Diseases of the Esophagus Flashcards
common symptom with acid reflux?
dysphagia - oropharyngeal and esophageal
Esophageal dysphagia: Mechanical obstruction possibilities:
- Schatzkis ring
- peptic stricture
- esophageal cancer
SOLID ONLY UNLESS SIGNIFICANT OBSTRUCTION THEN + LIQUID- worry about cancer if quickly cant swallow both
predictable recurrent symptoms
-progressive!
Esophageal dysphagia: Motility disorder possibilities:
- achalasia
- diffuse esophageal spasm
- scleroderma
SOLIDS AND LIQUIDS
- unpredictable and episodic
- non-progressive
odynophagia is? What does it mean?
- painful swallowing
- denotes severe erosive disease (acid reflx, infection, caustic ingestion, pill induced)
What percent of adults experience HB? How many weekly episodes?
40%
20% weekly
What we think causes acid reflux?
Not any particular food but just eating causes the LES to relax - some people more than others and in some people the esophagus doesnt clear out (VIA peristalsis) the acid as quick
What to do with hiatal hernias?
usually nothing unless they are experiencing a lot of symptoms
WHich condition decreases peristalsis and makes acid reflux diseases worse (less clearance)?
scleroderma
Which conditions decrease salivation and make acid reflux worse (less clearance)?
shogrens
anticholinergic meds
oral RT
Delayed gastric emptying caused by?
- gastroparesis
- gastric outlet syndrome
GERD - clinical findings:
- HB and non cardaic chest pain
- relief with antacids
- regurgitation
- dysphagia
- atypical symptoms (chronic cough and asthma, chronic laryngitis and sore throat, globus sensation)
Diagnsois of reflux disease?
- usually based on history alone
- upper endoscopy
- response to antacids
- barium upper GI
- pH study
How to treat patients with lots of barrett or extremely symptomatic acid reflux?
PPIs for life - do not use anyting else - no H2 blockers or antacids
Peptic strictures - presenting and treatment
- patients have erosive disease
- progressive dysphagia
- treat with dilators and long term PPI - the “-PRAZOLES”
- NO SURGERY
Mild acid reflux Tx?
- life style mods!
- antacids
- H2 blockers
- do not lie down after eating
- lose weight
Tx of Moderate acid reflux:
- Daily H2 blockers
- PPI - the “-prazoles”
PPI long term use issue?
osteopenia or osteoporosis
Severe acid reflux tx:
PPI - 90% of patients respond
Surgery for acid reflux:
- good relief of symptoms but may need to redo surgery late -need to do a lot of these surgeries to do a good job bc if they wrap the esohagus around the stomach to tighten it up
- dysphagia, bloating, flatulence side effects
- only good for 10 years
What to do in unresponsive cases of acid reflux?
- Check EGD and pH probe (need to stop PPH use)
- Rule out Zollinger-Ellison syndrome if still nothing
- try higer dose PPI
- consider surgery
Best test for acid reflux?
pH probe
Mallory Weiss Tear
- what is it?
- main predisposing factor?
- patient presentation?
- Tx?
- non-penetrating tear of the GE junction due to sudden retching or vomiting
- ALOCOHOLISM
- present with hematemesis
- usually self limited-no Tx
Diagnostic for Mallory Weiss tear?
EGD
Infectious esophagitis:
1) presentation?
2) who affected?
3) diagnostic?
1) odynophagia!
2) immuno-suppressed - oral thrush, Herpes, CMV
- herpes can affect healthy hosts too
3) EGD with brushings and biopsies
Adenocarcinoma:
1) usually due to what?
2) What part most affected?
1) due to barrett
* 2) Lower 1/3**
SCC:
1) causes?
2) Where
1) achalasia; caustic ingestions; tylosis; smoking and ETOH; other head and neck tumors
* 2) upper 2/3*
Which is easier to treat?
SCC
rapidly progressive dysphagia with wieght loss think****
esophageal cancer
achalasia - what is it? due to?
-idiopathic motility disorder
- loss or peristalsis lower esophagus
- impaired relaxation of LES
- denervation of myenteric plexus
-BiRDS BEAK*
achalasia- symptoms
dysphagia to solids and liquids
- slow and progressive
- chest apin
- regurg of food
- WL
- cough and aspiration
TX of achalsia
- pneumatic dilation
- botulinum toxin injection
- ***SURGICAL MYOTOMY
