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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
Q

Medical Tx of GERD

A
  • antacids –> mild symptoms
  • H2 blockers–> mod, occasional symptoms
  • PPI–> persistent symptoms
  • Surgical fundoplication if no relief w/ meds
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26
Q

Tips to prevent heartburn

A
  • 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)
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27
Q

What can progress to esophageal cancer if timely dx & tx isn’t made?

A

Barrett esophagus

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28
Q

What is Barrett’s esophagus?

A

Metaplastic change of the lining of esophageal mucosa from normal squamous epithelium to columnar epithelium

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29
Q

Barrett’s esophagus is caused by?

A

longstanding GERD

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30
Q

Barrett’s esophagus can progress to?

A

adenocarcinoma

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31
Q

Barrett’s esophagus dx

A

Identified in upper endoscopy (requires histologic confirmation)

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32
Q

Barrett’s Esophagus Tx

A

Treat GERD

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33
Q

How many times should you get an endoscopy w/ Barrett’s esophagus?

A

Every 6mo for 3 years

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34
Q

Who usually gets infectious esophagitis?

A

immunocompromised pts
- HIV
- solid organ transplants
- leukemia
- lymphoma

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35
Q

What are the most common infx that cause infectious esophagitis?

A
  • Candida
  • Herpes simplex
  • CMV
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36
Q

Infectious esophagitis S/S

A
  • Odynophagia
  • Dysphagia
  • Substernal chest pain
37
Q

Infectious esophagitis PE

A
  • May or may not see oral thrush
  • Herpes labialis often associated w/ herpes esophagitis
38
Q

Infectious esophagitis Dx

A
  • Tx may be empiric (if obvious candida or herpes)
  • Endoscopy w/ biopsy & brushings *
  • Test for HIV is status not known
39
Q

Tx for Candida Infective esophagitis

A

Fluconazole PO for 14-21 days

40
Q

Tx for CMV Infective esophagitis

A

ganciclovir

41
Q

Tx for Herpes Infective esophagitis

A
  • Immunocompetent: symptomatic tx
  • Immunocompromised: acyclovir, valacyclovir
42
Q

Most common meds that cause med induced esophagitis

A
  • NSAIDS
  • KCl
  • bisphosphonates
  • doxy
  • clinda
  • TMP- SMX
43
Q

Med induced esophagitis S/S

A
  • Retrosternal chest pain,
  • odynophagia
  • dysphagia several hours after taking pill
44
Q

Med induced esophagitis Dx

A

Endoscopy w/ one or several discrete ulcers
–> avoid in pts w/ dysmotility or strictures

45
Q

Pt. edu for med induced esophagitis

A

Take pills with at least 4oz of water and remain upright for 30 minute

46
Q

Describe eosinophilic esophagitis

A

chronic immune/antigen-mediated dz characterized by clinical symptoms of esophageal dysfunction & eosinophil-predominant inflammation

47
Q

Eosinophilic esophagitis RFs

A
  • asthma
  • allergies
  • dermatitis
  • rhinitis
48
Q

Describe chronic or relapsing symptoms of eosinophilic esophagitis.

A
  • dysphagia
  • food impaction
  • heartburn
49
Q

Eosinophilic esophagitis Tx

A
  • PPI
  • corticosteroids
  • elimination diet
  • esophageal dilation
50
Q

Another name for mucosal tear at the gastroesophageal junction

A

Mallory Weiss tear

51
Q

Mallory-Weiss syndrome is caused by…

A
  • lifting
  • retching
  • vomiting
52
Q

What is a strong predisposing factor for Mallory-Weiss syndrome?

A

alcoholism

53
Q

What is a less common predisposing factor for Mallory-Weiss syndrome?

A

Bulimia

54
Q

Mallory Weiss Syndrome Hx

A
  • Retching, vomiting, straining
  • Alcoholism
  • Bulimia
55
Q

Mallory Weiss Syndrome S/S-PE

A

Hematemesis w/ or w/o melena

56
Q

Mallory Weiss Syndrome Dx

A
  • Endoscopy
  • CBC
  • Type & Screen
57
Q

Mallory Weiss Syndrome Tx

A
  • Fluid Resuscitation
  • Blood Transfusions
  • If bleeding does not stop, endoscopy & injection w/ epi and/or clip the artery
58
Q

What are Esophageal Varices?

A

Dilated submucosal veins

59
Q

Esophageal Varices occurs in pts with…

A

underlying portal hypertension

60
Q

Esophageal Varices can cause…

A

life threatening bleeding

61
Q

NOTES

A
  • 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
Q

Esophageal varices pathophys

A

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
Q

Esophageal varices Hx

A
  • Severe upper GI bleeding
  • Sometimes preceded by retching or vomiting
  • Painless
64
Q

Esophageal varices PE

A

Hemorrhagic shock possible (hypotension, tachycardia)

65
Q

Esophageal varices Dx

A
  • CBC
  • Coag studies
  • Endoscopy (EMERGENT)
66
Q

Esophageal Varices Tx

A
  • 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
Q

Screening for esophageal varices in pts w/ cirrhosis

A

Endoscopy every 3 years

68
Q

What med can prevent bleeding in esophageal varices?

A

BB

69
Q

Describe Achalasia

A
  • 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
Q

Achalasia Hx

A
  • Gradual onset of dysphagia for solids AND liquids
  • Substernal discomfort/fullness after eating
  • +/- weight loss
71
Q

Achalasia PE

A

Unremarkable

72
Q

Achalasia Dx

A
  • Barium swallow: “birds beak”
  • Esophageal manometry
73
Q

What does an esophageal manometry tell us?

A
  • Measures the pressure in the esophagus
  • Shows incomplete relaxation of the LES
74
Q

Achalasia Tx

A
  • Botulinum toxin
  • Balloon dilation
  • Surgery (myotomy)
75
Q

What is a sign of obstructive disorders of the esophagus?

A

dysphagia for solids

76
Q

Does obstructive disorders of the esophagus develop gradually or fast?

A

gradually

77
Q

What are esophageal rings seen w/ obstructive disorders of the esophagus?

A
  • aka Schatzki
  • etiology unclear
  • mucosal rings, made of normal esophageal tissue
78
Q

What are esophageal webs seen w/ obstructive disorders of the esophagus?

A

appear similar, but thin mucosal tissue

79
Q

The strictures/stenosis seen in obstructive disorders of the esophagus is caused by…

A

GERD

80
Q

Esophageal Cancer age range

A

50-70yo

81
Q

Esophageal cancer is more common in which gender?

A

male

82
Q

Esophageal cancer is more common in which continent?

A

Asia

83
Q

Which type of esophageal cancer is more common in Asia?

A

Squamous cell

84
Q

Which type of esophageal cancer is more common in the US?

A

Adenocarcinoma
–> complication of Barrett’s esophagus

85
Q

Esophageal Cancer RFs

A
  • tobacco use & excess alcohol use, (squamous cell carcinoma)
  • obesity (adenocarcinoma)
  • Hx of GERD and/or Barrett esophagus (adenocarcinoma)
  • Age > 50, male
86
Q

Esophageal Cancer S/S

A
  • progressive dysphagia
  • unintended weight loss
  • persistent heartburn resistant to treatments
  • Most tumors are found w/ regional or distant metastasis
87
Q

Esophageal Cancer Dx

A
  • Endoscopy & biopsy
  • CT/PET to look for metastasis
88
Q

Esophageal Cancer Tx

A
  • Chemotherapy
  • Radiation
  • Surgery

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

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