A 23-year-old college senior visits the university health clinic after vomiting large amounts of blood. He has been vomiting for the past 36 hours after celebrating his team’s win at the national hockey championship with his varsity friends while consuming copious amounts of alcohol. His personal medical history is unremarkable. His blood pressure is 129/89 mm Hg while supine and 100/70 mm Hg while standing. His pulse is 98/min, strong and regular, with an oxygen saturation of 98%. His body temperature is 36.5°C (97.7°F), while the rest of the physical exam is normal. Which of the following is associated with this patient’s condition?
AEsophageal tear
BPortal hypertension
CEsophageal metaplasia
DEsophageal varices
EEsophageal perforation
A previously healthy 55-year-old man comes to the physician because of a 5-month history of progressively worsening substernal chest pain after meals. The pain occurs almost daily, is worst after eating spicy food or drinking coffee, and often wakes him up from sleep at night. He has not had any weight loss. He has smoked 1 pack of cigarettes daily for 35 years and he drinks 1 to 2 glasses of wine daily with dinner. Physical examination is unremarkable. Esophagogastroduodenoscopy shows erythema of the distal esophagus with two small mucosal erosions. Biopsy specimens obtained from the esophagus show no evidence of metaplasia. Without treatment, this patient is at greatest risk for which of the following complications?
AEsophageal squamous cell carcinoma
BEsophageal adenocarcinoma
CEsophageal stricture
DSliding hiatal hernia
EPyloric stenosis
A 58-year-old man comes to the physician for the evaluation of intermittent dysphagia for 6 months. He states that he drinks a lot of water during meals to help reduce discomfort he has while swallowing food. He has hypertension and gastroesophageal reflux disease. He has smoked one half-pack of cigarettes daily for 32 years. He does not drink alcohol. Current medications include hydrochlorothiazide and ranitidine. He is 173 cm (5 ft 8 in) tall and weighs 101 kg (222 lb); BMI is 33.7 kg/m2. His temperature is 37°C (98.6°F), pulse is 75/min, and blood pressure is 125/75 mm Hg. The lungs are clear to auscultation. Cardiac examination shows no murmurs, rubs, or gallops. The abdomen is soft and nontender. A barium esophagogram shows a smooth, circumferential narrowing at the distal esophagus. An upper endoscopy shows a sliding hiatal hernia and a thin mucosal ring at the gastroesophageal junction. Biopsies from the area show normal squamous and columnar epithelium with no dysplasia or malignancy. Which of the following is the most appropriate next step in the management of this patient?
AMechanical dilation
BIron supplementation
CEsophageal stent
DEsophagectomy
ENissen fundoplication
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