Podcast
Questions and Answers
What is a common clinical manifestation of thrush?
What is a common clinical manifestation of thrush?
- Visible white plaques on oral mucous membranes (correct)
- Red sores on the lips
- Difficulty swallowing food
- Bleeding gums
Which population has the highest incidence of cleft lip and palate?
Which population has the highest incidence of cleft lip and palate?
- Caucasians (1:1,200)
- Africans (1:2,500)
- Asians (1:500) (correct)
- Hispanics (1:1,000)
What would suggest the possibility of an immunodeficiency in a patient with thrush?
What would suggest the possibility of an immunodeficiency in a patient with thrush?
- Thrush occurring only in infants
- Older patients presenting with recurrent thrush (correct)
- Presence of white plaques that are easily removable
- Thrush associated with a sore throat
Which treatment option is recommended for thrush?
Which treatment option is recommended for thrush?
Isolated cleft palate is associated with which factor?
Isolated cleft palate is associated with which factor?
What is the main reason behind treating both the infant and the mother in thrush cases?
What is the main reason behind treating both the infant and the mother in thrush cases?
What percentage of infants is affected by cleft lip and palate?
What percentage of infants is affected by cleft lip and palate?
What is the appearance of thrush when scraped with a tongue depressor?
What is the appearance of thrush when scraped with a tongue depressor?
What is one of the most common symptoms of eosinophilic esophagitis in adolescents and adults?
What is one of the most common symptoms of eosinophilic esophagitis in adolescents and adults?
Which factor is NOT associated with a higher prevalence of eosinophilic esophagitis?
Which factor is NOT associated with a higher prevalence of eosinophilic esophagitis?
What laboratory finding is used to confirm a diagnosis of eosinophilic esophagitis?
What laboratory finding is used to confirm a diagnosis of eosinophilic esophagitis?
What is a common treatment option for eosinophilic esophagitis?
What is a common treatment option for eosinophilic esophagitis?
What is a possible gross finding at endoscopy in a patient with eosinophilic esophagitis?
What is a possible gross finding at endoscopy in a patient with eosinophilic esophagitis?
What type of allergic reaction is eosinophilic esophagitis believed to be related to?
What type of allergic reaction is eosinophilic esophagitis believed to be related to?
What might a barium study reveal in a patient with eosinophilic esophagitis?
What might a barium study reveal in a patient with eosinophilic esophagitis?
What age group is most likely to present with oral aversion as a symptom of eosinophilic esophagitis?
What age group is most likely to present with oral aversion as a symptom of eosinophilic esophagitis?
What is a common clinical manifestation in children with esophageal foreign body impaction?
What is a common clinical manifestation in children with esophageal foreign body impaction?
Which of the following is NOT a common object that can become lodged in the esophagus?
Which of the following is NOT a common object that can become lodged in the esophagus?
Which type of esophageal atresia has the highest incidence?
Which type of esophageal atresia has the highest incidence?
What is a significant risk for children with a history of esophageal atresia?
What is a significant risk for children with a history of esophageal atresia?
What imaging study is the simplest method to test for tracheoesophageal fistula?
What imaging study is the simplest method to test for tracheoesophageal fistula?
What type of medication is most likely to cause pill ulcers when swallowed without sufficient liquid?
What type of medication is most likely to cause pill ulcers when swallowed without sufficient liquid?
Which clinical features may help older children indicate the problem when a foreign body is lodged?
Which clinical features may help older children indicate the problem when a foreign body is lodged?
What is considered a less serious caustic agent in terms of esophageal injury?
What is considered a less serious caustic agent in terms of esophageal injury?
Study Notes
Cleft Lip and Palate
- Epidemiology:
- Affects approximately 1 in 700 infants
- More common in Asians (1:500) and least common in Africans (1:2,500)
- Can occur separately or together
- Two possible patterns:
- Isolated soft tissue cleft palate
- Cleft lip with or without associated clefts of the hard palate
- Isolated cleft palate has a higher risk of other congenital malformations
- Combined cleft lip/palate type has a male predominance
Thrush
-
Epidemiology:
- Common in breast-fed infants due to colonization or infection of the mother’s nipples
- In older patients, it can indicate an immuno-deficiency, broad-spectrum antibiotic or inhaled steroid use, or diabetes.
-
Clinical Manifestations:
- White plaques often with a “fuzzy” appearance on oral mucous membranes
- Plaques are difficult to remove and the underlying mucosa is inflamed and friable
- Orophayngeal candidiasis can be painful (especially with esophagitis) and can interfere with feeding
- Usually diagnosed clinically, but fungal culture or potassium hydroxide smear can confirm
-
Treatment:
- Topical nystatin or an azole antifungal agent such as fluconazole
- When the mother’s breasts are infected and painful, consider treating her at the same time
Esophageal Atresia and Tracheo-esophageal Fistula (TEF)
- Types:
- Esophageal atresia with distal TEF (85%)
- Esophageal atresia with no TEF (8%)
- H-type TEF (4%)
- Esophageal atresia with proximal TEF (2%)
- Esophageal atresia with proximal and distal TEF (1%)
Esophageal Foreign Bodies
-
Common Objects:
- Coins
- Food items
- Small toys or toy parts
- Button batteries
- Small household items
-
Clinical Manifestations:
- Drooling
- Food refusal
- Chest discomfort
- Older children can usually point to the location of the foreign body
Esophageal Food Impactions
- Risk Factors:
- Prior history of esophageal atresia
- Poor motility secondary to GER or EoE
- Rare in a normal esophagus
Eosinophilic Esophagitis
-
Clinical Manifestations:
- Oral aversion, vomiting, and failure to thrive (young children)
- Vague abdominal pain or vomiting (school-age)
- Dysphagia and food impactions (adolescents/adults)
- Symptoms are attributed to inflammatory response, causing edema & poor esophageal motility
-
Laboratory & Imaging Studies:
- Multilevel esophageal biopsies via flexible endoscopy with more than 15 eosinophils per high-power field
- High-dose proton pump inhibitor treatment used to exclude acidic esophageal injury and evaluate for acid reflux via pH probe testing
- Barium study may reveal food impaction or esophageal stricture
-
Gross Endoscopic Findings:
- Normal appearance
- Esophageal linear furrowing
- Trachealization
- Eosinophilic abscesses
Caustic Esophagitis
-
Causative Agents:
- Strong alkalis: lye, drain cleaners, ammonia
- Strong acids: sulfuric acid, hydrochloric acid
- Important Information: Caustic agents can cause severe, extensive burns, which can lead to strictures, perforation, and death
-
Clinical Manifestations:
- Oral burns
- Drooling
- Dysphagia
- Chest pain
- Vomiting
- Symptoms may not be apparent for 24 hours
-
Management:
- Secure airway
- Prevent aspiration
- Endoscopy to assess degree of injury
- Surgery may be required
Pill Esophagitis
-
Risk Factors:
- Tetracyclines and Nonsteroidal Anti-inflammatory Drugs (NSAIDs) swallowed without sufficient liquids
-
Clinical Manifestations:
- Some are asymptomatic
- Drooling
- Food refusal
- Chest discomfort
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