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Session 3 CM- GI-1

CM- GI -1- esophageal disorders

What is atresia absence of lumen
what is stenosis narrowing
what is diverticulosis formation of outpouches
what is a fistula connection between 2 lumens
What is the most common developmental abnormailty of esophagus Esophageal Atresia with tracheoesophageal fistula
Why does esophageal atresia with tracheoesophageal fistula need to be corrected surgically immediately after birth food cannot get into stomach food passes into trachea causing choking and coughing
What is a true vs false diverticula true composed of all 4 layers of normal esophageal tissue, mucosa, submucosa, smooth muscle, adventitia- outer serosa----------------------------False- Outpouching of just mucosa and submucosa
If the diverticula is a traction diverticula what is causing the deformity generally a fibrous adhesion pulling from outside the esophagus
what causes a pulsion diverticula push from the inside generally increased intraluminal pressure
what is a zenker diverticula An upper esophageal diverticula
What type of diverticula is common in the midportion of the esophagus traction diverticula from bronchial lesions, scarring of lymph nodes
what is are common causes of lower esophagus/epiphrenic diverticula associated with diaphragmatic hernia and GERD
what can happen if a zenker diverticula continues to increase in size you can get increased intrapharyngeal pressure and a functional obstruction.
what diagnostic study should you order in suspected diverticula fluoroscopy- also known as cineradiography or video fluoroscopy
Where do zenker diverticula commonly occur area of potential weakness in the inferior pharyngeal constrictor muscle
what are the clinical manifestations of zenker diverticulum "upper esophageal dysphagia recurrent pulmonary infections" halitosis-stuck rotting food regurgitation of undigested food aspiration noisy swallowing sensation of mass in throat
What diverticulum is a Pharyngoesophageal diverticulum Pulsion diverticulum False diverticulum = herniation of mucosa and submucosa through muscular layer (False diverticula generally lack the muscularis layer) Zenker Diverticulum
what is a serious complication of 30% of patients with zenker diverticulum aspiration pneumonia
What conditions are associated with zenker diverticulum GERD, and hiatal hernia
Type of diverticulum Usually in distal esophagus Lateral esophageal wall Right > left Often associated with hiatal hernia Pulsion diverticulum False diverticulum epiphrenic diverticulum
Type of diverticulum May be formed in response to pull from fibrous adhesions following lymph node infection (usually TB) True diverticulum contains all 4 esophageal layers May form from increased intraluminal pressure and be pulsion diverticula Midesophageal Diverticulum
what is dysphagia difficulty in swallowing
what is odynophagia pain with swallowing
What is heartburn burning sensation behind sternum
What is acid regurgitation acid reflux into the mouth sign of GERD
What sturcture prevents reflux of gastric contents into the pharynx upper esophageal sphincter
What is the cause of laryngopharyngeal reflux upper esophageal spinchter doesn't function properly acid backflows into esophagus enters throat and larynx
are LPR (laryngopharyngeal reflux) and Gerd the same thing NO different disorders causing different s/sx
What structure is formed from a loop of cricopharyngeal muscle and circular muscle sublayer Upper Esophageal Spinchter
What structure is formed by circular smooth muscle located at the level of the diaphragm and helps maintain a high pressure zone Lower esphageal spinchter
What is the major s/sx of laryngopharyngeal reflux dysphagia
If you have a problem initially getting food swallowed but once you do it goes down just fine what problem do you have? Transfer Dysphagia
If you have trouble getting food to go down your esophagus after swallowing what transport problem could you be described as having transport dysphagia
If you have transfer dysphagia what is the most liekly cause of your problem neuromuscular disorder likely caused by CVA, Scleroderma, myasthenia gravis, parkinsons, lead poisoning, thyroid disease
What s/sx will a patient likely present with who is suffering from transfer dysphagia gagging, coughing, nasal regurgitation and a high risk of aspiration
Patient complains of dysphagia what would you like to order to better understand what is causing their problem first check and see if it is acute or chronic and see if they can sip water. Then order a barium swallow with video-esophagography
Patient is over 40 yrs old and comes into your office complaining of dysphagia what should you be considering as a likely cause, is your patient more likely male or female Neoplasm, 95% are squamous cell, patient is likely male as M-F ratio is 3:1, need to r/o malignancy
What complication can arise from scaring due to GERD and where in the esophagus are you most likely going to find this complication esophageal stricture most likely to be found in the distal esophagus it usually only effects passage of solids r/o malignancy
