Term
| Tx of choice for young people with achalasia |
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Definition
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Term
| Classic triad of sx of achalasia |
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Definition
1. Dysphagia
2. Regurgitation
3. Weight loss |
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Term
| Diagnostic work-up of achalasia |
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Definition
1. Manometry
2. Barium esophagram (bird's beak)
3. Endoscopy (to r/o cancer) |
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Term
| Main risk factors for esophageal cancer |
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Definition
1. Smoking
2. EtOH
3. Ingestion of nitrosamine compounds
4. mineral deficiencies
5. betel nut chewing
6. long standing achalasia
7. Barrett esophagus
8. caustic burns
9. Tylosis (auto-dom d/o characterized by hyperkeratosis of palms and soles |
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Term
| Most common benign tumor of the esophagus |
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Definition
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Term
| Smooth crescent-shaped filling defect that encroaches on the esophageal lumen on barium swallow |
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Definition
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Term
| Smooth tumor that moves up and down with swallowing on upper endoscopy |
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Definition
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Term
Leiomyoma:
# appearance on barium swallow
# appearance on EGD
# treatment |
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Definition
# Smooth crescent-shaped filling defect that encroaches on the esophageal lumen on barium swallow
# Smooth tumor that moves up and down with swallowing on upper endoscopy
# If it has above 2 characteristics, DO NOT BX (risk of perforation)-> enucleate videoscopically with intra-op EGD |
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Term
| Cell of origin for leimyomas |
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Definition
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Term
Leimyomas
# avg age of presentation
# gender distribution
# MC location in esophagus |
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Definition
# 4th decade (38)
# 2:1 M:F
# lower two-thirds |
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Term
Barrett Esophagus
# incidence
# Gender breakdown
# risk of cancer
# racial/ethnic predilection |
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Definition
# 5-7% of people with GERD
# 3:1 M:F
# 0.5% per year once Barret develops
# uncommon in African Americans |
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Term
| Histopathologic hallmark in Barrett |
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Definition
| Metaplastic change of LES squamous cells to intestinal goblet cells |
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Term
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Definition
Medical treatment (PPIs) with surveillance until evidence of dysplasia. Once severe dysplasia develops, esophagectomy.
Medical management is equal to anti-reflux in preventing progression to dysplasia and cancer. |
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Term
| Pathophys of Boerhave syndrom and Mallory-Weiss tear |
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Definition
| Forcefull vomiting or couging in the presence of a hiatal hernia |
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Term
| MC congenital diaphragmatic hernia |
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Definition
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Term
| Fun facts about Bochdalek hernias |
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Definition
# posterolateral on left
# repaired via an abdominal approach
# no sac present in 80-90%) |
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Term
| Pathophys of Morgagni hernia |
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Definition
| herniation of contents through the foramen of Morgagni which is the sternocostal hiatus |
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Term
| Fun facts about Morgagni hernias |
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Definition
# usually on right
# usually contains a sac
# rare: about 5% of congenital diaphragmatic hernias
# usually not recognized at birth because of small size;
# pts may complain of indigestion and/or belching |
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Term
| Hoarseness, difficulty swallowing food, weight loss and inability to handle saliva secretion/expectoration |
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Definition
| Cricopharyngeal dysfunction |
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Term
| MOA of Cricopharyngeal dysfunction |
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Definition
| Cricopharyngeas, which is normally in a state of tonic contraction, fails to relax to allow passage of food into the cervical esophagus |
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Term
| Dysphagia with regurgitation and weight loss |
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Definition
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Term
| Dysphagia with chest pain |
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Definition
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Term
| W/u for cricopharyngeal disfunction |
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Definition
| Start with barium swallow (to avoid perforating a Zencker's diverticulum) + cine or video radiography, manometry, esophagoscopy |
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Term
| Possible lab abnormality a/w paraesophageal hernia and pathogenesis |
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Definition
| Anemia: as the fundus herniates, it twists, and causes mucosal erosions which is a source of chronic blood loss |
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Term
| Triad of Boerhaave syndrome |
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Definition
| Vomiting, chest pain and subq emphysema; AKA Mackler triad |
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Term
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Definition
| Boerhaave syndrome: chest pain, vomiting, and subq emphysema |
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Term
| Management of Boerhaave/esophageal perforation |
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Definition
| If detected witing 72 hrs, primary repair with intercostal muscle or pleural flap |
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Term
| Best method of dx of Boerhaave or esophageal perforation |
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Definition
| Gastrograffin esophagram (shows extravasation in 90%) |
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Term
| Possible lab abnormality a/w Boerhaave/esophageal perforation |
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Definition
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Term
| Most common location of spontaneous esophageal ruptures |
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Definition
| Left lower esophagus in 80-90% |
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Term
| Pt with a h/o GERD p/w vomiting, severe chest pain and a left-sided effusion |
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Definition
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Term
| MC location of Zenker's diverticulum |
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Definition
| Killian's triangle: inferior fibers of inferior constrictor muscle and superior border of cricopharyngeas muscle |
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Term
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Definition
| Open technique (esophagomyotomy) for small (< 3 cm) and endoscopic for larger ones |
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Term
| Management of iatrogenic esophageal perforation |
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Definition
# If leak is contained, non-op
# If perforation is free, surgery
# for leak > 72 hrs, severe imflammation or extremely ill/old patient: resection of injured segment, cervical esophagostomy, gastrostomy and feeding J tube |
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Term
| Management of caustic ingestion |
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Definition
ABCs followed by:
Kids with sx (stridor, hoarseness) and adults- esophagoscopy to assess the degree if injury |
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Term
| Classification of caustic injury to esophagus and management |
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Definition
Class I- mucosal hyperemia, edema (observation)
Class II- limited hemorrhage and pseudomembrane formation
Class III- complete obstruction by edema or charring
Class II or III (provided no perforation): NPO, IV abx, H2 blocers, PPI and IVF +/- steroids |
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