Gastroenterology

Front 1

Odonyophagia & dysphagia in immunocompromised patient

Back 1

Infectious esophagitis

Front 2

Viral causes of infectious esophagitis

Back 2

CMV, HSV

Front 3

Definitive diagnostic test for infectious esophagitis

Back 3

Cytology or culture from endoscopic brushings

Front 4

Cause of infx when endoscopy reveals large, deep ulcers?

Back 4

CMV or HIV

Front 5

Cause of infx when endoscopy reveals multiple shallow ulcers?

Back 5

HSV

Front 6

CMV treatment

Back 6

Ganciclovir

Front 7

Candida species treatment

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Fluconazole or ketoconazole

Front 8

Neurogenic dysphagia

Back 8

Difficulty with BOTH liquids and solids

Front 9

What causes neurogenic dysphagia?

Back 9

Injury or disease to brain stem or the cranial nerves involved in swallowing

Front 10

Zenker's diverticulum

Back 10

An outputting of the POSTERIOR HYPOPHARYNX that causes regurgitation of undigested food and liquid into the pharynx several hours after eating

Front 11

Solid food dysphagia

Back 11

Esophageal stenosis - slow progress of solid food dysphagia = benign, like webs or rings. rapid progression = malignancy

Front 12

Slowly progressive dysphagia with episodic regurgitation and chest pain

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Achalasia

Front 13

Characteristics of achalasia (2)

Back 13

1. Decreased peristalsis

2. Increased LES tone - fails to completely relax with swallowing

Front 14

Dysphagia or intermittent chest pain that MAY OR MAY NOT be associated with eating

Back 14

Diffuse esophageal spasm

Front 15

Esophageal disease causing decreased esophageal sphincter tone and peristalsis, predisposing patient to sx of GERD.

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Scleroderma

Front 16

"Parrot-beaked" or "bird-beaked" appearance

Back 16

Narrowing of distal esophagus and a large, dilated esophagus proximal to narrowing on barium swallowing - seen in patients with achalasia

Front 17

Which test reveals both structural AND motor abnormalities of the esophagus

Back 17

Barium swallow

Front 18

Next step after barium swallow reveals structural or motor abnormalities?

Back 18

Refer to otolaryngologist for endoscopy (pharyngoscopy or esophagoscopy) to clarify the nature of structural lesion

Front 19

How do you CONFIRM a motility disorder diagnosis?

Back 19

Esophageal manometry - Used to assess the strength and coordination of peristalsis - will reveal failure of LES relaxation and aperistalsis

Front 20

Three causes of achalasia:

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1. Idiopathic (most common)

2. Adenocarcinoma of proximal stomach

3. Chagas' Disease (parasite infx, South America)

Front 21

How do you differentiate between dysphagia caused by achalasia vs esophageal malignancy

Back 21

Achalasia: Equal difficulty with solids & liquids

Esophageal Cancer: Dysphagia with SOLIDS is GREATER than with liquids

Front 22

What's the risk of esophageal cancer in patients with achalasia?

Back 22

A SEVENFOLD increased risk - it will occur in 10% of patients 15-25 years after initial achalasia diagnosis

Front 23

Most common type of esophageal cancer

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Squamous cell

Front 24

Antimuscarinic agent that can be used to treat achalasia?

Back 24

Dicyclomine

Front 25

How do you cure achalasia?

Back 25

There is no cure. Only palliative measures (including surgery)

Front 26

Oral medications that can be used in the tx of achalasia

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1) Sublingual nitroglycerin

2) Long-acting nitrates

3) CCB's

These may improve swallowing in early stages BEFORE esophageal dilation occurs, but are most useful in short-term tx

Front 27

Specific injection used to treat achalasia?

Back 27

Botulinum toxin injection into the LES - Blocks cholinergic activity/paralyzes nerves - repeat procedure needs done every 2 years.

Front 28

In addition to achalasia, nitrates, botulinum and CCB's can also be used in the tx of which other motility disorders?

Back 28

Zenker's diverticulum and esophageal stenosis

Front 29

First line nonsurgical therapy for achalasia

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Pneumatic dilation - other forms of forceful dilation include mechanical and hydrostatic

Pt. swallows collapsed balloon, x-ray guides it to LES, it's then inflated to tear the large muscles of the LES

Front 30

Most common surgical procedure done for tx of achalasia?

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Heller Myotomy - surgeon cuts muscles at bottom of esophagus and top of stomach

*Reserved for pts who do not respond to dilation therapy

Front 31

"Corkscrew esophagus"

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Diffuse esophageal spasm - seen on barium swallow and represents multiple simultaneous contractions

Front 32

How do you differentiate achalasia from diffuse esophageal spasm (DES)?

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*Sphincter function is NORMAL in DES

*Dysphagia is common in DES, but regurgitation of food is uncommon.

Front 33

What are the 2 most common types of esophageal cancers and where are they found?

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Squamous cell carcinomas: proximal 2/3

Adenocarcinomas: distal third

Front 34

Barrett's esophagitis is associated with which type of esophageal cancer?

Back 34

Adenocarcinoma

Front 35

Most common area for esophageal neoplasms to metastasize?

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Mediastinum

Front 36

Biggest risk factors of squamous cell carcinoma

of esophagus?

Back 36

Cigarettes and chronic alcohol use

Front 37

Clinical features of esophageal cancer?

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PROGRESSIVE dysphagia for solid foods & weight loss

Heartburn, vomiting and hoarseness may occur

Front 38

Best INITIAL test for suspected esophageal neoplasm?

Back 38

Biphasic barium esophagram (to visualize lesion) -- aka barium swallow

Front 39

Biggest risk factors for adenocarcinoma of

esophagus?

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GERD & Barrett's esophagus

(Alcohol and tobacco are less important than in SCC)

Front 40

Which esophageal neoplasms are more common in white vs black men?

Back 40

Whites: Adenocardinoma

Blacks: Squamous cell carcinoma

Front 41

Test used to make the definitive diagnosis in esophageal neoplasm?

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Endoscopy with biopsy and brush cytology

Front 42

Test ordered for STAGING of esophageal

neoplasm?

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Transesophageal ultrasound (endoscopic

sonography) to determine DEPTH of penetration of tumor

Also, CT

Front 43

Linear mucosal tear at the gastroesophageal junction, associated with hematemesis

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Mallory-Weiss tear

Front 44

Diagnostic test for Mallory-Weiss tear?

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Endoscopy

Front 45

How do you treat a Mallory-Weiss tear?

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90% stop bleeding without treatment

Can do endoscopic injection of epinephrine OR thermal coagulation

Front 46

Koilonychia

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Spoon-shaped fingernails

Front 47

Upper esophageal web causing dysphagia

Back 47

Plummer-Vinson Syndrome

Considered a premalignant lesion b/c 10%

develop SCC of the oral cavity, hypo pharynx or esophagus

Front 48

What type of anemia does Plummer-Vinson Syndrome cause?

Back 48

iron deficiency

Front 49

Distal esophageal webs

Back 49

Schatzki's Ring - This is a circumferential ring in the lower esophagus ALWAYS accompanied by a sliding hiatal hernia.

Front 50

Most common cause of distal esophageal webs?

Back 50

Ingestion of alkali, acids, bleach or detergents (in suicide attempts)

Alkali is most dangerous - can lead to full-

thickness necrosis

Front 51

Transmural (involving entire thickness) esophageal tear that causes esophageal

perforation?

Back 51

Boerhaave's syndrome