2 Feb 24 Flashcards
Causes of mechanical obstruction in GERD
Esophageal stricture
Esoohageal Adenocarcinoma
Esophageal stricture cause And Endoscopy
Reparative collagen deposition in response to esophageal mucosal damage caused by acidic gastric contents.
Strictures are not malignant
Emdoscopy :
Symmetric concentric narrowing in distal esophagus.
Ttt:
Endoscopic dilation
Esophageal adenocarcinoma
Endoscopy:
Asymmetrical and irregular narrowing of distal esophagus
Esophageal stricture vs achalasia
Achalasia presents with dysphagia to solids and liquids at onset.
Barium swallow shows dilation of proximal to lower sphincter and narrowing at LES (birds beak)
Stricture is mechanical obstruction.
Achalasia is motility disorder
Stricture has progressive dysphagia to solids (not liquids).
Evaluation of dysphagia
Progressive solid food dysphagia
(Mechanical obs - stricture , CA , rings)
Dx. : endoscopy
(Diagnostic and therapeutic - stricture dilation)
-with /without barium swallow beforehand
Motility disorders :
Both solid and liquid dysphagia
DX : barium swallow , manometry
(Along with endoscopy to rule out obstruction)
Alarm features in GERD
Dysphagia /odynophagia
Iron def anemia
GI bleed
Unexplained weight loss
Persistent vomiting
Family history of GI cancer
Barret esophagus RF
Age >50
Male sex
Smoking history
GERD >5y
Obesity
Family history
White ethnicity
Hiatal hernia.
Pt with GERD and alarm symptoms
Do endoscopy
Ptvwith GERD. No alarm S/S.
Management
S/S mild (<2days per week)
Antacids or H2RA + lifestyle changes
S/S severe (>2days per week)
PPI + lifestyle changes.
Paraesophageal hernia cF , dx , ttt
Cause : PE membrane defect causing gastric fundus to herniate
CF. : NV , post prandial fullness , dysphagia , epigastric and chest pain.
Complications: Resp compromise , gastric volvulus.
XRay : retrocardiac air fluid level
Gold standard dx : Barium swallow or upper endoscopy.
Ttt: Surgery.
Sliding hernia cause dx Ttt
Most common
Cause : Phrenoesophageal membrane laxity causes gastric cardia to migrate into thoracic cavity.
GE junction and proximal stomach slide in chest.
SS : A/S or mild reflux symptoms
Ttt: Medical ttt of reflux
Dx : same as PEH
Eosinophilic esophagitis mechnism
Th2 mediated inflammatory response triggered by food antigen exposure
Comorbid atopic disease
Eosinophilic esophagitis CF
Intermittent solid food Dysphagia
Heartburn and epigastric pain
Regurg
Food impaction in chest
Refractory GERd
If not recognized early can lead to fibrosis (strictures) causing progressive dysphagia and food impaction.
DX of eosinophilic esophagitis
Endoscopy :
Furrowing
Small white exudates
Multiple stacked ringlike esophageal indentations (trachealization of esophagus)
Biopsy : >15 eosinophils /hpf
Ttt of EE
Elimination diet
PPis
Topical glucocorticoids.
Acute erosive gastropathy caustive agents
🍦Excessive alcohol (direct mucosal injury)
Dec normal protective barriers (secreted mucins and bicarb)
🍦Cocaine (dec gastric blood flow by vasoconstricting)
🍦 multiple doses of Aspirin (acutely in hours dec prostaglandin needed for gastric lining protection)
Acute erosive gastropathy def
Development of severe hemorrhagic lesions shortly after exposure of gastric mucosa to various injurious agents or after a substantial reduction in blood flow.
CF : Acute abd pain
Hematemesis
Pt on warfarin has high INR , requires surgery
Disconitinue warfarin
Give PCC if INR>2
3 factor PCC (2,9,10,C,S)
4 factor PCC (2,7,9,10,C,S)
Rapidly normalizes INR <10mins.
Effect is transient
IV vitamin K
If PCC not available, give FFP (risk of volume overload ,req multiple units , less effective)
Gold standard for Gastric Ca
Esophagodueodenoscopy
To visualize and take biopsy samples
Of lesion.
RF for Gastric CA
East asian (south korea)
Eastern europe
Andean part of south america
(Diet rich in nitroso compounds and salt preserved foods )
H.pylori
Smoking
Alcohol
Atrophic gastritis.
Dyspepsia SS
Epigastric pain or burning
PP fullness , early satiety , bloating
>1 months.
Causes of Dyspepsia
Functional/idiopathic 75%
Malignancy (gastric , esophageal)
Peptic ulcer (H.Pylori , NSAIDS)
Drig induced. (NSAIDS , bisphosphonates)
Workup of dypepsia
Low cancer risk ; (age <60 , no alarm features )
Test for Hpylori
High cancer risk (age >60 or alarm features)
Upper endoscopy
Ttt of dyspesia
Treat underlying cause
Give PPI if no cause found
