Disorders of the Esophagus and Stomach Flashcards by Minkeale Tedla

What is anatomy of the esophagus
Upper
Middle
Lower

Upper 1/3 skeletal muscle
Middle 1/3 skeletal and smooth muscle
Lower 1/3 smooth muscle

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What are the responsibilities of the upper esophagus sphincter vs the lower esophagus sphincter?

Upper (UES) controls food entry into the esophagus

Lower (LES) prevents reflux of gastric contents

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What are possible causes of Esophagitis

Fungal: Candida

Viral: CMV, HSV

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What demographic is most at risk of getting Esophagitis?

Immunocompromised- HIV

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Most common symptom associated with esophagitis?

Odynophagia

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What are findings seen with Esophagitis caused by CMV?

CMV - 1 to several, large, linear or longitudinal and deeper

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What are findings seen with Esophgitis caused by HSV?

multiple, small, well circumscribed, “volcano-like”

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What are findings seen with Esophagitis caused by Candida?

linear yellow-white plaques, diffuse, adherent

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How is Esophagitis diagnosed?

Need cytology or culture from endoscopy brushings

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How is Esophagitis treated caused byCMV?

What about HSV?

CMV: IV ganciclovir or foscarnet if needed

Acyclovir for HSV

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How is Esophagitis treated caused by Candida?

Fluconazole or ketoconazole for Candida

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How is Corrosive esophagitis caused?

Ingestion of caustic agents-Household cleaners, bleach

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How is corrosive esophagitis presented?

ulceration, necrosis and perforation in patches

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How is medication induced esophagitis caused?

What are typical meds that cause this?

usually due to direct, prolonged mucosal contact

NSAIDS, Potassium pills, Quinidine
Antiretrovirals, Bisphosphonates, Iron, Vitamin C
Abx: Doxycycline, tetracycline, clindamycin, Bactrim

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How does medication induced Esophagitis presented?

Severe retrosternal chest pain (referred pain)

Odynophagia, dysphagia

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What is the most common symptom seen with Esophageal dysmotitlity disorders?

Dysphagia!

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What is Zenkers Diverticulum

what do you develop dysphagia to?

pouch in posterior hypopharynx just above UES

Undigested food & liquid

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What do webs, rings and stenosis become dyphagic to?

Solids only

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What is Schatzki’s Ring? How is it caused?

Thin circumferential ring occurring at GE junction

Caused by GERD, or as a congenital/developmental deformity

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What does Schatki’s ring become dysphagic to?

Episodic dysphagia to solids

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How is an Esophageal web caused?

Mucosal fold that protrudes into lumen- unknown etiology

Intermittent dysphagia to solids

What is Achlasia?

Esophageal motor disorder;
decreased peristalsis;
ineffective relaxation of LES

How does Achlasia appear on imaging?

What do you become Dysphagic to?

How is this treated?

Parrot beak” in achalasia on esophagram

Solids and Liquids

Treated by dilation

What symptoms are associated with Diffuse Esophageal Spasm?

frequent, intermittent, abnormal, non-propulsive esophageal contractions

How does someone with Diffuse Esophageal Spasm present?

Chest pain, dysphagia or both Precipitated by stress or drinking cold liquids Pain may radiate to the back, chest, both arms, jaw Can be acute, severe and mimic an MI

What image appearance is seen with Diffuse Esophageal spasm on a Barium esophagram? What needs to ruled out?

Barium esophagram: corkscrew esophagus MI needs to ruled out

Treatment for Diffuse Esophageal spasms?

Smooth muscle relaxants NTG : before meals and at bedtime Isosorbide dinitrate: before meals Nifedipine SL: before meals

What is Scleroderma? What syndrome is associated with it?

Scleroderma – fibrosis of skin and viscera CREST syndrome ``` Calcinosis Raynaud’s phenomenon Esophageal dysmotility Sclerodactyly Telangiectasias ```

What is the purpose of ordering a Barium swallow (esophagram)

Can show structural and motor problems

What is the cause of a Mallory-Weis Tear What is the pathophysiology with this?

Linear tear in mucosa of esophagus ``` Usually occurs with forceful vomiting/retching Causes hematemesis (typically painless) ```

Risk factor for Mallory Weis Tear?

Alcohol use, hyperemesis gravidarum

How is a Mallory Weis Tear diagnosed and treated?

Diagnosis: Endoscopy (EGD) Treatment May resolve on own May inject epinephrine during endoscopy to stop bleeding

What is a Esophageal Varices?

Dilated veins of esophagus, usually distal

What are the causes of Esophageal Varices?

Portal hypertension-usually from cirrhosis of liver Due to alcohol abuse or chronic viral hepatitis Budd-Chiari syndrome – thrombosis of portal vein

What medication can exacerbate an Esophageal Varices?

NSAID use can exacerbate bleeding

What is the clinical presentation of Esophageal Varices

Painless upper GI bleed “brisk” bleeding Bright red blood or coffee ground emesis (hematemesis) Can also have melena,

How is Esophageal Varices diagnosed?

Endoscopy

Treatment options for Esophageal Varices? How is it treated in emergent cases?

Support: High volume fluid replacement Endoscopic Vasopressors/vasoconstrictors Emergent EGD Band ligation, sclerotherapy

what are ways to prevent esophageal varices?

B-blockers (propranolol) No alcohol Endoscopic band ligation

What are barriers that normally prevent GERD that are no longer working?

Reflux of stomach contents into esophagus Due to abnormality of LES Symptoms produced from prolonged exposure to gastric acid

What medications put a person at higher risk for GERD?

``` antibiotics (TCN), bisphosphonates, iron, NSAIDS, anticholinergics, CCBs, narcotics, benzodiazepines ```

What is the clinical presentation in someone with GERD? What is the MC symptom What is the most concerning/severe symptom

Heartburn – most common symptom Worse after meals Worse when lying down, bending over Some relief with antacids Severe=nighttime symptoms

What are considered the ALARM symptoms associated with GERD?

``` Anemia Loss of weight Anorexia Recent onset of progressive symptoms Melena or hematemesis Swallowing difficulties (Dysphagia / Odynophagia) ```

How is GERD diagnosed?

Most often clinical Uncomplicated patient: heartburn + regurg of acid + relief with antacids (cimetidine, ranitidine, famotidine) Trial of PPI x 4-8 weeks

When would endoscopy be used to try and diagnose GERD in someone?

``` Failure of PPI trial or alarm sx More severe disease Age >45 with new sx Long standing or recurrent sx Nonresponse to therapy ```

What are lifestyle modifications that can be used to alleviate GERD?

``` Smoking cessation Avoid eating at bedtime Raise head of bed Avoid large meals Avoid alcohol Avoid foods that cause irritation -caffeine, tomatoes, fried foods ```

Why are PPIs better H2 blockers to treat GERD?

Provides symptom relief AND heals mucosa?

When is surgery warranted for someone with GERD? What type of surgery is used and how is it performed?

If refractive to PPI therapy Surgery type: Nissen fundoplicatdion: gastric fundus wrapped around esophagus for sphincter competence

What is most concerning complication with GERD

Barrets esophagus ---> can lead to adenocarcinoma

How is Barrets esophagus treated?

normalization of acid, decrease cell proliferation in BE Treat with radiofrequency endoscopic ablation Surveillance endoscopy

What is the most frequent benign tumor of the esophagus?

Leiomyomas