Clinical 1 Flashcards
(33 cards)
What test is done if exacerbated esophageal herpes simplex is suspected?
Vesicle barium swallow radiograph
What will be present in exacerbated herpes simplex patients in their esophagus?
Cowdry body associated with viral odynophagia
Patient has buringin with swallowing, uses an inhaler, immunosuppressed.
odynophagia secondary to candida infection (opportunisitic)
Describe “steakhouse syndrome”
meat/food bolus gets caught trying to pass through shatzkis ring/ talking and eating at the same time, item too large and causes spasm of distal esophagus “characteristic over salivation:
Where is the junction of squamous epithelium and columnar epithelium found in the esophagus
shatzkis ring “B ring”
What should you suspect if an anemic female patient comes in with dysphagia?
Plummer vinson syndrome
formation of another ring just below the pharynx cauases teh symptoms
What can an exacerbation of CMV cause?
Ulceration of the esophageal wall.
Smooth benign tumor found in the esophageal wall?
Lyomyoma
Likely cause of esophageal stricture?
Usally an ulceration like this is caused by taking pills without water, or not enough water
What is the common etiology of boerhavve syndrome?
usualy in acute wretching episodes casuing a rupture of the esophageal wall, and subsequent effusion of the surrounding tissues/organs.
Surgical emergency
what is a mallory-weiss tear?
Mucosal lacerations at the gastroesophageal junction due to vomiting, seen commonly in alcoholics/bulimics.
What is the cause of achalasia?
degeneration of dorsal motor functions or degeneration of vagal nerve fibers, also possibly ganglion cells within esophageal wall.
Describe the CCK octapeptide test?
In normal patients CCK will cause relaxation of the LES due to neural inhibition overcoming CCKs signal to constrict.
In achalasia patients, CCK will go unchecked by neural impulse, causing an acutal increase in constriction at the LES
Describe the common radiographic finding in achalasia patients.
Bird’s beak sign. on barium swallow… shows no relaxation of the LES
Treatments for achalasia
Nitrates
Ca++ channel blockers
Botox injections
Surgery (dilations/myotomy)
In scleroderma patients what is a common complication/
Vascular obliteration causes fibrosis of the smooth muscles in teh LES causing weakness, poor gastric emptying
How does one diagnose Eosinophilic Esophagitis?
Need 4 biopsies from 2 separate areas, need endoscopic confirmation w/ >15eosinophils/hpf, 8 Week trial of PPIs before dx can be valid
Adults: food impaction
Children: failure to thrive
What are the endoscopic features of EoE/
Mucous Pallor Furrows Exudates Stricture Fixed Rings (trachealization)
What are teh treatment options for patients with EoE
Steroids (Fluticasone, Budesonide) PO
Refractory patients receive systemic steroids.
Endoscopic Reassessment
How are patients with EoE treated if they don’t respond to steroid treatment?
Dietary approach
Test for food allergies
Discuss the various esophageal motility disorders.
Diffuse esophageal spasm
Nutcracker esophagus
Hypertensive LES (achalasia?)
Nonspecific disorders
sx/chest pain, dysphagia
What is the most common non-cardiac esophageal cause of chest pain?
Nutcracker esophagus disorder
What are common tests used to look at non-cardiac chest pain associated with the esophagus?
Acid perfusion (Bernstein test)
Endrophonium (Tensilon test)
Balloon Distention Test
What is the most common gastrointestinal disease?
GERD
