PANCE/PANRE: Gastroenterology
Exam-Graded A
What is another term for GERD? - ANSWER-Reflux esophagitis
What might chronic GERD or Reflux Esophagitis result in if left untreated? - ANSWER-
Barrett Esophagitis; Squamous epithilium turns into columnar epithelium.
What are some medications that can worsen GERD? - ANSWER-Tetracycline,
Bisphonates, Iron, NSAIDS, Anticholingergics (i.e. Iptatropium Bromide), CCB,
Narcotics & Benzodiazepines.
What is the most common presenting feature of Reflux Esophagitis? - ANSWER-
Heartburn
What are some clinical features of GERD? - ANSWER-Heartburn, Halitosis, Hiccupping,
Cough, Laryngitis, atypical chest pain
What are some diagnostic studies for GERD? - ANSWER-Although usually clinical,
more severe disease warrants Endoscopy to confirm and assess damage.
What are some diagnostic studies for GERD when refractory to treatment? - ANSWER-
EKG
Barium Swallow
Esophageal manometry
24-Hour pH monitoring
CBC
What is the treatment of Refulx Esophagitis? - ANSWER-Lifestyle modification: stop
smoking, eating late, no large meals, avoid alcohol and caffeine and fried foods, raise
head at night.
Antacids, H2 Blockers (Cimetidine, Ranitidine, Famotidine) for symptomatic relief
If antacids and lifestyle modification don't work ---> Proton Pump Inhibitors, such as
Omeprazole, Pantoprazole, etc.
True or False
Infectious esophagitis is RARE, except in immunocompromised persons. - ANSWER-
TRUE
,What etiological cause of Infectious Esophagitis reveals DEEP ULCERS? - ANSWER-
CMV
What etiological cause of Infectious Esophagitis reveals SHALLOW ULCERS? -
ANSWER-HSV
What are the clinical features of Infectious esophagitis? - ANSWER-Odynophagia
(painful swallowing) or Dysphagia (Difficulty swallowing)
What are the diagnostic studies for infectious esophagitis? - ANSWER-Endoscopy,
Cytology
What is the treatment for infectious esophagitis? - ANSWER-Candida: Fluconazole or
Ketoconazole
HSV: Acyclovir
CMV: IV Ganciclovir or Foscarnet
What is the most common clinical finding with all esophageal motility disorders? -
ANSWER-Dysphagia (Difficulty swallowing)
What is a Zenker Diverticulum? - ANSWER-This is an outpouching of the posterior
hypo-pharynx that is seen in older patients and can cause dysphagia, regurgitation and
halitosis.
What is the diagnostic test for Zenker's Diverticulum? - ANSWER-Barium Swallow
What is the treatment for Zenker's Diverticulum? - ANSWER-Myotomy or
Diverticulectomy
What is Achalasia? - ANSWER-Achalasia is a disorder in which the peristalsis is
decreased and the LES tone is increased, causing slowly progressive dysphagia
(difficulty swallowing) and chest pain.
What is the diagnostic test for Achalasia and it's associated findings? - ANSWER-
Barium Swallow. Birds beak appearance
What is the treatment of Achalasia? - ANSWER-Dilatation
Botox
Surgery
What are the clinical findings of Scleroderma of the esophagus? - ANSWER-Dysphagia
(difficulty swallowing) to BOTH solids & liquids.
, What is the diagnostic method of choice for Scleroderma? - ANSWER-Barium Swallow,
which would show no peristalsis and Manometry, which would show decreased LES
tone.
What is the treatment of Scleroderma of the esophagus? - ANSWER-Proton Pump
Inhibitors such as Omeprazole and Pantoprazole.
What are the most common esophageal neoplasms (cancers)? - ANSWER-SCC and
Adenocarcinoma
What is the etiology behind Esophageal spasms? - ANSWER-Idiopathic, possibly Nitric
Oxide deficiency
What is the classic feature seen upon barium swallow with esophageal spasms? -
ANSWER-Corkscrew esophagus
What type of esophageal cancer is Barrets Esophagus likely to evolve into? - ANSWER-
Adenocarcinoma (in the distal 1/3 of the esophagus)
Where are the neoplasms typically located within the esophagus? - ANSWER-
Adenocarcinomas are in the distal 1/3 and SCC are usually in the proximal 2/3.
What is the typical clinical features of Esophageal neoplasms? - ANSWER-Progressive
dysphagia for solid food with weight loss.
What are the diagnostic studies for esophageal neoplasms? - ANSWER-Endoscopy is
the DEFINITIVE choice.
Biphasic barium esophagram
Endoscopic sonography & CT ....for staging.
What is the treatment for Esophageal neoplasms? - ANSWER-Surgical, Radiation,
Chemo.
What is a Mallory Weiss Tear? - ANSWER-Mallory Weiss syndrome is characterized by
a non-penetrating mucosal tear at the GE junction that is from a rise in transabdominal
pressure. It is often associated with alcoholism or vomiting.
What is the treatment for a Mallory Weiss Tear? - ANSWER-None. Most heal within 48
hours (self-limiting). However, if bleeding, endoscopic epi/thermal coagulation.
Note: After the active bleed is resolved, a PPI may be used.
