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Session 3 CM- GI-1
CM- GI -1- esophageal disorders
| Question | Answer |
|---|---|
| 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
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