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41 Cards in this Set

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  • Back
name the hormones that causes LES contraction.
Muscarinic M2 and M3 receptor agonists, -adrenergic agonists, gastrin, substance P, and prostaglandin F2
name the hormones that reduced LES pressure.
nicotine, -adrenergic agonists, dopamine, cholecystokinin, secretin, vasoactive intestinal peptide (VIP), calcitonin gene–related peptide, adenosine, prostaglandin E, nitric oxide donors such as nitrates, and inhibitors of phosphodiesterase 5
Can you reproduce the symptom of heartburn?
yes.Heartburn can be reproduced by infusion of dilute (0.1 N) hydrochloric acid (Bernstein test) or neutral hyperosmolar solutions into the esophagus.
what is the most frequent esophageal cause of chest pain?
reflux esophagitis
name differentials for esophageal or atypical chest pain
1) GERD
2) DES-diffuse esophageal spasm.
3) Achalasia (with associated dysphagia)
what is the diagnosis?
what is the diagnosis?
(1) Pharyngeal paralysis with tracheal aspiration (arrow).
(2) Cricopharyngeal achalasia.
(3) Diffuse esophageal spasm.
(4) Achalasia
(5) Muscular (contractile) lower esophageal ring.The asymmetric contraction visible in (5A) has disappeared in (5B) , obtained during the same examination.
(6) Scleroderma esophagus showing dilated esophagus with a stricture
(6A) and reflux of barium from the stomach into the esophagus (6B).
What is the underying cause for achalasia
loss of intramural neurons
what are the secondary causes for achlasia
gastric carcinoma that infiltrates the esophagus, lymphoma,
Chagas' disease,
certain viral infections, eosinophilic gastroenteritis, neurodegenerative disorders
Why does regurgitation and pulmonary aspiration occur in achalasia?
Regurgitation and pulmonary aspiration occur because of retention of a large amount of saliva and ingested food in the esophagus
what is the CXR appearance in achalasia?
chest x-ray shows absence of the gastric air bubble and sometimes a tubular mediastinal mass beside the aorta
what does the barium swallow show in achalasia?
Barium swallow shows esophageal dilation, and in advanced cases the esophagus may become sigmoid.

The terminal part of the esophagus shows a persistent beaklike narrowing representing the nonrelaxing LES
What is achalasia?
In achalasia, the esophageal body loses peristaltic contractions and the LES does not relax normally in response to swallowing.
Treatment for achalasia?
- nitrates and calcium blockers-short term relief.
- sildenafil for symptomatic relief.(Increased cGMP, reduce LES pressure)
-BOTOX for elderly or high risk pts.
- Balloon dilatation.
- Heller's extramucosal myotomy of the LES(laparoscopic)
What is the characteristics of diffuse esophageal spasm?
DES is characterized by nonperistaltic contractions.

It is due to dysfunction of inhibitory nerves
What is the characteristics of the chest pain in DES?
The pain is retrosternal; it may radiate to the back, the sides of the chest, both arms, or the sides of the jaw and may last from a few seconds to several minutes.

Pain may be acute and severe, mimicking the pain of myocardial ischemia

dysphagia with solids or liquids may occur.
how to diagnose DES?
best diagnosed by manometry
Treatment for DES?
GTN
nifedipine
ISMN
may be helpful
What is scleroderma esophagus?
It consist of atrophy of smooth muscle, manifested by weakness in the lower two-thirds of the esophagus and incompetence of the LES
Dysphagia in scleroderma is mainly to solids or liquids?
solids.
What does the barium swallow show for scleroderma esophagus?
Barium swallow shows dilation and loss of peristaltic contractions in the middle and distal portions of the esophagus.
What does motility study show in scleroderma?
marked reduction in the amplitude of smooth-muscle contractions

resting pressure of the LES is subnormal but sphincter relaxation is normal
What causes the symptoms in GORD?
Symptoms are caused by backflow of gastric acid and other gastric contents into the esophagus due to incompetent barriers at the gastroesophageal junction.
what are the complications of GORD?
reflux esophagitis
non erosive reflux disease (NERD)
erosive esophagitis
peptic stricture
In patients with Barrett's esophagus, rapidly progressive dysphagia and weight loss may indicate what?
The development of adenocarcinoma
How do you GORD?
By history alone.
Trial of PPI.

Diagnostic studies indicated for non-responders to PPI or in those with complications.
Name 3 test for investigating GORD.
1) mucosal injury:
barium swallow, esophagoscopy, and mucosal biopsy

2) Quantitation of reflux:
ambulatory long-term (24–48 h) esophageal pH recording

3) Pathophysiologic factors:
esophageal motility study.
What is the risk of taking PPI for prolonged period of time?
increased incidence of hip fractures
Treatment for GORD?
- weight loss
- adjusting sleeping height
- avoid consuming fatty foods, coffee, chocolate, alcohol, mint, orange juice
-H2- receptor blocking agents.ie ranitidine.
-PPI more effective.
most effective in preventing recurrences.relapse if stopped.
-fundoplication.
Which patients are ideal candidates for fundoplication?
Ideal candidates for fundoplication are those who have classical GERD with good response to PPI therapy and in whom motility studies show poor LES pressures but normal peristaltic contractions in the esophageal body.
What is Barrett's esophagus?
The metaplasia of esophageal squamous epithelium to columnar epithelium
What is the main worry with Barrett's?
risk factor for esophageal adenocarcinoma
What finding in histology is diagnostic of Barrett's?
Finding intestinal metaplasia with goblet cells in the esophagus is diagnostic of Barrett's esophagus
What is the follow up for patients found to have high grade dysplasia?
Close endoscopic follow-up (every 3 months) is recommended in all patients with HGD.
Follow up for low grade dysplasia?
Endoscopy follow up at 6 and 12 months initially and yearly thereafter.
Name 4 viruses known to cause esophagitis in humans
1) HSV
2) VZV
3) CMV-only in i8mmunocompromised host.
4) HIV
Most common organism causing candida esophagitis and the treatment.
Candida albicans is most common.
Treatment with fluconazole.
how is the diagnosis eosinophilic esophagitis confirmed?
Diagnosis is confirmed by esophageal mucosal biopsies that show increased eosinophils (>15) per high-power field or eosinophilic microabscesses.
how do you treat eosinophilic esophagitis?
Swallowed fluticasone propionate (440 g bid) MDI for 12 weeks.
Features of eosinophilic esophagitis?
young age.male
history of allergy
failure to thrive
refuse to swallow.
What is the Plummer-Vinson syndrome?
The combination of symptomatic hypopharyngeal webs and iron-deficiency anemia in middle-aged women