Diseases of the Esophagus Flashcards
Define pyrosis
Hearburn
Substernal burning sensation
Differentiate mechanical obstructions and motility disorders in relation to esophageal dysphagia
Mech = solids
Motility = both bad
What four things ca cause GERD
Dysfunction of LES
Hiatal Hernia
Abnormal esophageal clearance
Delayed gastric emptying
What is the Z-line?
Squamo columnar junction of the esophagus
GERDis one of the three most common causes of what?
Chronic cough
What symptom may suggest advanced disease with GERD
Dysphagia
How do we work up GERD?
Typically we tx symptomatically unless there are alarm signs (dys/odynophagia, weight loss, fever stuff)
If alarm signs present or emperic tx fail –> EGD or possible LES manometry and pH
Describe GERD lifestyle mods?
Lifestyle mods - No spicy, acid, tobacco. Dont lay flat. Exercise ETC..
Describe OTC antacids and H2 receptor antagonists
OTC - Tums, Rolaids = Rapid, short duration
H2 - Cimetidine, Ranitidine, Famotidine. Onset = 30m, Dur= 8 hours take before meals
Describe PPIs
Omeprazole (Prazole drugs)
Once daily dosing 30 minutes before b-fast
Describe Tx algorithm for GERD patients
All = lifestyle
Mild/intermittent - PRN OTC or H2
“Troublesome” - Once daily PPI
Persist x 4 weeks once daily PPI = BID PPI
Persit w/ BID PPI = EGD referral.
***All w/ alarm = get EGD
When can a GERD patient stop PPI?
If asymptomatic after 8-12 weeks.
Will prob relapse… need lowest therapuetic dose
If a GERD patinet is completely refractory to medical treatment or has a severe manifestation, what can be done?
Nissen Fundoplication.
Wrap stomach around esophgus to reinforce the LES
2 complications of GERD include Barret esophagus and Peptic stricture. Describe these.
Barret - Squam –> Columnar w/ goblet. Prolonged caustic exposure. Can cause decrease in GERD symptoms. Your gonna get an adenocarcinoma
PEPTIC Stricture (5%) - Narrowing of lumen at GEJ. Progressive solid dysphagia. Dilate it.
Infectious esophagitis is mainly caused by what? What are two other notable causes?
Candida Albicans
CMV and herpes
Infectious esophagitis is typically found in what kind of patients? What do we do for them?
Immunocompromised, dysphagia, odynophagia**, maybe chest pain
Diagnose w/ EGD with biopsy
But… can tx emperically, Use fluconazole x 5 days… if nothing –> EGD
Pill induced esophagits is what?
Any pill making your throat hurt because the pill mechanically disturbed it
Describe pathology behind Eosinophilic esophagitis
Infiltration of eosinophils into the esophagus as a inflamm response to allergen.
Leads to progressive dysphagia and narrowing of the lumen
How do eosinophilic esophagitis patients present. What should we do?
Dysphagia to solids, Heartburn.
Ask about hx asthma, allergies, atopic derm. EGD w/ mucosal biopsy (eosinophils) *Empiric PPI BID x 2 months Refer to Allergist Swallow fluticosone
Describe esophageal rings and webs
Webs - Thin membranes of squamous epi, many asymptomatic. Can cause GERD, usually mid to high
Ring - Schatzki, circumferential mucosal structure, distal, sim to webs, assoc w/ *Hiatal hernia
How do we diagnose webs and rings? How do we Tx?
Barium swallow
Endoscopic dilation *if symptomatic
An esophageal carcinoma is a ______ form of cancer that primarily affects ______ (3/1). Can be squamous or adenocarcinoma and present ______ w/ advanced disease
Rare
Men
Late
How will esophageal carcinoma patient present? What to we do?
Progressive solid food dysphagia, odynophagia, **unexplained weight loss, Body aches and pains
Barium swallow –> EGD because barium doesnt show shit. See cancer –> cancer tx.
Esophageal carcinoma is a super safe cancer right?
No. <20% 5-year survival.
What is Boerhaave syndrome? What are our common findings?
Complete rupture of esophagus
Shock, **Pneumomediastinum ….. Also look at Sub-Q emphysema of chest
What is a Mallory-Weiss Tear? What do we do about it?
Mucosal tear at GEJ (vomit,alchoholism)
Pt presents w/ hematemesis (Acute Upper GI bleed)
**Stabilize pt.
Upper Endoscopy w/ epi, cautery, endoclip
What causes esophageal varices?
Dilated submucosal veins due to portal hypertension (50% w/ cirrhosis)
**high mort due to severe UGIB
How do we Tx Esophageal varices (rupture esp)
Emergent = Hemostasis and stabilization
Follow on -
Propranolol, Variceal band ligation, octreotide
Differentiate presenting symptoms of achalasia and other esophageal issues
Progressive dysphagia to SOLIDS AND LIQUIDS**
How do we diagnose Achalasia?
Barium swallow –> bird
EGD and manometry confirms
What causes an esophageal dysfunction that mimics achalasia but is more rapid in onset?
Chagas disease - T. Cruzi in mexico and s/c america
How does Achalasia get treated
Botulinum toxin in LES
Pneumatic dilation
Surgery
Sup with Zenker’s?
Pharyngeal pouch. Food sticking, breath smells, regurg undigested.
Barium swallow.
