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Clin Med: GI (block 3) > Esophageal Disorders > Flashcards

Esophageal Disorders Flashcards

1
Q

What is esophagitis?

A

inflammation of the esophagus

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2
Q

2 types of esophagitis

A

Non-infectious & infectious

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3
Q

List non-infectious examples

A
  • Reflux/GERD
  • Medication induced
  • Eosinophilic
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4
Q

List infectious examples

A

Fungal & viral

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5
Q

What is GERD?

A

is a condition that develops when the reflux of stomach contents into the esophagus causes troublesome symptoms

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6
Q

What is reflux esophagitis?

A

esophageal inflammation that occurs due to GERD

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7
Q

What is the most common GI-related dx in the US?

A

GERD

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8
Q

GERD seen more in men or women?

A

women

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9
Q

Peak prevalence age of GERD

A

30-60yo

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10
Q

GERD pathophys

A
  • Lower esophageal sphincter relaxes, allowing gastric contents into the esophagus
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11
Q

Which populations have incr intraabdo pressure which causes reflux?

A

obesity & pregnancy

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12
Q

What are typical symptoms seen w/ GERD?

A

heartburn & regurgitation

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13
Q

What is heartburn?

A

sensation of discomfort or burning behind sternum rising up to neck, worse after meals or in reclining position

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14
Q

What is regurgitation?

A

perception of flow of refluxed gastric contents into mouth or hypopharynx

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15
Q

Who presents w/ atypical symptoms of GERD?

A

kids & elderly

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16
Q

What are some other common complaints w/ GERD?

A
  • “chest pain”
  • cough
  • belching
  • hoarseness
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17
Q

Meds that can cause GERD due to relaxation of LES

A
  • CCB
  • Theophylline
  • Nitrates
  • Sildenafil
  • Albuterol
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18
Q

What social things may provoke GERD symptoms?

A
  • stress
  • diet
  • caffeine
  • smoking
  • alcohol
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19
Q

PE for GERD

A

generally normal

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20
Q

PE for severe chronic cases of GERD

A
  • dental erosions
  • nasopharyngeal sinusitis
  • polyps
  • granuloma
  • ulcerations
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21
Q

How is dx made for GERD?

A
  • based on Hx, PE, & trial of empiric therapy
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22
Q

What dx testing are avaiblable to evaluate tx failure?

A
  • Upper endoscopy (possibly w/ biopsy, may show hiatal hernia)
  • pH monitoring (if non responsive to therapy & normal endoscopy)
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23
Q

What is a Hiatal hernia?

