Ch. 11 Abd & GI Emergencies Flashcards
What is the treatment for pill esophagitis?
Instruct patients to drink 8 oz of water with each pill and then remain upright for at least 30 minutes. Full symptom relief may take
up to 6 weeks.
What is the treatment for esophagitis caused by C albicans?
mild disease & not immunocompromised: Clotrimazole troches or nystatin swish and swallow for 1-2 weeks
Advanced disease and/or immunocompromised:
Oral fluconazole or itraconazole for 3-4 weeks.
What is the treatment for esophagitis caused by CMV?
IV ganciclovir or foscarnet
What is the treatment for esophagitis caused by HSV?
Oral acyclovir or valacyclovir
How is GERD treated?
an empiric trial of proton pump inhibitor (PPI) for 4-6 weeks
What are alarm symptoms for GERD that may necessitate need for upper endoscopy with biopsy?
dyphagia
odynophagia
weight loss
anemia
long-standing symptoms
blood in stool
age > 50
What are the only two behavior modifications proven to improve sx of GERD?
elevate head of bed
weight loss
but should be advised in combination with PPI
What are 4 conditions found to be associated with use of PPIs?
- pneumonia
- atrophic gastritis (hypergastrinemia)
- enteric infections (c diff)
- hip fractures
When should PPIs be avoided?
Patients with acute coronary syndrome on clopidogrel
- associated with increased reinfarction
Caustic ingestions with acids cause _______ necrosis.
Coagulation
Caustic ingestions with alkalis cause ______ necrosis.
Liquefactive
Ingestion of household bleach is unlikely to cause serious problems unless > ______ (volume) has been ingested.
> 100 mL
What is the workup for a caustic ingestion?
if perforation suspected –> CXR or CT; +/- upper endoscopy
IV fluids, IV pain medications, and IV PPI; +/- abx
do not give anything by mouth; do not give activated charcoal
What is Hamman sign?
Mediastinal crunch heard during systole with auscultation of the heart (not respiration)
Indicates Esophageal perforation
What tests should be considered if concerned for perforation?
Plain CXR and/or lateral neck film
if normal –> does not exclude
Obtain esophagram using WATER-SOLUBLE contrast +/- EGD
Do NOT use BARIUM as it can worsen mediastinitis
can consider CT
How can pleural fluid from thoracentesis be used to increase suspicion for esophageal perforation?
elevated amylase levels
If you diagnose esophageal perforation, what is the next step?
keep NPO
administer broad spectrum abx
surgical consultation
How is achalasia diagnosed?
Bird’s beak on barium swallow
–> refer to GI for endoscopy and confirmatory manometry
What is the treatment for achalasia?
Typically outpatient GI referral for:
surgical myotomy vs dilation vs botulinum
toxin injections.
Medical options include nifedipine or nitrates before meals to decreases LES pressure.
What triad makes up Plummer-Vinson Syndrome?
Triad of dysphagia, glossitis, and iron-deficiency anemia – commonly see esophageal webs
In foreign body ingestions, where does obstruction typically occur in children?
In children < 4 years, this is the level of the cricopharyngeus muscle (C6)
When is emergent endoscopy indicated for foreign body ingestions?
sharp objects or disc batteries in the esophagus,
or for objects causing obstruction with inability to handle secretions
When is urgent endoscopy (<24 hours) indicated for foreign body ingestions?
for smooth objects or food impaction
in the esophagus, sharp or large (> 6 cm) objects in the stomach/duodenum, or magnets
How long can esophageal coins be observed?
12-24 hours