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Gastro Review > Esophagus@ > Flashcards

Esophagus@ Flashcards

1
Q

Name the steps of the belch.

A
  1. Gastric distention –> TLESR
  2. Cessation of phasic resp contraction of diaphragm
  3. Esoph long muscle contracts and pulls LES proximally
  4. Circular muscle relaxes
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2
Q

T/F: H pylori tx leads to inc need for PPI higher dose.

A

False

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3
Q

T/F: HP tx can lead to new onset reflux sxs.

A

False

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4
Q

T/F: If pt w reflux sxs & HP +, tx of sxs easier if do not tx HP

A

True

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5
Q

Barretts RFs

A

White, male, older age, prolonged reflux, erosive esoph on EGD

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6
Q

Which type of achalasia best responds to pneumatic dilation?

A

T2 - pan esophageal pressurization, 100% fx swallows

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7
Q

MC mechanism of GERD after meals?

A

TLESR

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8
Q

Which type of pt benefits most from Nissen?

A

Typical reflux sxs, good PPI response

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9
Q

What are some comorbidities/sxs that decrease chance of response to Nissen?

A

Psych DO, obesity, poorly defined sxs

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10
Q

T/F: H&N rads inc risk of erosive esophagitis on EGD?

A

True

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11
Q

Adjunct to PPI for reflux

A

Baclofen - inhibits TLESR

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12
Q

T/F: MCTD can have similar GI findings like poor clearance as scleroderma 2/2 smooth muscle atrophy and fibrosis.

A

True

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13
Q

When should pH monitoring ON PPI be considered?

A

When dx with reflux already and want to test PPI response

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14
Q

T/F: Acute radiation injury to the esophagus is dose based and can be augmented with chemotx.

A

True

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15
Q

Name the yearly CA risk in pts with Barretts and no to high dysplasia.

A

None - 0.5% over gen pop
HGD - 6%/yr
LGD - risk of prog to CA or HGD 0.5-13%/yr

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16
Q

T/F: Histo is better than EUS for Barretts nodule and so EUS not needed prior to EMR.

A

True

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17
Q

What are the criteria for type III achalasia?

A

Mean IRP > 15 mmHg

>20% premature contractions, no normal peristalsis

18
Q

What are criteria for DES?

A 
Normal IRP ( < 15)
>20% premature contractions, DL < 4.5s, will have some normal peristalsis
19
Q

What will you see on manometry from lap band surgery?

A

Can see pseudoachalasia - High IRP, > 20% premature contractions due to shortened esophagus

20
Q

If pt with EOE on steroids gets odynophagia and evidence of candida, what should be done?

A

Empiric trial of fluticasone, do not stop steroid

21
Q

What do you see in hypercontractile esophagus?

A

Normal IRP
normal peristalsis
normal DL
DCI > 5000 but < 9000

22
Q

How does jackhammer esoph differ from hypercontractile?

A

JH DCI > 9000

HC DCI 5-9000

23
Q

Name the steps of physiologic belch

A

Gastric distention –> TLESR –> cessation of diaphragm contraction, esoph long muscle contraction & circ muscle relaxation

24
Q

T/F: If body HP+ and have reflux, response to tx is better if HP is NOT treated.

A

True

25
Q

T/F: Pts with Barretts esophagus tend to feel reflux events less.

A

True

26
Q

Name a condition that increases likelihood of erosive esophagitis in a patient.

A

Previous H&N rads - less saliva made and so less barrier protection

27
Q

If persisting regurg even though on PPI, which med should be considered.

A

Baclofen

28
Q

Which obesity surgery can improve reflux?

A

REY

29
Q

T/F: Inlet patch can be AW globus and endoscopic ablation can help with sxs.

A

True - inlet patch can secrete acid and cause sxs for pts

30
Q

How to diff inlet patch from Barretts?

A

Inlet patch has NO goblet cells on bx, Barretts does

31
Q

T/F: Radiation induced esophagitis is worse if rads+chemo is used instead of just rads.

A

True

32
Q

T/F: With EOE should do dilation at the time of starting swallowed budesonide in pts without full response to PPI?

A

False - do dilation only after failing PPI and steroid swallowed

33
Q

Barretts follow up if NO dysplasia found in how many years?

A

3-5 yrs

34
Q

What is best initial mgmt of achalasia type II?

A

Pneumatic dilation or myotomy

35
Q

What are diagnostic criteria of type III Achalasia? Criteria of DES?

A

T3A - Mean IRP > 15, >20% premature contractions, DCI > 450, DL < 4.5s
DES - Nl IRP, > 20% premature contractions, DL < 4.5s

36
Q

T/F: You can get pseudoachalasia from lap band.

A

True

37
Q

Which should be done? Pt on steroid inhaler and with candida and odynophagia - tx with fluc or just stop inhaler?

A

Treat with fluc

38
Q

When see OP candida and pt with dysphagia/odynophagia - should just tx or scope then tx?

A

Just tx if can see candida

39
Q

Diagnostic criteria for hypercontractile esophagus?

A

Nl IRP, peristalsis, DL

DCI between 5000 and 9000

40
Q

How to tx hypercontractile esophagus?

A

SNRI or SSRI

41
Q

Esophagus whitish spots and odynophagia - what to think of first?

A

Candida more common than EOE

Gastro Review (15 decks)

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