Gastroenterology

Question 1

What is the first test if dysphagia is present with unknown diagnosis?

Answer 1

barium swallow

Question 2

Dx in a young nonsmoking patient who has dysphagia to both solids and liquids

Answer 2

achalasia

Question 3

what is the best initial test and the most accurate test for achalasia?

Answer 3

best initial test = barium swallow or CXR

most accurate test = esophageal manometry (absence of normal peristalsis. there is no mucosal abnormality)

Question 4

treatment for achalasia

Answer 4

pneumatic dilation of the esophageal sphincter or surgical myotomy (severe disease treated with oral endoscopic myotomy or POEM, where upper endoscopy used to reach the surgical site)
botulinum toxin is an option if patient refuses the above

Question 5

treatment for esophageal cancer

Answer 5

surgical resection (if there are no local or distant metastases) followed by 5-FU chemo 
palliative stenting for obstruction

Question 6

presenting symptoms for esophageal cancer

Answer 6

dysphagia: solids first then liquids
possible heme-(+) stool or anemia
often found in patients >50 who smoke and drink alcohol

Question 7

a common association with eosinophilic esophagitis is

Answer 7

atopy (asthma, rhinitis, atopic dermatitis, and alimentary allergies)

Question 8

treatment of eosinophilic esophagitis includes:

Answer 8

PPI’s for 8 weeks
(topical steroids is second line, which are swallowed aerosolized steroids such as fluticasone and budesonide)
dietary elimination
esophageal dilation if narrowing is present from strictures

Question 9

achalasia is defined as:

Answer 9

motility disorder with inadequate relaxation of the lower esophageal sphincter AND nonperistaltic contractions of the distal 2/3 of the esophagus

Question 10

achalasia is most commonly idiopathic, but can be secondary to..

Answer 10

esophageal/stomach cancer, chagas disease, amyloidosis, NF type 1, and sarcoidosis

Question 11

how is esophageal cancer diagnosed?

Answer 11

EGD + biopsy first

then staging with chest/abdominal CT and bronchoscopy

Question 12

best initial test for rings/webs in the esophagus?

Answer 12

barium swallow (most common presenting symptom is dysphagia)

Question 13

treatment of Plummer-Vinson syndrome

Answer 13

(proximal strictures associated with iron deficiency anemia and SCC of the esophagus, sx also include odynophagia, angular cheilitis, and atrophic glossitis)
treatment with iron replacement

Question 14

what is a schatzki ring?

Answer 14

distal ring of the esophagus that presents with intermittent dysphagia

Question 15

what is zencker’s diverticula?

Answer 15

false diverticula at Killian triangle caused by dysmotility (abnormal spasming or impaired relaxation) along with increased intraluminal force that leads to dysphagia, regurgitation of food and halitosis

Question 16

treatment of zenker’s diverticula

Answer 16

(Dx with barium study)

treatment is surgical resection (cricopharyngeal myotomy)

Question 17

what would be the next step in a patient with consistent chest pain with occasional dysphagia that has a normal cardiac workup? (EKG, stress test, etc…) and what is most likely dx?

Answer 17

most likely diffuse esophageal spasm

start with a barium study (though most accurate test is manometry)

Question 18

treatment of diffuse esophageal spasm

Answer 18

CCBs and nitrates (just as you would treat prinzmetal angina)
if CCBs cannot be used, try TCAs