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88 Cards in this Set
- Front
- Back
What are the three anatomical constrictions of the esophagus?
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cricopharyngeus; UES; LES
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What is atresia?
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absence of the lumen
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What is stenosis?
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narrowing
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What is diverticulosis?
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formation of outpouches
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What is a fistula?
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connection between two lumens
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What is dysphagia?
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difficulty swallowing
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What is odynophagia?
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pain swallowing
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Where is heartburn located?
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burning sensation behind sternum
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What is treatment of esophageal atresia with tracheoesophageal fistula?
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immediate surgical correction
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Describe esophageal atresia with tracheoesophageal fistula?
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lumen of esophagus ends in a blind pouch
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What is the result of esophageal atresia with tracheoesophageal fistula?
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food can not pass into stomach; food passes into trachea
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What are S/S of esophageal atresia with tracheoesophageal fistula?
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choking and coughing
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What are the three ways by which esophageal diverticula are classified?
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structure, location, pathogenesis
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What are the structural classifications of an esophageal diverticula?
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true and false
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What is a true diverticula?
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composed of all four layers of normal esophageal wall
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What is a false diverticula?
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outpouching occurs only in mucosa and submucosa layers
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What are the classifications based on location (esophageal diverticula)?
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upper esophageal, midportion, and epiphrenic
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How is a Zenker's diverticula formed?
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over time increased intrapharyngeal pressure due to FUNCTIONAL obstruction
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How is Zenker's diverticula classified?
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false and pulsion diverticula
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What are the pathogenic classifications of esophageal diverticula?
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tractional and pulsion
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What is a tractional diverticula?
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PULL from the OUTSIDE; fibrous adhesions
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What is a pulsion diverticula?
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PUSH from the INSIDE; increased intraluminal pressure
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What is the manifestation of a Zenker's diverticula?
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older women; posteriorly at sight of thyropharyngeal m; inferior boundary is cricopharyngeal m
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What type of esophageal diverticula is associated with lymph node infection a/w TB?
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midportion
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What are the classifications typically of a midportion esophageal diverticula?
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true and pulsion
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What esophageal diverticula is a/w diaphragmatic hernias and GERD?
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ephiphrenic
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Where is an epiphrenic diverticula generally located (3)?
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distal portion of esophagus; lateral wall; RIGHT > left
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What esophageal diverticula is a/w hiatal hernias?
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epiphrenic
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How are epiphrenic esophageal diverticula generally classified?
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false and pulsion
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What happens in laryngopharyngeal reflux?
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UES does not work properly and acid backflows into esophagus, enters throat in larynx
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If a patient suffers with chronic cough, voice fatigue or changes, a globus sensation and a sore throat, what should be suspected?
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laryngopharyngeal reflux
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What are the two types of dysphagia?
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transfer and transport
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When does transfer dysphagia happen?
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early in swallowing process
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What are the S/S of transfer dysphagia?
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coughing, gagging, nasal regurgitation
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What is involved with transport dysphagia?
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impaired movement down esophagus through LES; feeling food "getting stuck"
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Patients with neurological problems generally have more difficulty swallowing liquids or solids?
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liquids
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Patients with structural problems generally have more difficultly swallowing liquids or solids?
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solids
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If a patient is greater than 40 years old with dysphagia, what should be suspected?
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neoplasm
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What S/S is indicative of presence of a neoplasm?
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fast progression from solids to liquids dysphagia
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In what instances must you rule out malignancy as a cause of dysphagia?
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neoplasm and esophageal strictures
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How does an esophageal stricture develop?
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over years from scarring due to GERD
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If a patient has symptoms of dysphagia, developing over years, of solids, what should be suspected?
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esophageal stricture
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What are the most common structural abnormalities of the esophagus?
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webs and rings
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What structural abnormality of the esophagus is a/w glossitis and iron deficiency anema?
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webs (Plummer Vinson Syndrome)
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Describe webs (3).
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mucosal folds causing narrowing of lumen; thin constrictions; proximally located
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What is the treatment for webs and rings?
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dilation
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What is the most common cause of intermittent dysphagia with solids?
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schatzki ring
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What are schatzki rings?
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prominant, smooth, annular narrowing of the DISTAL esophagus
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How is a schatzki ring best visualized?
