Oral/Esophageal Disorders

Question 1

What is a hiatal hernia?

Answer 1

Part of the stomach pushes through the diaphragm into the esophagus, especially with increased abdominal pressure.

Question 2

What is the #1 Risk factor for Hiatal Hernia

Answer 2

Barrett’s esophagus

Question 3

What is Barrett’s esophagus?

Answer 3

Damage to the esophagus from untreated GERD; it’s the #1 risk factor for hiatal hernia.

Question 4

What are the other risk factors for a hiatal hernia?

Answer 4

pregnancy, obesity, low fiber diet, untreated constipation, and smoking.

Question 5

What are symptoms of a hiatal hernia?

Answer 5

dysphagia, fullness, SOB, acid reflux, heartburn, and epigastric pain.

Question 6

Is hiatal hernia symptomatic or asymptomatic?

Answer 6

asymptomatic in the beginning but as time goes on the esophagus wears and tears

Question 7

What diagnostic tests are used for hiatal hernia?

Answer 7

A: EGD, Barium Swallow Test, abdominal X-ray, and endoscopy.

Question 8

What is an EGD?

Answer 8

Esophagogastroduodenoscopy—looks at the inner lining of the esophagus, stomach, and upper small intestine.

Question 9

Q: What do PPIs like Protonix (-zole) do?

Answer 9

Decrease stomach acid production by blocking the proton pump to allow the stomach lining to heal.

Question 10

What do H2 receptor antagonists (like Pepcid/Zantac -dine) do?

Answer 10

Decrease gastric acid production; take 30 minutes before eating.

Question 11

What do antacids like Maalox, Mylanta, and Tums do?

Answer 11

Provide temporary relief by neutralizing stomach acid.

Question 12

What does the prokinetic agent Reglan (end in
- pramide) do?

Answer 12

Increases gastric emptying

Question 13

What complication can chronic erosions from hiatal hernia cause?

Answer 13

Iron deficiency anemia from chronic blood loss due to ulcerations in gastric folds.

Question 14

What is intussusception?

Answer 14

A condition where part of the intestine telescopes into another part, causing obstruction.

Question 15

What is supradiaphragmatic volvulus?

Answer 15

A 180°+ twist of the stomach above the diaphragm, blocking food and blood flow, risking necrosis/perforation.

Question 16

When should volvulus be suspected?

Answer 16

If a patient is vomiting and not responding to medications.

Question 17

What is Nissen fundoplication?

Answer 17

Surgery for Type 2 hernia/GERD that tightens the LES to prevent reflux.

Question 18

What should patients with hiatal hernia avoid?

Answer 18

Tight clothes, straining/lifting, lying down right after eating, chocolate, peppermint, caffeine, tobacco, and meds that relax LES (like CCBs, anticholinergics).

Question 19

Why should the HOB be elevated in a patient with a hiatal hernia?

Answer 19

Elevate the HOB 30–45 degrees because laying flat increases abdominal pressure.

Question 20

What is the best position for a patient with a hiatal hernia to promote gastric emptying?

Answer 20

Supine on the right side because it promotes gastric emptying, peristalsis, and uses gravity to send acid reflux back to the stomach.

Question 21

What is esophageal cancer and how does it spread?

Answer 21

It’s a rapidly growing cancer that spreads quickly into surrounding lymph nodes.

Question 22

Why is esophageal cancer often diagnosed late?

Answer 22

Because patients are often asymptomatic until the cancer has progressed

Question 23

What are symptoms of progressed esophageal cancer?

Answer 23

Progressive dysphagia, chest burning, bloody sputum, and weight loss

Question 24

What is the #1 risk factor for esophageal cancer?

Answer 24

Untreated GERD.

Question 25

What is Barrett’s esophagus and how is it related?

Answer 25

A condition where normal esophageal cells are replaced with columnar cells due to chronic acid exposure, increasing cancer risk.

Question 26

How does achalasia increase risk?

Answer 26

It causes impaired esophageal motility, leading to food retention and irritation.

Question 27

What is the standard diagnostic test for high-risk esophageal cancer patients?

Answer 27

Endoscopy.

Question 28

What is an esophagectomy?

Answer 28

Surgical removal of the esophagus; often done when the cancer is localized.

Question 29

What is a major complication after esophagectomy?

Answer 29

Dumping syndrome and short gut syndrome

Question 30

What are common symptoms of dumping syndrome?

Answer 30

Tachycardia, dizziness, hypotension, nausea after meals.

Question 31

What is the recommended diet after esophagectomy?

Answer 31

6–8 small, frequent meals that are high in protein and low in sugar.

Question 32

What labs should be monitored post-esophagectomy?

Answer 32

Protein/Albumin: For nutritional status Liver function tests: If metastasis is suspected H&H: To monitor for bleeding Calcium: Hypercalcemia can indicate bone metastasis

Question 33

Why is the NG tube important after surgery?

Answer 33

It rests the bowel; oral intake is delayed until bowel sounds return.

Question 34

What is a major cause of spontaneous esophageal rupture?

Answer 34

Alcoholism (due to esophageal varices).

Question 35

What are diagnostic tools for esophageal trauma?

Answer 35

Chest X-ray, CT scan, and esophagography.

Question 36

What is the priority concern in esophageal trauma?

Answer 36

Swelling, edema, and airway obstruction.

Question 37

What precautions should be taken?

Answer 37

Aspiration precautions and monitoring for bleeding.

Question 38

Why are broad-spectrum antibiotics given for esophageal trauma?

Answer 38

To prevent or treat infection due to tissue injury or rupture.

Question 39

Why are high-dose corticosteroids used in esophageal trauma?

Answer 39

To reduce inflammation and swelling that could compromise the airway.

Question 40

What is the purpose of giving opioid or non-opioid analgesics in esophageal trauma?

Answer 40

To manage pain caused by tissue damage or surgical interventions.

Question 41

Why are topical analgesics used for esophageal trauma?

Answer 41

To provide localized pain relief to the esophageal mucosa.

Question 42

: What is the role of glucagon in esophageal trauma?

Answer 42

It relaxes the esophagus and helps the object move down.

Question 43

What is an anastomosis leak in esophageal trauma?

Answer 43

A leak at the surgical connection site due to poor sealing, which can cause infection or sepsis

Question 44

What is a serious infection risk following esophageal trauma?

Answer 44

Abscess formation in the surrounding tissue.

Question 45

What does subcutaneous emphysema indicate in esophageal trauma?

Answer 45

Air has leaked into subcutaneous tissue, often from esophageal rupture.

Question 46

Why is hemorrhage a risk in esophageal trauma?

Answer 46

The esophagus has a rich blood supply and trauma can rupture vessels, leading to bleeding

Question 47

What causes aspiration pneumonia in esophageal trauma?

Answer 47

Stomach contents entering the lungs due to impaired swallowing or rupture.

Question 48

How does sepsis develop from esophageal trauma?

Answer 48

When infection spreads systemically from a ruptured esophagus or abscess.

Question 49

What respiratory complication may arise in esophageal trauma?

Answer 49

: Respiratory impairment due to swelling, aspiration, or pneumothorax.

Question 50

Why is shock a concern in esophageal trauma?

Answer 50

Due to severe bleeding, infection, or sepsis, leading to poor perfusion and low blood pressure.

Question 51

How can pneumothorax result from esophageal trauma?

Answer 51

Damage to the esophagus can let air leak into the pleural space, collapsing the lung.