31. Esophageal pathologies Flashcards Preview

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Flashcards in 31. Esophageal pathologies Deck (37):
1

Trypanosoma cruzi - disease and symptoms, transmission, diagnosis , tx

Chagas disease : 1 . dilated cardiomyopathy with apical atrophy
2. megalocolon
3. megaesophagus
ROMANA SIGN : unilateral periorbital swelling
REduviid bug ( kissing bug ) feces , deposited in a painless bite
diagnosis : Blood smear
tx: Benzidazole or nifurtimox

2

Boerhaave syndrome - definition / treatment

transmural usually distal esophageal rupture with pneumodiastinum
tx : surgical emergency

3

Boerhaave syndrome - due to / MC location

violent retching
MC loation : distal esophagus

4

causes of esophageal strictures

1. caustic ingestion
2. acid reflux

5

Eosinophilic esophagitis

infiltration of eosinophils in the esophagus often in atopic patients

6

Eosinophilic esophagitis - manifestation / endoscopy

food allerfens --> dysphagia, food impaction

7

Eosinophilic esophagitis - endoscopy

esophageal rings and linear furrows often on endoscopy

8

Eosinophilic esophagitis unresponsive to

GERD therapy

9

esophageal varices ( definition, secondary to ...., coomon in ...)

dilated submucosal veins in lower 1/3 of esophagus 2ry to portal hypertension. Common in cirrhotics

10

esophageal varice - complication

may be source of life threatening hematemesis ( PAINLESS HEMATEMESIS)

11

causes of esophagitis

1. reflux
2. infenction in immunocompromised ( Candida, HSV-1 CMV)
3. Caustic ingestion
4 . medication

12

causes of infectious esophagitis ( and apperance)

Candida, CMV , HSV-1 in immunocompromised
HSV-1 --> puched out ulcers
CMV---> linear ulcers
Candida --> white pseudomembrane

13

Gastroesophageal reflux - presentation

1. heartburn
2 regurgitation
3. dysphagia
4. chronic cough
5. hoarseness

14

Gastroesophageal reflux - hoarseness , chronic cough - mechanism

laryngopharyngeal reflux (stomach acid up into throat)

15

Gastroesophageal reflux - usually associated with

asthma

16

Mallory- Weis syndrome ( definition and presentation)

Mucosal lacerations at the gastroesophageal junction due to severe vomiting ---> hematemesis that can be painful

17

Mallory- Weis syndrome - usually found in

1. alcoholics
2. bulimics

18

Plummer vision syndrome - manifestation

Triad of 1. dysphagia 2. iron def anemia 3 esophageal web. May be associated with glossitis

19

Plummer vision syndrome- increased risk for

esophageal SCC

20

esophageal web - definition , location, presentation

protrusion of esophagus mucosa, most often in the upper esophagus, dysphagia for poorly chewed food

21

Screloderma esophageal dysmolity - is a part of

CREST

22

Screloderma esophageal dysmolity - mechanism and presetation

esophageal muscle atrophy ---> decreased lowe esophageal sphincter and dysmotility ---. acid reflux , dysphagia ---> stricture , Barret esophagus, aspiration

23

Zenker diverticulum - defintion and location

outpouching of pharyngeal mucosa through an acquired defect in muscular wall ( false diverticulum ) ---> arises above the upper esophageal sphincter at esophagus - pharynx junction

24

Sialednitis - inflammation / due to

salivary gland inflammation ---> obstructing stone ( sialolithiasis ---> S.aureus infenction ( unilateral )

25

• What is the underlying pathophysiology of dysphagia associated with CREST?

Esophageal dysmotility (poor peristalsis) and low esophageal pressure proximal to the lower esophageal sphincter

26

• A man has dysphagia. Work-up shows esophageal smooth muscle atrophy, poor peristalsis, low LES pressure, reflux, and a stricture. Diagnosis?

Sclerodermal esophageal dysmotility (part of CREST syndrome)

27

• A man complains of dry cough and chest pain not associated with activity and worse when supine. If not treated, he is at risk for what?

Barrett esophagus (a complication of GERD)

28

• A man has increasing asthma frequency, as well as nocturnal cough and mild chest discomfort before falling asleep. What might you prescribe?

Proton pump inhibitor or H2 receptor blocker (GERD can cause adult-onset asthma, and nocturnal cough and dyspnea are common)

29

• A 45-year-old woman comes to the ED with vomiting. Her vomitus becomes bloody and painful. What is the cause of her hematemesis?

Mallory-Weiss tears, which often result from vomiting associated with alcoholics and bulimics (cause painful bleeding)

30

• Ingestion of what compound classically causes esophageal strictures?

Lye (strictures are also seen with gastroesophageal reflux disease)

31

• Esophagitis is commonly caused along with what three etiologies?

Reflux, infection, and chemical ingestion

32

• Which of these infectious agents is least likely to be associated with esophagitis: HSV-1, cytomegalovirus, Candida, Helicobacter pylori?

H. pylori (this bacterium is associated with peptic ulcer disease but rarely with esophagitis)

33

• Esophagitis associated with HSV-1 shows ____ ulcers on endoscopy, whereas esophagitis associated with cytomegalovirus shows ____ ulcers.

Punched-out; linear

34

• Endoscopy performed on a patient with esophagitis shows white pseudomembranes. Is the patient immunocompromised?

Yes, as this is Candida esophagitis, which often occurs in immunocompromised patients

35

• Plummer-Vinson syndrome has what symptom triad?

Dysphagia due to esophageal webs, Iron deficiency anemia, and Esophageal webs (plumbers DIE)

36

• A patient has a food allergy that causes dysphagia, heartburn, and strictures. Does it respond to GERD therapy?

No, as this is eosinophilic esophagitis, which does not respond to typical GERD therapies

37

• A patient with numerous allergies and GERD unresponsive to therapy has an esophageal biopsy. What is it likely to show?

Eosinophilic infiltration (this is eosinophilic esophagitis, common in patients with atopy)

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