A

upper part of the stomach bulges through an opening in the diaphragm

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24
Q

GERD lifestyle tx

A
  • Weight loss
  • Elevate head of bed
  • Avoidance of trigger foods
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25
Medical Tx of GERD
- antacids --> mild symptoms - H2 blockers--> mod, occasional symptoms - PPI--> persistent symptoms - Surgical fundoplication if no relief w/ meds
26
Tips to prevent heartburn
- place blocks under beg to tilt it - eat 2 to 3 hours before lying down. - take naps sleeping in a chair. - no smoking - lose weight - don’t overeat. - Eat high-PRO, low-fat meals. - Avoid tight clothes & tight belts. - Avoid foods & other things that give you heartburn (alcohol, spicy foods, citrus, tomatoes)
27
What can progress to esophageal cancer if timely dx & tx isn't made?
Barrett esophagus
28
What is Barrett's esophagus?
Metaplastic change of the lining of esophageal mucosa from normal squamous epithelium to columnar epithelium
29
Barrett's esophagus is caused by?
longstanding GERD
30
Barrett's esophagus can progress to?
adenocarcinoma
31
Barrett's esophagus dx
Identified in upper endoscopy (requires histologic confirmation)
32
Barrett's Esophagus Tx
Treat GERD
33
How many times should you get an endoscopy w/ Barrett's esophagus?
Every 6mo for 3 years
34
Who usually gets infectious esophagitis?
immunocompromised pts - HIV - solid organ transplants - leukemia - lymphoma
35
What are the most common infx that cause infectious esophagitis?
- Candida - Herpes simplex - CMV
36
Infectious esophagitis S/S
- Odynophagia - Dysphagia - Substernal chest pain
37
Infectious esophagitis PE
- May or may not see oral thrush - Herpes labialis often associated w/ herpes esophagitis
38
Infectious esophagitis Dx
- Tx may be empiric (if obvious candida or herpes) - Endoscopy w/ biopsy & brushings * - Test for HIV is status not known
39
Tx for Candida Infective esophagitis
Fluconazole PO for 14-21 days
40
Tx for CMV Infective esophagitis
ganciclovir
41
Tx for Herpes Infective esophagitis
- Immunocompetent: symptomatic tx - Immunocompromised: acyclovir, valacyclovir
42
Most common meds that cause med induced esophagitis
- NSAIDS - KCl - bisphosphonates - doxy - clinda - TMP- SMX
43
Med induced esophagitis S/S
- Retrosternal chest pain, - odynophagia - dysphagia several hours after taking pill
44
Med induced esophagitis Dx
Endoscopy w/ one or several discrete ulcers --> avoid in pts w/ dysmotility or strictures
45
Pt. edu for med induced esophagitis
Take pills with at least 4oz of water and remain upright for 30 minute
46
Describe eosinophilic esophagitis
chronic immune/antigen-mediated dz characterized by clinical symptoms of esophageal dysfunction & eosinophil-predominant inflammation
47
Eosinophilic esophagitis RFs
- asthma - allergies - dermatitis - rhinitis
48
Describe chronic or relapsing symptoms of eosinophilic esophagitis.
- dysphagia - food impaction - heartburn
49
Eosinophilic esophagitis Tx
- PPI - corticosteroids - elimination diet - esophageal dilation
50
Another name for mucosal tear at the gastroesophageal junction
Mallory Weiss tear
51
Mallory-Weiss syndrome is caused by...
- lifting - retching - vomiting
52
What is a strong predisposing factor for Mallory-Weiss syndrome?
alcoholism
53
What is a less common predisposing factor for Mallory-Weiss syndrome?
Bulimia
54
Mallory Weiss Syndrome Hx
- Retching, vomiting, straining - Alcoholism - Bulimia
55
Mallory Weiss Syndrome S/S-PE
Hematemesis w/ or w/o melena
56
Mallory Weiss Syndrome Dx
- Endoscopy - CBC - Type & Screen
57
Mallory Weiss Syndrome Tx
- Fluid Resuscitation - Blood Transfusions - If bleeding does not stop, endoscopy & injection w/ epi and/or clip the artery
58
What are Esophageal Varices?
Dilated submucosal veins
59
Esophageal Varices occurs in pts with...
underlying portal hypertension
60
Esophageal Varices can cause...
life threatening bleeding
61
NOTES
- Portal system takes blood from GI system, filters it through the liver, and returns it to the heart - The distal esophagus veins are part of the portal system
62
Esophageal varices pathophys
If there is liver cirrhosis, it can put incr pressure on the portal system, causing incr pressure in the esophageal veins, leading to esophageal varices
63
Esophageal varices Hx
- Severe upper GI bleeding - Sometimes preceded by retching or vomiting - Painless
64
Esophageal varices PE
Hemorrhagic shock possible (hypotension, tachycardia)
65
Esophageal varices Dx
- CBC - Coag studies - Endoscopy (EMERGENT)
66
Esophageal Varices Tx
- Fluid Resuscitation - Blood Transfusions (may need platelets or plasma) - Vasoactive drugs: octreotide (reduces portal pressure) - Vit K (if abnormal PT) - Endoscopy: -->Banding of varices - Decr portal HTN (surgery)
67
Screening for esophageal varices in pts w/ cirrhosis
Endoscopy every 3 years
68
What med can prevent bleeding in esophageal varices?
BB
69
Describe Achalasia
- Gradual, progressive dysphagia for solids & liquids - Neurogenic disorder w/ impaired peristalsis in the distal 2/3 of the esophagus --> loss of ganglion cells in the mesenteric plexus of the esophagus
70
Achalasia Hx
- Gradual onset of dysphagia for solids AND liquids - Substernal discomfort/fullness after eating - +/- weight loss
71
Achalasia PE
Unremarkable
72
Achalasia Dx
- Barium swallow: “birds beak” - Esophageal manometry
73
What does an esophageal manometry tell us?
- Measures the pressure in the esophagus - Shows incomplete relaxation of the LES
74
Achalasia Tx
- Botulinum toxin - Balloon dilation - Surgery (myotomy)
75
What is a sign of obstructive disorders of the esophagus?
dysphagia for solids
76
Does obstructive disorders of the esophagus develop gradually or fast?
gradually
77
What are esophageal rings seen w/ obstructive disorders of the esophagus?
- aka Schatzki - etiology unclear - mucosal rings, made of normal esophageal tissue
78
What are esophageal webs seen w/ obstructive disorders of the esophagus?
appear similar, but thin mucosal tissue
79
The strictures/stenosis seen in obstructive disorders of the esophagus is caused by...
GERD
80
Esophageal Cancer age range
50-70yo
81
Esophageal cancer is more common in which gender?
male
82
Esophageal cancer is more common in which continent?
Asia
83
Which type of esophageal cancer is more common in Asia?
Squamous cell
84
Which type of esophageal cancer is more common in the US?
Adenocarcinoma --> complication of Barrett's esophagus
85
Esophageal Cancer RFs
- tobacco use & excess alcohol use, (squamous cell carcinoma) - obesity (adenocarcinoma) - Hx of GERD and/or Barrett esophagus (adenocarcinoma) - Age > 50, male
86
Esophageal Cancer S/S
- progressive dysphagia - unintended weight loss - persistent heartburn resistant to treatments - Most tumors are found w/ regional or distant metastasis
87
Esophageal Cancer Dx
- Endoscopy & biopsy - CT/PET to look for metastasis
88
Esophageal Cancer Tx
- Chemotherapy - Radiation - Surgery

Clin Med: GI (block 3) (8 decks)

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