Clinic-Esophagitis Flashcards
the top ___ of the esophagus is skeletal muscle
one-third
what three things come together to avoid esophageal reflux in a normal esophagus?
LES, crux of diaphragm, and angle of His
what is primary peristalsis?
orderly contraction of smooth muscle to propagate food particles caudad, specifically associated with a swallow
what innervates the LES?
vagal pre-ganglionic and sympathetic post-ganglionic neurons
when does the LES relax?
with onset of swallow; intermittently and transiently all day to allow venting
mucosal barrier defenses
tight junctions, enhanced bicarb production, transmembrane pumps (Na/H, Cl/bicarb), salivary bicarb to neutralize pH
common sx of GERD
substernal chest burning, regurgitation/belching, dysphagia (SPECIFIC but not sensitive)
atypical reflux sx
hoarseness, asthma, chronic cough, sinusitis, bronchitis, bronchiectasis, erosion of dental enamel
RFs for GERD
male, increases with age, obesity, pregnancy, smoking, collagen vasc dz, alcohol use, hiatal hernia
contributors to pathophys of GERD
loose LES, prolonged/too many tLESRs, poor peristalsis, decreased gastric emptying, weakened epithelial resistance (smoking, alcohol) – NOT BC TOO MUCH ACID
major complications of GERD
erosive esophagitis, stricture formation, Barrett’s esophagus
sx of erosive esophagitis secondary to GERD
chest pain, dysphagia, odynophagia
strictures are composed of?
circular bands of scar tissue under the mucosa
tx of stricture
dilatation
Barrett’s esophagus occurs in ___% of ppl with GERD and increases the risk of ____
10%; adenocarcinoma
the risk of cancer is a patient with Barrett’s esophagus is?
very low (less than 5%)
what alarm symptoms trigger early investigation of GERD? What test is done?
weight loss, dysphagia, anemia, early satiety, bleeding; endoscopy or barium swallow
what is the most common diagnostic test for GERD?
empiric therapy (endoscopy better for complications, but not GERD)
what is the most accurate dx test for GERD?
24 hour pH probe (functional test for “functional” disease)
best test to examine a pt with dysphagia
barium swallow
what non-pharmacologic therapy should be tried first?
elevate head, stop smoking, stop drinking, reduce fat consumption, lose weight, avoid chocolate, caffeine, peppermint, citrus, tomato
moderate esophagitis should be treated with _____, while severe disease may be healed using ______
H2 blockers; PPIs
how do PPIs work?
irreversible blockage of H/K/ATPase (proton pump) = NO ACID production
what is a possible surgical anti-reflux procedure?
Nissen = fix hernia and move LES down, strengthen stricture
usual presentation with eosinophilic esophagitis
dysphagia
endoscopy of eosinophilic esophagitis shows?
ringed esophagus
dx of eosinophilic esophagitis
endoscopy with biopsy; biopsy shows eosinophils
CMV esophagitis shows ____ ulcers, where as pill-induced esophagitis shows ____ ulcers
punched out; kissing
