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Gastroenterology > Esophageal Disorders > Flashcards

Esophageal Disorders Flashcards

1
Q

Esophageal Disorders

A

Esophagitis

  • GERD
  • Eosinophilic esophagitis
  • Infectious
  • Medication

Barrett’s Esophagus

Esophageal Carcinoma

Achalasia

Esophageal Motor Disorders

  • Spasm
  • Nutcracker
  • Jackhammer
  • Hypotensive Peristalsis

Oropharyngeal dysphagia

Zenker’s

Boerhaave’s

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2
Q

Types of Esophagitis

A

Reflux (GERD)

Eosinophilic esophagitis: food allergy

Infectious: candida, CMV, herpes

Medication Induced:

  • cycline drugs
  • NSAIDs
  • K supplements
  • Biphosphonates
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3
Q

GERD Pathophysiology

A

Sustained or transient decreased in LES tone

Incompetence of the diaphragmatic crural muscle

Pressure gradient between LES and stomach is lost (intrathoracic becomes < intraabdominal)

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4
Q

GERD Risk Factors

A

Central Obesity

Smoking

Alcohol Abuse

Systemic disease (i.e. Neuro)

Medications

Pregnancy

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5
Q

GERD Sxs

A
  • **Regurgitation **
  • **Retrosternal burning **
  • **Epigastric burning **
  • **Dysphagia **

Extraesophageal Sxs (Atypical)

  • Hoarseness
  • Sore throat
  • Throat clearing
  • Globus
  • Cough
  • Inc’d sinus drainage
  • Chest pain
  • Asthma
  • Nausea
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6
Q

Complications of GERD

A

**Common: **

  • Schatzki’s Ring
  • **Esophagitis **

Uncommon:

  • Hemorrhage/anemia
  • Perforation
  • Barrett’s esophagus/CA
  • Esophageal spasm
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7
Q

GERD Diagnosis

A
  • Esophagitis on EGD
  • Barrett’s esophagus
  • Hiatal hernia
  • Positive pH testing (catheter in esophagus, measure % time acidic)
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8
Q

Treatment for GERD (Lifestyle modifications)

A

Elevate head of bed

Weight loss to reduce central obesity

Avoid

  • lying down after meals
  • eating late at night
  • cigarettes and alcohol
  • NSAIDs
  • meds/foods that exacerbate reflux
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9
Q

Surgical treatment options

A

Nissen Fundoplication

Toupet procedure (modified Nissen if have trouble swallowing)

Torax Magnetic Sphincter

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10
Q

Eosinophilic Esophagitis Presentation and Sxs

A

Usually presents as solid food dysphagia ongoing for many years. May present as GERD unresponsive to tx

Pt has Hx of environmental allergies (result of a food allergy)

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11
Q

Eosinophilic Esophagitis Diagnosis

A

Endoscopy with esophageal biopsies for diagnosis

Appears ringed and furrowed

Stiff and rigid

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12
Q

Eosinophilic Esophagitis Treatment

A

Fluticasone swallowed BID

PPI

Prednisone in severe case

Can try anti-histamines but are minimally effective

Elimination Diet for 8 weeks (gluten, milk, soy, eggs, nuts/tree nuts, fish/shellfish)

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13
Q

Candida Esophagitis

A

Usually presents as dysphagia or odynophagia

Occurs in immunosupressed pts

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14
Q

Herpes Esophagitis

A

Presents as odynophagia, occasional dysphagia

Usually in immunocompromised pts

Can lead to herpes encephalitis if not tx’d promptly

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15
Q

CMV Esophagitis

A

Usually in immunocompromised pts

Activated from a latent phase or acquired from a blood product transfusion

Serpiginous ulcers in otherwise normal mucosa

Present with odynophagia, chest pain, hematemesis, nausea

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16
Q

Barrett’s Esophagus Definition, Risk Factors, Sxs

A

Metaplastic columnar epithelium (intestinal cells) that is predisposed to CA development replaces squamous epithelium–from ongoing GERD

Often no symptoms

Risk factors:

  • Age >50
  • Male
  • Caucasian
  • Central obesity
  • Chronic GERD
17
Q

Surveillance for Barrett’s

A

3months - 3years depending on level of dysplasia present and if segment is long or short

