Esophageal Disease Flashcards
What are 5 causes of esophagitis?
Pill, Infectious, Eosinophilic, Caustic, gErd/everything else.
What meds often cause pill esophagitis?
Non-enteric coated nsaids, abx (tetracycline), biphosphonates, HAART
Dx and Tx of pill esophagitis?
EGD + bx - if pill still there, remove, otherwise adminster PPI while still healing.
Main causes of infectious esophagitis?
Candida, HSV, CMV, HIV
Presentation of infectious esophagitis (Candida?):
Oral thrush, white plaques.
Treatment of infectious esophagitis (candida)?
Nystatin swish/spit, or swish/swallow for oral candida, fluconazole for esophagitis.
Presentation of infectious esophagitis (HSV?):
Oral lesions = painful vesicles w/ erythematous base. Ulcers at multiple stages of healing.
TX of infectious esophagitis (HSV?):
Val/acylovir.
Presentation of infectious esophagitis (CMV?):
No oral manifestations.
Treatment of infectious esophagitis (CMV?):
val/a/ganciclovir.
What is eosinophilic esophagitis?
allergic rxn to food/ingestion, causes allergic rxn in eso too. Seen in people w/ asthma, eczema, seasonal allergies, etc.
Dx of eosinophilic esophagitis?
EGd + bx. > 15 esos per high powered field.
TX of eosinophilic esophagitis?
Bc GERD can cause eosino-eso, give PPI. If rial fails, try aerosolized steroids.
What is caustic esophagitis?
Burning of esophagus due to ingestion of very strong acid/base (drain cleaner etc), usually kid by accident or adult suicide attempt.
Sx of caustic esophagitis?
Burning of larynx - hoarseness.
Burning of trachea - stridor. INTUBATE.
Eso burning - drooling.
Dx of caustic esophagitis?
EGD + bx
TX of caustic esophagitis?
NEVER TRY TO NEUTRALIZE PH. NEVER INDUCE EMESIS. Instead, NGT + lavage if early. If high severity (strictures, necrosis), NPO 72 hrs. If low, liquid diet/observe.
What is GERD?
transiently weakened LES - regurg of acid up burns mucosa - ouch.
Risk factors for GERD?
↑ intra-abdominal pressure (e.g., obesity, pregnancy), scleroderma, alcohol, caffeine, nicotine, chocolate, and fatty foods.
Typical presentation of GERD?
Patients present with heartburn that commonly occurs 30–90 minutes after a meal, worsens with reclining, and often improves with antacids, sitting, or standing. Sour taste (“water brash”), laryngitis, dysphagia, and cough or wheezing.
Atypical presentation of GERD?
nocturnal “asthma”.
Diagnosis of GERD?
Dx with treatment - trial of PPIs AND lifestyle modification for 6 weeks. If doesn’t work, consider EGD + bx (esp if long-standard sx), or barium swallow to r/o hiatal hernia/esophageal manometry if considering surgery. 24 hr pH monitoring best test.
When to go straight to EGD for GERD?
Alarm symptoms: n/v, anemia, weight loss.
What may EGD + bx in the setting of GERD show?
Nothing: Gerd
Metaplasia of squamous –> columnar epithelium - Barret’s. Tx w/ PPI.
Dysplasia - local ablation + PPI.
Adenocarcinoma -> staging/resection/chemo/rads.
What is the Nissen fundoplication
If someone cannot tolerate PPIs, nissen fundop wraps gastric tissue around LES. Too tight: Achalasia.
What is achalasia?
Absence of myenteric plexus that inhibits LES contraction; LES cannot relax.
Presentation of achalasia?
Sensation of knot/ball of food stuck mid-sternum.
Dx of achalasia?
Barium swallow - birds beak.
Manometry - abnormal tone.
EGD w/ bx - rule out Ca.
Treatment of achalasia?
Botulinum toxin - only if terrible surg candidate.
Dilation - perf risk
Myotomy - best. But too much –> Gerd.
What is esophageal scleroderma?
Collagen deposition in LES, LES is too relaxes cannot contract.
What is esophageal scleroderma associated with?
CREST (calcinosis, raynauds, esophag dysmotility, sclerodactyly, telangiectasias) - anti-centromere Ab or anti-scl70 or anti-topoisomerase.
What is the treatment of esophageal scleroderma?
Only sx –> PPI.
What is diffuse esophageal spasm?
contractions of esophagus, will look like an MI! retrosternal chest pain, releived by nitrates and CCBs.
Dx of diffuse eso spasm?
Once MI ruled out:
Barium swallow - corkscrew esophagus
Manometry - random contraction
EGD - not necessary, maybe if unclear.
treatment of diffuse esophageal spasm?
CCBs, nitrates PRN.
What is Schatzki’s ring?
Ring at the GE junction, food gets stuck there.
What is the buzzword for Schatzki’s ring?
Steakhouse dysphagia. Only w/ big bites of poorly masticated food.
Treatment of Schatzki’s ring?
During EGD, lyse ring.
What are esophageal webs? What syndrome?
Plummer-Vinson syndrome. Woman w/ dysphagia, iron deficiency anemia, risk of eso cancer.
Dx of esophageal webs?
barium swallow.
Treatment of esophageal webs?
Give iron, EGD bx to screen for cancer. NO prophylactic ESOPHAGECTOMY unless cancer DEVELOPS.
What is Zenker’s diverticulum?
outpouching of mucosa in eso. Undigested food gets stuck there. halitosis! older man.
Dx and tx of Zenker’s?
barium swallow, TX: surg repair.
Two etiologies of esophageal cancer?
Squamous - upper 1/3 - etoh + tobacco
Adenocarcinoma - lower 1/3 - GERD.
