1.2 MTB Step 3 - Esophageal Disorders (Esophagitis & Mallory-Weiss) Flashcards

Cards Complete:

1
Q

ESOPHAGITIS

β€œAn HIV-positive man comes in with progressive dysphagia and Odynophagia. He has 75 CD4 cells but no history of opportunistic infections.”

What is the Next BEST Step in Management?

A

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

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2
Q

ESOPHAGITIS

PRESENTATION

How does Esophagitis Present?

A

Odynophagia

PAIN on Swallowing as the food rubs against the Esophagus

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3
Q

ESOPHAGITIS

DIAGNOSIS

  1. What is the Best INITIAL Management Step for Esophagitis in an HIV-_Negative_ patient?
  2. What is the Best INITIAL Management Step for Esophagitis in an HIV-_Positive_ patient with < 100 CD4 cells?
A
  1. Endoscopy
  2. Fluconazole - only use endoscopy in these patients if there is NO response to this medication.
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4
Q

ESOPHAGITIS

ETIOLOGY

What are the (3) Main Causes of Esophagitis?

A
  1. Candida Esophagitis - causes > 90% of Esophagitis in HIV-Positive patients.
  2. Pills - Doxycycline or Alendronate.
  3. 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
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5
Q

ESOPHAGITIS

MANAGEMENT

  1. What is the Best INITIAL Test for Eosinophilic Esophagitis?
  2. What is the Most ACCURATE Test for Eosinophilic Esophagitis?
A
  1. Endoscopy
  2. Biopsy showing Eosinophils
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6
Q

ESOPHAGITIS

MANAGEMENT

  1. What is the Best INITIAL Therapy for Eosinophilic Esophagitis?
  2. What is the Most EFFECTIVE Therapy for Eosinophilic Esophagitis?
A
  1. Proton Pump Inhibitors (PPIs) and Eliminating Allergenic Foods
  2. Steroid Inhalers
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7
Q

MALLORY-WEISS TEAR

How does Mallory-Weiss Tear present?

A

Sudden Upper GI Bleeding

with

Violent Retching and Vomiting

+/- Hematemesis or Black Stool

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8
Q

MALLORY-WEISS TEAR

What is the Best Diagnostic Test for Mallory-Weiss Tear?

A
  1. Endoscopy
  2. Epinephrine, if bleeding persists
    • Most cases resolve spontaneously
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