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with a valsalva maneuver at full inspiration in prone patient during barium swallow
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What is the number one motor lesion cause of dysphagia?
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CVA
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If you have a patient with intermittent symptoms, difficulty swallowing liquids, what would you suspect?
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neuromuscular disorder
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If you have a 20 - 40 year old male, with S/S of regurgitation, weight loss, and odonophagia, what would you suspect?
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achalasia
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What is the cause of achalasia?
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impaired LES relaxation; absence of esophageal peristalsis thus bolus of food becomes trapped in esophagus PROXIMAL to stricture
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What is the pathogenesis of achalasia?
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viral infection/environmental factors
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How would you diagnose achalasia?
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barium swallow with BIRD'S BEAK at LES
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What is the surgical treatment of achalasia?
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myotomy (Heller's myotomy)
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What is the non-surgical treatment of achalasia?
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CCBs, long acting nitrates; pneumatic dilation; botulinum toxin to LES
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What is the most effect non-surgical treatment of achalasia?
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pneumatic dilation
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What esophageal motility disorder requires manometry for diagnosis?
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diffuse esophageal spasm
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If, on barium swallow, you note a CORKSCREW esophagus, what do you suspect?
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esophageal spasm
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What is the treatment for diffuse esophageal spasm?
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CCBs, nitrates, botulinum toxin; anoxilytic agents in conjunction with anti-reflux therapy
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If you have patient who complains of angina-like chest pain, with pain at night, spontaneous onset, regurgitation, odynophagia, dysphagia that is meal induced, what should you suspect?
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nutcracker esophagus
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How would you diagnose nutcracker esophagus?
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high amplitude, long duration contractions; with high pressure waves (>180 mmHg) in distal esophagus
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What is the most common form of esophagitis?
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chemical
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What is the #1 cause of infectious esophagitis?
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candida
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What is the most common cause of chemical esophagitis (GERD)?
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HCL regurgitated from the stomach
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What are complications of GERD?
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esophageal strictures, ulcers, bleeding, perforation, Barret's esophagitis, esophageal adenocarcinoma
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What is Barret's esophagitis?
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metaplasia of esophagus
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What is Barrett's esophagitis most often caused by?
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GERD
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What section of esophagus is typically involved with Barrett's Esophagus?
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lower segment
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How do you diagnose Barrett's esophagus?
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endoscopy, SALMON RED patches, COLUMNAR replacing squamous epithelium
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What is the #1 cause of esophageal perforation?
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endoscopy
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What is Boerhaave Syndrome?
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emesis-induced esophageal perforation
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What type of esophageal perforation is generally seen in alcoholics?
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Boerhaave Syndrome
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If you have a patient who claims to drink a six-pack of beer every night and has severe vomiting with severe chest pain/dyspnea following, what should you suspect?
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Boerhaave Syndrome
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What is Hammon's crunch and what is it indicative of?
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air in mediastinum being moved by beating heart; esophageal perforation
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What is an associated finding of esophageal perforation?
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cervical crepitis caused by pneumomediastinum
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How is esophageal perforation diagnosed?
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CXR (first GASTROGRAFIN); CT/Endoscopy confirms
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What is the most common cause of esophageal bleeding?
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cirrhosis
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What is first line for control of esophageal bleeding?
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endoscopy
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Describe Mallory-Weiss Syndrome.
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ARTERIAL bleeding from longitudinal mucosal lacerations of DISTAL esophagus/PROXIMAL stomach
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What is treatment initially of Mallory-Weiss Syndrome?
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supportive, as most stop spontaneously
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What is the treatment for ongoing Mallory-Weiss Syndrome?
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electrocoagulation, sclerotherapy, laser photocoagulation, angiographic embolization, surgery
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What is the cause of Mallory-Weiss Syndrome?
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violent retching, large food
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What population is Mallory-Weiss typically seen in?
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alcoholics
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What is the most common type of esophageal cancer?
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adenocarcinoma arising from Barrett's Mucosa
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If you see a patient with smooth appearing hands and dysphagia, what should you suspect?
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scleroderma
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What is sclerodactyly?
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diffuse thickening of skin on hands; smooth appearance
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