What is the diagnostic procedure of choice with the Mallory weiss tear? - ANSWER-
Endoscopy
Exam-Graded A
What is another term for GERD? - ANSWER-Reflux esophagitis
What might chronic GERD or Reflux Esophagitis result in if left untreated? - ANSWER-
Barrett Esophagitis; Squamous epithilium turns into columnar epithelium.
What are some medications that can worsen GERD? - ANSWER-Tetracycline,
Bisphonates, Iron, NSAIDS, Anticholingergics (i.e. Iptatropium Bromide), CCB,
Narcotics & Benzodiazepines.
What is the most common presenting feature of Reflux Esophagitis? - ANSWER-
Heartburn
What are some clinical features of GERD? - ANSWER-Heartburn, Halitosis, Hiccupping,
Cough, Laryngitis, atypical chest pain
What are some diagnostic studies for GERD? - ANSWER-Although usually clinical,
more severe disease warrants Endoscopy to confirm and assess damage.
What are some diagnostic studies for GERD when refractory to treatment? - ANSWER-
EKG
Barium Swallow
Esophageal manometry
24-Hour pH monitoring
CBC
What is the treatment of Refulx Esophagitis? - ANSWER-Lifestyle modification: stop
smoking, eating late, no large meals, avoid alcohol and caffeine and fried foods, raise
head at night.
Antacids, H2 Blockers (Cimetidine, Ranitidine, Famotidine) for symptomatic relief
If antacids and lifestyle modification don't work ---> Proton Pump Inhibitors, such as
Omeprazole, Pantoprazole, etc.
True or False
Infectious esophagitis is RARE, except in immunocompromised persons. - ANSWER-
TRUE
,What etiological cause of Infectious Esophagitis reveals DEEP ULCERS? - ANSWER-
CMV
What etiological cause of Infectious Esophagitis reveals SHALLOW ULCERS? -
ANSWER-HSV
What are the clinical features of Infectious esophagitis? - ANSWER-Odynophagia
(painful swallowing) or Dysphagia (Difficulty swallowing)
What are the diagnostic studies for infectious esophagitis? - ANSWER-Endoscopy,
Cytology
What is the treatment for infectious esophagitis? - ANSWER-Candida: Fluconazole or
Ketoconazole
HSV: Acyclovir
CMV: IV Ganciclovir or Foscarnet
What is the most common clinical finding with all esophageal motility disorders? -
ANSWER-Dysphagia (Difficulty swallowing)
What is a Zenker Diverticulum? - ANSWER-This is an outpouching of the posterior
hypo-pharynx that is seen in older patients and can cause dysphagia, regurgitation and
halitosis.
What is the diagnostic test for Zenker's Diverticulum? - ANSWER-Barium Swallow
What is the treatment for Zenker's Diverticulum? - ANSWER-Myotomy or
Diverticulectomy
What is Achalasia? - ANSWER-Achalasia is a disorder in which the peristalsis is
decreased and the LES tone is increased, causing slowly progressive dysphagia
(difficulty swallowing) and chest pain.
What is the diagnostic test for Achalasia and it's associated findings? - ANSWER-
Barium Swallow. Birds beak appearance
What is the treatment of Achalasia? - ANSWER-Dilatation
Botox
Surgery
What are the clinical findings of Scleroderma of the esophagus? - ANSWER-Dysphagia
(difficulty swallowing) to BOTH solids & liquids.
, What is the diagnostic method of choice for Scleroderma? - ANSWER-Barium Swallow,
which would show no peristalsis and Manometry, which would show decreased LES
tone.
What is the treatment of Scleroderma of the esophagus? - ANSWER-Proton Pump
Inhibitors such as Omeprazole and Pantoprazole.
What are the most common esophageal neoplasms (cancers)? - ANSWER-SCC and
Adenocarcinoma
What is the etiology behind Esophageal spasms? - ANSWER-Idiopathic, possibly Nitric
Oxide deficiency
What is the classic feature seen upon barium swallow with esophageal spasms? -
ANSWER-Corkscrew esophagus
What type of esophageal cancer is Barrets Esophagus likely to evolve into? - ANSWER-
Adenocarcinoma (in the distal 1/3 of the esophagus)
Where are the neoplasms typically located within the esophagus? - ANSWER-
Adenocarcinomas are in the distal 1/3 and SCC are usually in the proximal 2/3.
What is the typical clinical features of Esophageal neoplasms? - ANSWER-Progressive
dysphagia for solid food with weight loss.
What are the diagnostic studies for esophageal neoplasms? - ANSWER-Endoscopy is
the DEFINITIVE choice.
Biphasic barium esophagram
Endoscopic sonography & CT ....for staging.
What is the treatment for Esophageal neoplasms? - ANSWER-Surgical, Radiation,
Chemo.
What is a Mallory Weiss Tear? - ANSWER-Mallory Weiss syndrome is characterized by
a non-penetrating mucosal tear at the GE junction that is from a rise in transabdominal
pressure. It is often associated with alcoholism or vomiting.
What is the treatment for a Mallory Weiss Tear? - ANSWER-None. Most heal within 48
hours (self-limiting). However, if bleeding, endoscopic epi/thermal coagulation.
Note: After the active bleed is resolved, a PPI may be used.
What is the diagnostic procedure of choice with the Mallory weiss tear? - ANSWER-
Endoscopy
