Esophageal Disease Flashcards
Clinical findings associate with esophageal disease
Regurgitation, WL and anorexia/ polyphagia
Poor BCS, halitosis, drooling, coughing, nasal discharge, pyrexia, wet lungs sounds
Dilated, cervical esophagus, food slopping in esophagus, mass/ FB
Diagnostics to assess regurgitation
Routine + rads (contrast- barium), endoscopy
Special tests: thyroid, ACTH stimulation, ACHR, Ab serology, ANA titer and lead levels
What is the next best step after radiology?
Endoscopy: direct visualization of mucosal lesion and luminal content
Determines the extent of injury
Esophagitis
Inflammation of the esophagus
Mild to severe
Mucosa to muscularis layer
Anatomic differentials of regurgitation
Megaesophagus
esophagitis
Esophageal obstruction, diverticulum
Vascular ring anomaly
Pyloric outflow obstruction
Hiatal hernia
What is esophagitis secondary to?
Chemical injury
GERD,
Chr. vomit,
Oral abx (doxycycline and clindamycin)
Heat injury
Direct mucosal damage (FBs, masses)
CS of esophagitis
Asymptomatic
Anorexia, dysphagia, odynophagia and hypersalivation
Cachexia, WL, cough, dyspnea and pyrexia
________ + _________ is a definitive dx for esophagitis
Endoscopy and biopsy
endoscopic changes alone may indicate presence of esophagitis
Based on location in the esophagus, what could cause esophagitis?
Upper esoph (past upper sphincter): oral doxy/ clindamycin
Dist. esoph. (cr. to lower sphincter): anesthesia related or GI reflux
Esophagitis tx
Remove cause and prevent exposure to acidic substance
Soft diet, small frequent meals, easily digestible diet, fat restricted
Medical esophagitis tx
Oral sucralfate (protects from reflux)
Parenteral followed by oral prokinetic agent (↑ gastric emptying)
Parenteral followed by oral H2 blocker or proton pump inhibitor (reduce acidity, helps with GERD)
Esophagitis medication duration
Mild: 5-7d
Moderate- severe: 2-3w
Recheck 1w after discharge and 1w after meds stopped
severe if strictures occur
Types of esophageal FBs
Bones (76.5%)
Fishhooks, rawhides chews, greenies, hairballs
Play toys (cats)
CS associated with FBs
Salivation, regurg, anorexia, odynophagia, halitosis
Tx of FBs
Remove immediately (sharps, large, metal, obstructive)
Rigid sigmoidoscope with grasping forceps (cr. esoph FBs only)
Flexible endoscope
Sx (dist. esoph or pushed into stomach)
Esophageal FB post removal therapy
Fast 24-48 hrs
Fluid therapy with dehydration
Gastrostomy tube with severe esophagitis
Same therapy as esophagitis