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DU PA Dz of the Esop
Duke PA Diseases of the Esophagus
| Question | Answer |
|---|---|
| substernal burning, epigastric pain radiating to the neck | heartburn |
| substernal burning, epigastric pain radiating to the neck | pyrosis |
| dysphagia | difficulty in swallowing-liquids/solids |
| odynodphagia | painful swallowing-reflects erosive esophageal disease |
| infectious causes of odynophagia | CMV, herpes, candida, HIV |
| __ of adults report occasional heartburn | 1/3 |
| __ of adults report daily heartburn | 7% |
| etiologies of GERD | incompetent lower esophageal sphincter, transient lower esophageal sphincter relaxation, irritant effects of the refluxate, delayed gastric emptying, abnormal esophageal clearance |
| heartburn 30-60 minutes after meal, regurgitation, sour brash, dysphageia, relieft with antacids, severity does not correlate with esophagitis, asthma flairs, non-cardiac chest pain, laryngitis, hoarsness, loss of dental enamel | symptoms of GERD |
| treatment for uncomplicated GERD | conservative-PPI empirically, no need for further investigation unless treatment failure |
| symptoms of GERD after age __ warrants furhter investigation | 50 |
| complicated GERD alarm symptoms | dysphagia, weight loss, hematemesis, melena |
| __ has a limited role in investigation of reflux | barium swallow |
| indications for ambulatory pH monitoring | refractory symptoms and normal EGD, atypical symptoms, failure to respond to pharmacology therapy, patients considered fro antireflux surgery |
| tests the function of the esophageal muscel contractions and esophageal sphincters | manometry |
| occurs in 10-20% of GERD patients, change fro squamous to columnar epithelium in esophagus | Barrett's esophagus |
| Barrett's esophagus predisposes to __ | adenocarcinoma of the esophagus |
| lifestyle modifications for GERD | elevated the head of the bed, lose excess weight, eliminate: tobacco, late night meals, ETOH, fatty foods, chocolate, caffeine |
| Medical treatment for GERD | acid suppression (PPI's), motility agents (not used as much anymore) |
| Surgical treatment for GERD | Nissen fundoplication |
| __ increases the risk of esophageal cancer 30-60 times the general population | Barret's esophagus |
| heartburn, regurgitation or both greater than or equal to once per week increases cancer risk __ times | 8 |
| frequent sever heartburn and regurgitation for >20 years increases cancer risk by __ times | 44 |
| GERD is a __ disease | chronic |
| complications of GERD | Barrett's esphagus, esophageal cancer, stricture |
| most GERD patients will eventually be sent for __ | endoscopic evaluation |
| signs and symptoms of infectious esophagitis | odynophagia, dysphagia, chest pain |
| treatment for candida esophagitis | fluconozole for 14 days |
| HSV, HIV and CMV will cause __ in the esophagus | ulcerations |
| occurs secondary to portal hypertension | esophageal varices |
| treatment for esophageal varices | banding, shunt procedure, meds |
| secondary to repeated retching | Mallory Weiss tear |
| patients with a caustic injury to esophagus need to have endoscopy withing the first __ hours | 24 |
| outpouchings of upper esophagus, always involves the posterior wall of the pharynx, most common cause of transfer dysphagia. Symptoms are regurgitation, dysphagia, halitosis | Zenker's diverticulum |
| esophageal motility disorders | achalasia, diffuse esophageal spasm, nutcracker esophagus, scleroderma esophagus |
| means- failure to relax | achalasia |
| one identifiable cause of achalasia, not prevalent in this country | Chagas disease |
| gradual progressive dysphagia for solids and liquids, regurgitation of undigested foods, develops at 25-60 y/o, symptoms usually lasted months to years, substernal discomfort or fullness after eating, poor esoph emptying, nocturnal regurg | achalasia clinical presentation |
| gold standard for diagnosis of achalasia | manometry |
| on manometry in achalasia you will see | complete absense of peristalisis, with simultaneous, low amplitude waves. Incomplete LES relaxation |
| chest x-ray finding in achalasia | air fluid level |
| barium swallow finding in achalasia | bird's beak, esophageal dilation, loss of peristalsis |
| achalasia therapy | pharmacologic therapy to relax smooth muscle, pneumatic dilation, surgical myotomy, botox |
| treatment of choice for achalasia | surgical myotomy-85% success rate with a mortality <1% |
| achalasia treatment with __ is highly variable and usually doesn't work very well | medications (nifedipine, calcium channel blockers, nitrates) |
| simultaneous, nonperistaltic contractions of the esophagus, provoked by stress, large food boluses, hot or cold liquids (carbonation), anterior chest pain unrelated to exertion or eating | diffuse esophageal spasm |
| barium esophagography reveals simultandeous cork screw contractions, "rosary bead" appearance | diffuse esophageal spasm |
| common in patients with progressive systemic sclerosis, raynaud's phenomena, or CREST, atrophy and fibrosis of the esophageal smooth muscle | scleroderma esophagus |
| causes of esophageal stenoses | rings and webs, reflux esophagitis, tumors, caustic ingestions, infections |
| iatrogenic causes of esophageal stenoses | pill-induced, radiation, sclerotherapy |
| presents with progressive solid food dysphagia, weight loss, most present in late stages, seen in 50-70 y/o | esophageal cancer |
| predisposing factors for squamous cell carcinoma | alcohol, tobacco, achalasia, caustic induced esophageal injury, head and neck cancers, plummer-vinson syndrome. African American, male |
| develops as a complication of Barrett's esophagus, more common in whites than blacks, lower third of esophagus | adenocarcinoma |
| complications of esophageal cancer | local tumor extension into the trachobronchial tree, chest or back pain, laryngeal nerve involvement-hoarsness, pneumonia, malnutrition |
| treatment for unresectable esophageal cancer for palliation | radiation, stenting |
| chemotherapy for esophageal cancer | cisplatin/5 FU |
Created by:
bwyche
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