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Esophageal Disorders
Clinical Medicine Test 5
40
Medical
Graduate
11/01/2010

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Cards

Term
What can determine diagnosis in 80% of esophageal disorders?
Definition
History
Term
Achalasia is most likely to cause what?
Definition
dysphagia for liquids
Term
What is the cardinal symptom of GERD?
Definition
chronic heartburn
Term
What do strictures usually cause?
Definition
dysphagia that is progressive in frequency and severity
Term
What do a majority of patients with dysphagia from adenocarcinoma in Barret esophagus have a history of?
Definition
long-standing heartburn
Term
What are the most common medications cause pill esophagitis?
Definition
antibiotics, Potassium chloride, NSAIDS, adn quinidine
Term
What are scleroderma, RA, and SLE associated with?
Definition
Raynaud Phenomenon
Term
Infectious esophagitis is most common in whom?
Definition
compromised immune system: HIV, malignancy, post-transplant
Term
Barium swallow is more sensitive than endoscopy for what?
Definition
1) subtle narrowing of esophagus
2) motility disorders
Term
Endoscopy is used in whom and is more sensitive than barium for what?
Definition
1) virtually all patients to diagnosis
2) subtle mucosal lesions
Term
what is the gold standard for esophageal motlity disorders?
Definition
Esophageal manometry
Term
What are 2/3 of benign esophageal strictures caused by?
Definition
GERD
Term
how are benign esophageal strictures treated?
Definition
dilation

*If 2ndar to GERD - PPI
Term
Where are esophageal (Schatzki) rings located at?
Definition
squamocolumnar junction
Term
What are lower esophageal (Schatzki) rings often associated with?
Definition
hiatal hernias and GERD
Term
What are four major categories of esophageal motility abnormalities
Definition
1) inadequate relaxation of LES
2) Uncoordinated contraction
3) Hypercontraction
4) Hypocontraction
Term
What chemical is decreased due to neuronal inhibitory neuron degeneration in achalasia?
Definition
nitric oxide
Term
What infectious disease is associated with achalasia?
Definition
Chagas disease from trypanosoma cruzi
Term
Barium swallows will show what in 95% of achalsia patients?
Definition
beaklike narrowing
Term
What is a feared complication of pneumatic dilation therapy?
Definition
esophageal perforation
Term
What is a complication associated with myotomy?
Definition
GERD in 10%
Term
What happens in 80% of patients with scleroderma?
Definition
fibrosis and ischemia damage of esophagus
Term
GERD higher incidence with what risk factor?
Definition
obesity
Term
Most patients with GERD have what anatomic abnormality?
Definition
hiatal hernia
Term
increasing acid secretion and decreasing salivation in GERD are associated with?
Definition
Ciagrette smoking
Term
What may be protective in GERD and has a negative association with esophageal carcinoma
Definition
H. pylori
Term
how is pain described with GERD?
Definition
uncomfortable, burning sensation behind sternum. often begins in the epigastrum and radiates upward
Term
What medication tx eliminates GERD?
Definition
PPIs
Term
What is the most sensitive test for GERD and Barret esophagus?
Definition
endoscopy
Term
reflux is defined as a pH of what?
Definition
below 4
Term
What treatment provides healing 80-100% in 8-12 weeks?
Definition
PPIs maintenance therapy usually required
Term
adenocarcinoma develops in what percent of barrett esophagus
Definition
0.5%
Term
What are the three most common infections causing esophagitis?
Definition
1) candida
2) HSV
3) cytomegalovirus CMV
Term
What clinical manifestations are seen in most patients with infectious esophagitis?
Definition
1) dysphagia
2) odynophagia
Term
what is the most frequent etiology of esophagitis and what is the most common symptom?
Definition
Candida and thrush
Term
What are the treatments for
1) mild esophagitis
2) more severe infection
3) severe infection
Definition
1) topical agent, clotrimazole
2) systemic antifungal, fluconazole
3) IV amphotericin B
Term
What is the drug of choice for HSV esophagitis?
Definition
acyclovir- systemic antiviral agent
Term
What type is 90% of esophageal cancers and who are they more common in?
Definition
squamous cell, more common in blacks
Term
What are the 3 most common risk factors for adenocarcinoma?
Definition
1) GERD
2) Barrett esophagus
3) Obesity
Term
What does the presence of symptoms usually represent in esophageal cancers?
Definition
advanced disease and poor prognosis
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