Esophageal Disorders

Question 1

Mallory-Weiss Tear

Answer 1

mucosal layer of distal esophagus (GE junction), usually after V, MAJOR cause of upper GIB

Question 2

Mallory-Weiss Tear RFs

Answer 2

portal HTN

Question 3

Mallory-Weiss Tear S/Ss

Answer 3

middle ages, male, hematemesis, h/o EtOH use

Question 4

Mallory-Weiss Tear WU

Answer 4

EGD = test of choice

Question 5

Mallory-Weiss Tear mgmt/prognosis

Answer 5

most resolve spontaneously, may req inj or thermal coag

risk of rebleed

Question 6

Benign esophageal neoplasms

Answer 6

leiomyoma (smooth muscle, surg resec if sx)
adenoma (glandular, barrett’s)
papilloma (trans to SCC)

Question 7

Malignant esophageal neoplasms epi, S/Ss

Answer 7

males 50-70

solid food dysphagia, wt loss, sx if late stage

Question 8

Types of malignant esophageal neoplasms

Answer 8

SCC (upper 2/3, RF: EtOH, cigs, achalasia, caustic inj, head/neck CA, PV synd, black, male)
Adenocarcinoma (lower 1/3, RF: Barrett’s, white, male)
Lymphoma (rare)

Question 9

Malignant esophageal neoplasm WU

Answer 9

CXR (mediastinal wide, lung/bony mets)
barium swallow (many infiltrative/ulcerative lesions/strictures)
chest CT
endoscopic US (staging)

Question 10

Malignant esophageal neoplasm mgmt

Answer 10

surgical resection
palliative radiation or stenting
chemo

Question 11

medication-induced esophagitis

Answer 11

• tetracyclines, anti-inflams, KCl, quinidine, alendronate (Fosamax)
• sudden onset odynophagia, retrosternal pain s/p pill
• WU w/ EGD or barium swallow if sev/atypical sx
• mose heal w/o tx in few days

Question 12

eosinophilic esophagitis

Answer 12

• heartburn unresponsive to meds, h/o allergies/atopy, V, abd pain, dysphagia
• EGD w/ bx
• ref to allergy, elim diet, acid suppression, topical glucocorticoids (swallowed fluticasone), esophageal dil PRN, rpt EGD for sx change

Question 13

GERD causes

Answer 13

LES relax, hypotensive LES, hiatal hernia

Question 14

GERD s/s

Answer 14

heartburn, regurg, dysphagia, chronic cough, hoarseness

Question 15

GERD ddx

Answer 15

inf esophagitis, pill esophagitis, eosinophilic, PUD, non-ulcer dyspepsia, biliary tract dz, cholelithiasis, CAD, esophageal motility d/o

Question 16

GERD WU

Answer 16

• EGD w/ bx for alarm sx (dysphag, odynophag, wt loss, Fe def anemia), sx refract to PPI trial, new onset sx in pt > 50 or sx > 10 yrs
• amb pH monitor for neg EGD w/ persistent sx
• esophageal manometry if suspect dysmotility d/o

Question 17

GERD mgmt

Answer 17

• lifestyle mods
• change tx prn q 2-4 wks, maintain optimal tx x 8 wks (if sx return w/in 3 mos, need cont tx)
• meds by potency: OTC antacids/H2 blockers, rx H2 blockers BID (30 min to work), PPI x 2 wks, 20 mg omep qd, 20 mg omep BID, 40 mg omep qd
• Nissen fundoplication = last resort
• EGD q 3 yrs if Barrett’s

Question 18

Other types of esophagitis (think immunocomp’d)

Answer 18

HSV, CMV, Candida

Question 19

Esophageal motility disorders (4)

Answer 19

achalasia
diffuse esophageal spasm
scleroderma esophagus
esophageal strictures

Question 20

achalasia eti

Answer 20

• absence of nml peristalsis w/ inc tone of LES
• Chagas’ dz (inf by protozoan parasite (Trypanosoma cruzi) = acute inflam skin changes (chagomas) and poss inf/inflam of heart and GI tract)

Question 21

achalasia s/s

Answer 21

sx x mos-yrs, gradual/prog dysphagia, regurg, substernal discomfort/fullness s/p eating

Question 22

achalasia WU

Answer 22

• manometry = GOLD STANDARD
• CXR (enlarge, fluid-filled)
• barium swallow (bird’s beak)
• EGD for other eti

Question 23

achalasia mgmt

Answer 23

• smooth muscle relax (CCB, nitrates)
• balloon dil of LES (high perf rate)
• surgical myotomy
• botox inj to relax LES

Question 24

Diffuse esophageal spasm (what & s/s)

Answer 24

• simultaneous, nonperistaltic contractions

- intermittent dysphagia, anterior CP (nonexterional/rel to eating), worse w/ stress, large food bolus, hot/cold liqs

Question 25

diffuse esophageal spasm (wu & mgmt)

Answer 25

- barium swallow (corkscrew, rosary bead), manometry (intermittent/simultaneous contractions of high amplitude unrelated to eating/nml peristalsis) - self-limited

Question 26

scleroderma esophagus

Answer 26

- atrophy & fibrosis of smooth muscle - loss of LES competence, decreased peristalsis, dec gastric empty - can occur w/ prog systemic sclerosis, Raynaud's, CREST (calcinosis, Raynaud's phenomenon, esophageal dysmotility, sclerodactyly, and telangiectasia)

Question 27

scleroderma esophagus (s/s, wu)

Answer 27

- sev acid reflux, stricturs, erosions, heartburn, dysphagia | - manometry (diminished peristalsis w/ low pressures, relaxed LES), barium swallow (dilated, flaccid esophagus)

Question 28

esophageal strictures causes

Answer 28

-GERD, hiatal hernia, radiation, h/o esophageal sclerotherapy, surgical anastomosis, rare derm dz, TB

Question 29

esophageal strictures S/S

Answer 29

pyrosis (heartburn), bitter/acidic taste in mouth, choking, coughing, SOB, freq belching/hiccups, hematemesis, wt loss

Question 30

esophageal strictures wu/mgmt

Answer 30

- barium swallow or EGD | - tx underlying condition, mech dilation, PPI to avoid prog, intralesional steroid inj for refract strictures

Question 31

Esophageal varices eti/RF/prev

Answer 31

- dilated submucosal veins in lower esophagus - portal vein thrombosis, liver dz - diagnotic EGD to screen in cirrhosis pts (based on Child-Pugh score = prog scale for liver dz, like MELD) - may need ppx BB or ligation

Question 32

esophageal varices s/s, WU

Answer 32

- sx of cirrhosis & portal HTN, if ruptured: hematemesis, melena, hematochezia, dizziness - labs (reflect liver dz: high LFT/bili/coags, low albumin/cholesterol), EGD = TEST OF CHOICE 4 DX

Question 33

esophageal varices mgmt, prog

Answer 33

- octreotide (or vasopressin + NTG) to dec portal vein inflow, endoscopic therapy = TX OF CHOICE (sclerotherapy, band lig) - TIPS if this fails, pRBC for hemorrhage prn - bleeding limited 50% of time, if not - inc mort

Question 34

GERD comps

Answer 34

Barrett's (10%), asthma, laryngitis, chronic cough