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42 Cards in this Set

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(3) causes of viral Esophagitis
HSV

VZV

CMV
(5)* causes of Bacterial Esophagitis
My Pnew Strep Lacts Crypt:
Mycobacterium TB;
Pneumocystis Carnii;
Strep;
Lactobacillus;
Cryptospordium
My Pnew Strep Lacts Crypt
*When is a Barium Esophagram the best initial test?

when is it the most accurate?
(3)
Dysphasia

(that shows no signs of obstruction...for obstruction it would be Upper Endoscopy)

most accurate:
1. Esoph Webs
2. Esoph Rings
3. Esoph Diverticuli
Dx:
Odynophagia (pain w/ swallowing), dysphagia, esophageal bleeding, N/V, chest pain, (or asymptomatic)
Infectious Esophagitis
Dx:
Infectious esophagitis w/ nodular filling defects on barium esophagram

Tx?
Candida

Tx:
Fluconazole PO
Causes:
Infectious esophagitis w/ vesicles and descrete erosions on endoscopy
(2)

Tx?
HSV or VZV

Tx:
Acyclovir for HSV
Dx:
Infectious esophagitis w/ intranuclear inclusions on bx via endoscopy

Tx?
CMV

Tx:
Ganciclovir IV
Who should upper endoscopy screening be offered to?
(2)
1. Patients w/ GERD and Sx for > 5 years
(to check for Barrett's esophagus)

2. Patients w/ Esophageal varices
Dx:
A Full-thickness tear usu in the weak left posterolateral wall of distal esophagus

(3) causes?
Boerhaave's Syndrome

Causes:
Forceful vomiting;
Cough;
Trauma
Dx:
A Partial-thickness tear usu in the right posterolateral wall of the distal esophagus and results in bleeding that resolves spontaneously

Cause?
Mallory-Weiss syndrome

Cause:
Forceful vomiting
medical Tx for non-bleeding Esophageal Varices
Propranolol
What is the next step in the Tx of a patient w/ GERD that has persistent Sx after 4 weeks of Tx w/ a PPI?
24-hour Esophageal pH recording
If patient has mediastinal and subcutaneous emphysema, what esophageal problem do they have?
Full-thickness tear

(Boerhaave's syndrome)
Dx sign:
"Crunching sound" heard w/ heartbeat

what is it due to?
"Hammon's crunch"

(Mediastinal emphysema)

From:
Full-thickness esophageal tear
(Boerhaave's syndrome)
*What is the Diagnostic test of choice for Boerhaave's syndrome or a partial esophageal perforation?

What is the most accurate test?
Dx test: Gastrograffin
(water-soluble contrast)

most accurate: CT scan
Tx for esophageal tear
(1 for each type)
Partial-thickness (Mallory-Weiss):
may resolve spontaneously

Full-thickness (Boerhaave's):
Surgery
Definition:
Pharyngeal or esophageal pouch due to a defect in the muscular wall of the posterior hypopharynx
Zenker's Diverticulum
Dx:
Halitosis, regurgitation of food after eating it, frequent aspiration, esophageal obstruction
Zenker's Diverticulum
Dx test for Zenker's Diverticulosis
(2 possible)

Tx (2 possible)
Tests:
Barium swallow;
Endoscopy

Tx:
Surgical removal;
Cricopharyngeal myotomy
Dx:
56-yo man complains of food feeling "stuck" on its way down and vomiting food he ate days ago
Zenker's Diverticulum
Definition:
Neurogenic disorder of esophageal motility w/ absence of normal peristalsis and impaired relaxation of the LES
Achalasia
Definition:
Esophageal motility disorder w/ frequent non-peristaltic contractions
Diffuse Esophageal Spasms
(DES)
What esophageal problem affects 70% of people with Scleroderma?
Achalasia
What type of problem does dysphagia to solids and liquids indicate?
(2 examples)

To just solids?
(3 examples)
Solids + Liquids:
Motility problem
(Achalasia; DES)

Solids only:
Mechanical problem
(Tumor; Schatzki's ring; Plummer-Vinson syndrome)
Dx:
weight loss, cough, dysphagia of both solids and liquids, "bird's beak" on CXR

Tx options?
(2 drugs and 2 procedures)
Achalasia

Tx options:
Nitroglycerin;
Local Botulinum toxin;
Balloon Dialation;
Sphinctor Myotomy
Dysphagia to both solids and liquids, diffuse chest pain, "corkscrew" appearance on CXR

DES Drug Tx options? (2 possible)
Diffuse Esophageal Spasms (DES)

Tx options:

1. Nitroglycerin;

2. Anticholinergics
When is an Esophageal Manometry the test of choice?
(2)
1. an Inconclusive Barium or upper endoscopy

2. Description of a Motility problem
(Achalasia, DES, Nutcracker esophagus)
Etiology of Achalasia
(2)
Scarring of Auerbach's plexus from:

Chagas Dz
or
Ganglionic degeneration
Definition:
Hypopharyngeal webs (thin mucosal structures protruding into lumen of the esophagus) associated w/ iron deficiency anemia
Plummer-Vinson Syndrome
Definition:
Narrow lower esophageal ringlike outgrowth associated w/ dysphagia
Schatzki's Ring
Etiology of GERD
(4)*
HIDE:
Hiatal hernia;
Incompetent LES tone
Delayed Gastric emptying;
Esopageal motility decreased
HIDE
(5)* causes of Delayed Gastric Emptying
Delayed Food GAG:
DM;
Fatty foods;
Gastroparesis;
Anticholinergics;
Gastric outlet obstruction
Delayed Food GAG
(8)* causes of a decreased LES tone
Coffee CAN Cause Esophageal Sphinctor Problems:
Coffee;
Chocolate;
Alcohol;
Nitrates;
Calcium channel blockers;
Estrogen;
Smoking;
Progesterone
Coffee CAN Cause Esophageal Sphinctor Problems
Differential of Chronic Cough
(3)*
GAP in breathing:

GERD;

Asthma / Chronic Bronchitis;

Post-nasal drip
GAP in breathing
Dx:
Substernal chest pain, dysphagia, hypersalivation, cough, wheezing
GERD
What (3) lifestyle modifications should be told to patients w/ GERD?
Discontinue foods that lower LES tone;

Elevate head of bed;

No food < 3 hours before bed
(2) drug Tx options for GERD

What can be done if medication doesn't work?
Proton Pump Inhibitor (1st);

H-2 Blocker

Final solution:
Surgical fundoplication
Definition:
Esophageal damage, bleeding and friability due to prolonged exposure to gastric contents
Esophagitis
(4)* complications of GERD
BEEP:
Barrett's Esophagus;
Esophagitis;
Esophageal cancer;
Peptic stricture
BEEP
(2) types of esophageal cancers and where each is formed in esophagus
Squamous:
Upper 2/3 of esophagus

Adenocarcinoma:
Lower 1/3 of esophagus
Risk factors for CA of the esophagus
(7)*
ABCDEF:
Alcohol;
Barrett's esophagus;
Cigarettes;
Diverticuli (Zenker's);
Esophageal web (P-V synd), Esophagitis (reflux or irritants);
Familial
ABCDEF
What causes Barrett's?

What can it become?

How often should a patient with Barrett's have an upper endoscopy?
BARRett's:
Becomes Adenocarcinoma, Results from Reflux

UE:
Barrett's: every 2 - 3 years