What is the most common structural abnormality of the esophagus Webs and Rings
If webs are associated with glossitis and iron deficiency anemai what syndrome is the pt suffering from Plummer vinson Syndrome
If your patient has INTERMITTENT dysphagia with solids what is the likely cause and what tx would you order shatzki rings tx is dilation
If you suspect patient has shatzki's ring what would you have them do while doing a barium swallow to best visualize the ring best seen with valsalva maneuver in prone patient
What is the most common s/sx of patients with esophageal motility disorders dysphagia, regurgitation, substernal pain, aspiration, weight loss
What age group is most likel to suffer from esophageal motlility disorders pts past 5th decade of life
Pt presents with regurgitation of food, weight loss and odynophagia on manometry reveals increased LES tone. What test would you order to confirm you diagnosis and what are you leaning towards as your dx Order either a pharyngoscopy or esophagoscopy especially a barium swallow. Patient is most likely suffering from achalasia. If you see a "parrot beak" on barium swallow you would have a confiramtion of this
You order a barium swallow esophagography of a patient and notice a parrot beak shape revealed in the study what does the patient likely have Achalasia
If your pt is suffering from achalasia what tx options are available to you surgical tx w/ myotomy or non surgical tx w/ CCB, long acting nitrates, pneumatic dilation, botulism injection into LES
You are trying to confirm your dx of diffuse esophageal spasm what test must you order to dx this disorder Manometry is required barium studies are also helpful
What tx would be helpful for pt with diffuse esophageal spasm NTG, CCB, botulism, anxilyctix agetns with antireflux therapy
You order a barium swallow esophagography and notice a cork screw appearance to the esophagus patient has been suffering from dysphagia and intermittent chest pain what are the likely suffering from Diffuse Esophageal Spasm
What is the most likely underlying cause of Diffuse Esophageal Spasm Neuromuscular abnormalities
Patient complains of angina like pain but during a cardiac work up there are no findings being a smart PA you decide to work the patient up for nutcracker esophagus what test should you order and what are you looking for you should order a manometry study and look for high pressure waves in DISTAL esophagus
What s/sx would you be looking for to show that the chest pain complaints are cardiac and not esophageal dyspnea but do a cardiac work up on any patient with cardiac risk factors complaining of chest pain
Your pt presents with infectious esophagitis what are the most likely comorbid conditions Immunosuppression either from HIV or transplant rejection drugs.
What is the most common cause of infectious esophagitis Candida
What is the most common cause of esophagitis over all (ie not just infectious esophagitis) GERD, caused by exposure to errosive acid from the stomach
What condition can occur as a complication of GERD where normal esophageal squamous epithelium is replaced with metaplastic columnar tissue and why should this alarm you as a PA Barett's esophagus increases pt's risk of developing malignancy
What would you see on endoscopy w/ pt suffering from barrett's esophagus salmon red patches in lower esophagus
What is the number 1 cause of esophageal perforation endoscopy, after that ETOH and emesis are the likely cuases (boerhaave syndrome)
If you suspect patient has suffered a esophageal perforation following boerhaave's sndrome (ETOH involved emesis) what contrast study would you order and why gastrografin because it is water soluable and will not cause mediastinitis
Patient has been a lifelong abuser of ETOH and has developed portal hypertension what is a likely complication that can develop involving the esophagus Patient can develop esophageal varices enlarged veins from the pressure backup
If patient develops esophageal bleed from varices what tx should be given and what is the likely outcome endoscopy should be performed to control the bleeding and even with tx mortality risk is high so don't abuse ETOH
Patient is past their 4th decade of life has been trying to overcome lifelong alcoholism and in treatment started retching violently until something tore in their esophagus what syndrome are they suffering from Mallory-Weiss Syndrome/tear
If patient suffers a mallory-weiss tear what would you expect to see in their vomitus bright red blood in vomit also could be seen in their stool
Where is the most likely place a patient will tear if they suffer a mallory-weiss syndrome tear Most likely to tear at gastroesophageal junction
What systemic disease has affects the esophagus it typically presents with sclerodactylyl, pulmonary fibrosis and reflux induced strictures, GERD and dysphagia Scleroderma
Created by: smaxsmith