1.2 MTB Step 3 - Esophageal Disorders (Esophagitis & Mallory-Weiss) Flashcards
Cards Complete:
ESOPHAGITIS
βAn HIV-positive man comes in with progressive dysphagia and Odynophagia. He has 75 CD4 cells but no history of opportunistic infections.β
What is the Next BEST Step in Management?
Fluconazole
When Odynophagia occurs in an HIV-positive patient, particularly when there are < 100 CD4 cells, the diagnosis is most likely Esophageal Candidiasis, and giving empiric Fluconazole is both Therapeutic and Diagnostic
ESOPHAGITIS
PRESENTATION
How does Esophagitis Present?
Odynophagia
PAIN on Swallowing as the food rubs against the Esophagus
ESOPHAGITIS
DIAGNOSIS
- What is the Best INITIAL Management Step for Esophagitis in an HIV-_Negative_ patient?
- What is the Best INITIAL Management Step for Esophagitis in an HIV-_Positive_ patient with < 100 CD4 cells?
- Endoscopy
- Fluconazole - only use endoscopy in these patients if there is NO response to this medication.
ESOPHAGITIS
ETIOLOGY
What are the (3) Main Causes of Esophagitis?
- Candida Esophagitis - causes > 90% of Esophagitis in HIV-Positive patients.
- Pills - Doxycycline or Alendronate.
- Eosinophilic Esophagitis - presents with swallowing difficulty, food impaction, and heartburn. Look for a patient with a history of Asthma and Allergic diseases and findings of Multiple Concentric Rings on Endoscopy
ESOPHAGITIS
MANAGEMENT
- What is the Best INITIAL Test for Eosinophilic Esophagitis?
- What is the Most ACCURATE Test for Eosinophilic Esophagitis?
- Endoscopy
- Biopsy showing Eosinophils
ESOPHAGITIS
MANAGEMENT
- What is the Best INITIAL Therapy for Eosinophilic Esophagitis?
- What is the Most EFFECTIVE Therapy for Eosinophilic Esophagitis?
- Proton Pump Inhibitors (PPIs) and Eliminating Allergenic Foods
- Steroid Inhalers
MALLORY-WEISS TEAR
How does Mallory-Weiss Tear present?
Sudden Upper GI Bleeding
with
Violent Retching and Vomiting
+/- Hematemesis or Black Stool
MALLORY-WEISS TEAR
What is the Best Diagnostic Test for Mallory-Weiss Tear?
- Endoscopy
-
Epinephrine, if bleeding persists
- Most cases resolve spontaneously