104b Esophagus clinical Flashcards
globus
perception of a lump in throat even without swallowing
water brash
excessive salivation; response to reflux
structural abnormality vs propulsive disorder - presentation for solids and liquids
structural - solid food only usually
propulsive - solid and liquid
structural abnormality examples
EoE
tumor
stricture
propulsive disorder examples
GERD
achalasia
esophageal rings/webs
schatzki ring - lower esophageal mucosal ring
cervial web - higher in esophagus (part of plummer vinson syndrome)
GERD pathophys
90% transient LES relaxations
impaired salvation
impaired partistalitic empting
Possible GERD outcomes
Non-erosive GERD (EGD negative) - poor QOL
Esophagitis - stricture, bleeding, BE and adenocar.
Extra-esophagus GERD
GERD treatment
Pharm: PPI and H2RA blockers
Lifestyle mods: weight loss, avoid certain foods
surgical: nissen
EoE - history, symptims, endoscopy, pathology
history - atopy, food allergies symptoms - dysphagia and food impaction endoscopy - rings, furrows, exudates path - biopsy with eosinophil inflammation isolated to esophagus
EoE diagnosis, complications and outcomes
dx - biopsy (superficial eosinphils >15/hpf)
fibrosis in lamina propria, strictures, food impaction, NO CANCER
EoE treatment
medical - topical steroids (fluticasone, budesonide)
diet (6 food elimination diet)
endoscopic therapy
achalasia pathophys
loss of ganglion cells in esophagus myenteric plexus affects inhibitor neurons –> can’t relax LES
achalasia pathophys
loss of ganglion cells in esophagus myenteric plexus affects inhibitor neurons –> can’t relax LES
achalasia complications
progressive dilation and sigmoid deformity
bird’s peak tapering at LES
dysphagia, regurg, weight loss, aspiration, stasis–>increased cancer risk
achalasia complications
progressive dilation and sigmoid deformity
bird’s peak tapering at LES
dysphagia, regurg, weight loss, aspiration, stasis–>increased cancer risk
achalasia diagnosis
manometry (impaired LES relaxation and absent peristalsis)
radiography (barium swallow - bird’s beak)
achalasia diagnosis
manometry (impaired LES relaxation and absent peristalsis)
radiography (barium swallow - bird’s beak)
achalasia treatment
botox (cleaves SNAP25 and prevents ACh release)
pneumatic dilation
heller myotomy
achalasia treatment
botox (cleaves SNAP25 and prevents ACh release)
pneumatic dilation
heller myotomy
diffuse esophageal spasm
simultaneous contractions leading to episodes of chest pain and dysphagia
Rx-nitrates, ccb, botox
diffuse esophageal spasm
simultaneous contractions leading to episodes of chest pain and dysphagia
Rx-nitrates, ccb, botox
infectious esophagitis - causes
candidal - most common
herpetic
CMV
infectious esophagitis - causes
candidal - most common
herpetic
CMV