Long segment more likely to develop malignancy

18
Q

Barrett’s Treatment

A

**First line: Radiofrequency ablation **

Endoscopic mucosal resection or Esophagectomy

19
Q

Esophageal Carcinoma Epidemiology and Presentation

A

Becoming more and more common

More likely in men and 50-70yrs old

Poor prognosis: 5% alive after 5 years

Can spread to LN, lungs, liver

Symptoms: progressive dysphagia and weight loss

20
Q

Types of Esophageal CA

A

Squamous cell carcinoma:

  • Increased risk with ETOH and smoking

Adenocarcinoma

  • More common type
  • From GERD/Barrett’s
  • Distal esophagus
21
Q

Types of Esophageal Motors Disorders

A

Achalasia

Diffuse Esophageal Spasm

Hypercontractility Disorders

Hypocontractility Disorders

22
Q

Achalasia

(Path, sxs, dx, type, tx)

A

Loss of intramural neurons

**Inadequate LES relaxation **

Any age group–Generally idiopathic

Sxs: progressive solid and liquid dysphagia (things are building up), refractory GERD, regurgitation

Diagnosis: Barium esophagram (“Bird’s Beak”); Gold Standard is Esophageal manometry with increased LES pressure

Treatment depends on**Type: **
Type I: aperistaltic, more difficult to tx
Type II: peristaltic, more favorable to tx

Tx: Drugs (CCB), botox, pneumatic dilatation (dilation with large balloon under fluoro), Heller myotomy (Cut LES–best way to resolve sxs).

Important to tx b/c otherwise will progress to type II and won’t be able to eat

23
Q

Diffuse Esophageal Spasm

A

Results from uncoordinated contractions

Any age group

Sxs: chest pain or dysphagia

Dx: Esophageal manometry is gold standard

Tx: Only need to tx if symptomatic (won’t progress like achalasia). NTG, CCB, botox, long myotomy

24
Q

Hypercontractile Motor Disorders

A

Characterized by high pressure manometric contractions

Peristaltic contractions propagate normally, LES relaxes normally

Nutcracker (constant) or Jackhammer (more spastic)

25
Q

Hypocontractile Disorders

A

AKA peristaltic dysfunction

Reduced or absent peristaltic waves; decreased or absent resting LES pressure

Can result from scleroderma, connective tissue diseases, or idiopathic

Sx: solid/liquid dysphagia or refractory GERD

Dx: manometry

No good tx options available

26
Q

Oropharyngeal (Transfer) Dysphagia

A

Difficulty transferring a bolus from the mouth to the esophagus

Due to epiglottic dysfunction or poor muscle coordination

Sxs: coughing or choking with swallowing

Causes:

  • Brain: CVA, Parkinson’s, MS, head injury
  • Muscle/Nerve: myasthenia gravis, polio
  • Cricopharyngeal dysfunction: Zenker’s diverticulum, cricopharyngeal bar
27
Q

Zenker’s Diverticulum

A

Outpouching in the wall of the esophagus, usually in posterior hypopharyngeal wall

Can cause regurgitation of food particles consumed several days previous

Dx: barium swallow (endoscopy could puncture)

Tx: surgery–sew shut

28
Q

Esophageal Varices

A

Dilated, sub-mucosal veins in the lower esophagus from portal hypertension, usually the result of cirrhosis

Can be fatal

29
Q

Esophageal Webs

A

Webs are usually congenital or inflammatory

Intermittent dysphagia to solids

30
Q

Schatzki’s Ring

A

Thin, weblike constriction near the LES which is benign

Usually smooth and circumferential

Can produce dysphagia when lumen is small enough

Tx: Dilation

31
Q

Mallory Weiss Tear

A

Linear mucosa tear near at the GE jtn

Non-penetrating

Alcoholism is a pre-disposing factor

Usually associated with vomiting or retching

Most often self-limiting, may resulting in brisk bleeding

Dx: from Hx or endoscopy

32
Q

Boerhaave’s Syndrome

A

From increased intra-esophageal pressure from forceful vomiting/retching or instrumentation

Free air enters mediastinum and causes pain, sub-Q emphysema, and can produce pneumothorax

Pressents as hematemesis and severe, retrosternal pain

Initial dx with CXR, confirm with CT, esophagram

Tx: Surgery

Gastroenterology (20 decks)

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