Esophageal Disorders

Question 1

What is Dysphagia?

Answer 1

Difficulty swallowing

Question 2

What are the alarm symptoms of Esophageal disorders?

Answer 2

Blood in stool
Anemia
Weightloss

Question 3

What must you do if alarm symptoms are present?

Answer 3

Endoscopy to r/o cancer

Question 4

What is a hiatal hernia?

Answer 4

Protrusion of the upper part of the stomach into the chest

Question 5

What is a hiatal hernia generally caused by?

Answer 5

Obesity weakening the diaphragm

Question 6

How is a hiatal hernia diagnosed?

Answer 6

Endoscopy or barium study

Question 7

What is the best initial treatment for a hiatal hernia?

Answer 7

Weight loss and PPIs

Question 8

What is Achalasia?

Answer 8

The inability of the Lower esophageal sphincter (LES) to relax due to a loss of the nerve plexus within the lower esophagus

causes aperistalsis of the esophageal body

Question 9

How does Achalasia typically present?

Answer 9

Younger patient<50

Progressive dysphagia to both solids and liquids

Question 10

What is the most accurate test to diagnose Achalasia?

Answer 10

Manometry: showing a failure of the LES to relax

Question 11

What are other diagnostic tools that can be used for Achalasia?

Answer 11

Barium Esophagram: birds beak as esophagus comes down to a point

Upper endoscopy: shows normal mucosa

CXR: may show some abnormal widening of the esophagus

Question 12

How is Achalasia Treated?

Answer 12

Mechanical dilation of the esophagus

Question 13

What are the treatment methods for Achalasia?

Answer 13

Pneumatic Dilation

Surgical sectioning or myotomy

Botulinum toxin injection to relax the LES

Question 14

How does Esophageal cancer typically present?

Answer 14

Older pt >50

Dysphagia for solids progressing to dysphagia for liquids

Question 15

What is esophageal cancer associated with?

Answer 15

Prolonged alcohol and tobacco use

Question 16

What is the only way to diagnose esophageal cancer?

Answer 16

Biopsy

Question 17

How do you treat esophageal cancer?

Answer 17

Surgical Resection + chemo and radiation

If non-resectable: stent to keep esophagus open

Question 18

What is an Esophageal Spasm?

Answer 18

Diffuse Esophageal spasm (DES) and Nutcracker Esopahgus

Question 19

How does Esophageal spasm present?

Answer 19

Sudden onset of chest pain unrelated to exertion

Precipitated by cold liquids

Normal EKG and Stress Test

Normal Esophagram and Endoscopy

Question 20

How do you diagnose and distinguish different forms of Esophageal Spasm?

Answer 20

Manometry: shows abnormal contraction for each

Question 21

How do you treat Esophageal Spasms?

Answer 21

CCBs: alternative is TCA: if both fail you use sildenafil

Nitrates

PPI

Question 22

How does Eosinophilic Esophagitis present?

Answer 22

Swallowing difficulty, food impaction and heartburn with a hx of asthma and allergic diseases

Question 23

What is the most accurate test for Eosinophilic Esophagitis?

Answer 23

Biopsy showing eosinophils

Question 24

What is seen on Endoscopy for Eosinophilic Esophagitis?

Answer 24

Multiple Concentric Rings

Question 25

What is the best initial treatment for Eosinophilic Esophagitis?

Answer 25

PPI + elimination of allergenic food If no response: swallow steroid inhalers

Question 26

What pills are associated with causing Esophagitis?

Answer 26

Doxycycline Alendronate Potassium Chloride

Question 27

What treatment do you start in a patient with dysphagia and CD4<100?

Answer 27

Empirical PO Fluconazole

Question 28

If Empiric Fluconazole shows improvement what is your next step?

Answer 28

Continue Fluconazole and add ART

Question 29

If Empiric Fluconazole does not show improvement what is your next step?

Answer 29

Perform Upper endoscopy with biopsy

Question 30

If upper endoscopy with biopsy Shows Large Ulceration what is your most likely diagnosis?

Answer 30

CMV

Question 31

What is your therapy for CMV Esophagitis?

Answer 31

Ganciclovir or Foscarnet

Question 32

If upper endoscopy with biopsy shows Small ulcerations what is your most likely diagnosis?

Answer 32

HSV

Question 33

How do you treat HSV esophagitis?

Answer 33

Acyclovir

Question 34

What is "Steakhouse Syndrome"?

Answer 34

Dysphagia from solid food associated with Schatzki ring

Question 35

What is Schatzki ring often caused by?

Answer 35

Acid Reflux

Question 36

How does Schatzki Ring present?

Answer 36

Associated with Hiatal Hernia: scarring or tightening of the distal esophagus Intermittent Dysphagia

Question 37

What is Plummer-Vinson Syndrome associated with

Answer 37

Iron Deficiency Anemia Located more proximally than Schatzki ring

Question 38

How do you treat Schatzki ring?

Answer 38

Pneumatic Dilation in endoscopic-procedure

Question 39

How do you treat Plummer-vinson syndrome?

Answer 39

Iron replacement first which may resolve the lesion

Question 40

What is a Zenker Diverticulum?

Answer 40

Outpocketing of the posterior pharyngeal constrictor muscles

Question 41

How does a Zenker Diverticulum present?

Answer 41

Dysphagia Severe halitosis and bad smell Regurgitation of food particles Aspiration pneumonia

Question 42

How is Zenker Diverticulum diagnosed?

Answer 42

Barium Study

Question 43

How is Zenker Diverticulum treated?

Answer 43

Surgery

Question 44

What should you avoid in patients with suspected Zenker Diverticulum?

Answer 44

NG tubes and upper endoscopy: they may cause perforation

Question 45

What does Manometry show In Scleroderma?

Answer 45

Decreased LES pressure from inability to close the LES

Question 46

How is Scleroderma Esophageal involvement treated?

Answer 46

PPIs

Question 47

How Does Mallory-weiss tear present?

Answer 47

Upper GI bleed after prolonged or severe vomiting or retching repeated retching followed by hematemesis of bright red blood or black stool

Question 48

How do you treat Mallory-weiss tears?

Answer 48

Resolves spontaneously For severe persistent bleeding: epinephrine injection or electrocautery

Question 49

What is Mallory-weiss tear?

Answer 49

Nonpenetrating tear of only the mucosa

Question 50

What is Boerhaave Syndrome?

Answer 50

Full penetration tear of the esophagus

Question 51

What is a clinical clue for Boerhaave syndrome?

Answer 51

Crepitus on exam