoscopy and biopsy * Complications: food impaction, strictures, and perforation

Question 38

\_\_\_\_ presents with odynophagia and dysphagia and involves white plaques on the esophagus

Answer 38

Candidal esophagitis presents with odynophagia and dysphagia and involves white plaques on the esophagus * Treat with oral fluconazole x 14 days

Question 39

Herpetic esophagitis is caused by HSV-1 or HSV-2 and involves \_\_\_\_

Answer 39

Herpetic esophagitis is caused by HSV-1 or HSV-2 and involves punched out ulcerations on the esophagus * Treatment: self-limited, acyclovir or valcyclovir if needed

Question 40

CMV occurs in ____ patients and involves \_\_\_\_

Answer 40

CMV occurs in immunocompromised patients and involves serpiginous ulcerations Treatment: ganciclovir

Question 41

Pill esophagitis occurs when a swallowed pill lodges in the ____ and presents with ____ or \_\_\_\_

Answer 41

Pill esophagitis occurs when a swallowed pill lodges in the esophagus and presents with sudden onset chest pain or odynophagia