Esophageal Disorders Flashcards
atypical symptoms of GERD
noncardiac chest pain
pulmonary problems (asthma, cough)
laryngeal symptoms (hoarseness and aspiration)
loss on dental enamel
when do you do a barium swallow for GERD?
considering surgery
only test to give you the length of the esophagus
barium swallow
is a barium swallow diagnostic of GERD
no
what can diagnose GERD
upper endoscopy with
barrett esophagus
stricture
excludes other dz that can mimic GERD (PUD)
Defines the function of the LES and the esophageal body (peristalsis)
Rules out esophageal motility disorder
Essential for correctly positioning the probe for the 24-hour pH monitoring
Esophageal manometry
Quantifies the gastroesophageal reflux and allows a correlation between the symptoms of reflux and the episodes of reflux
they push a button everytime they have a symptom
ambulatory 24-hour pH monitoring
does someone w/ endoscopically confirmed esophagitis, stricture or Barrett’s need pH monitoring
No
Indications for esophageal manometry and prolonged pH monitoring
peristance of symptoms while taking adequate PPI or other pharms
recurernce of sx after discontinuation of drugs
atypical symptoms
confirmation in prep for antireflex surgery
lifestyle modication for GERD
Weight lose if overweight Avoid foods that worsen symptoms Avoiding large meals Waiting 3 hours after a meal before lying down Elevating the head of the bed 8 inches
pharm tx stepwise for GERD
Histamien H2-receptor antagonists
PPIs
ADRs w/ long term PPIs
Can interfere with calcium homeostasis and aggravate cardiac conduction defects
Responsible for hip fracture in postmenopausal women
surgical indications for GERD
symptoms not completely controlled by PPI symptoms that are controlled by PPI but dont' want to take forever Barrett esophagus extraesophageal manifestations young patients poor patient compliance postmenopausal w/ osteoporosis pts. w/ cardiac conduct defects
who has the best results w/ antireflex surgery
well controlled on PPI and has typical symptoms
most frequently preformed surgery for GERD
Laparoscopic Nissen fundiplication (360° wrap)
complications with GERD
Esophagitis
Esophageal ulcer
Esophageal stricture
Barrett’s esophagus
The esophagus is lined with columnar epithelium
Represents advanced GERD
Salmon-pink mucosa that lines the esophagus
Barret’s Esophagus
what type cells are found in Barrett’s Esophagus
Specialized intestinal metaplasia of the esophageal mucosa due to replacement of squamaous epithelium by columnar epithelium
goblet cells
is there malignant potential w/ barrett’s esophagus
yes
Do PPIs prevent bile reflex?
No
what do prevent bild reflex?
antireflex surgery
patient’s with long-standing GERD (>5 years) espeically those >50 should have what to screen for Barett esophagus?
upper endoscopy and biopsy in 4 quadrants
Patients with persistent low-grade dysplasia on repeat endoscopy should undergo surveillance how often
every 6 months for 2 cycles (can then be yearly if no progression)
2 ways to manage high-grade syplasia w/ Barett’s esophagus
Surveillance endoscopy, with intensive biopsy at 3-month intervals until cancer is detected
Surgical resection
what type is a sliding hiatal hernia (GE junction is intrathoracic)
Type 1
what type hiatal hernia is rolling where only the fundus is intrathoracic
Type II
what is the only hiatal hernia where the GE junction is intraperitoneal
Type II
Fundus and body and other abdominal organs
are intrathoracic
Type IV hiatal hernia
type of hiatal hernia that can be associated w/ life-threatening complications. should be repaired if symptomatic
paraesophageal hernia (II, III, IV)
symptoms of paraesophageal hernias
only 50% are symptomatic epigastric abdominal pain postprandial fullness chest discomfort heart burn dyphagia vomiting weight loss dyspnea
complications from paraesophageal hernias
Anemia from Cameron ulcers from erosions of the gastric mucosa
incarceration w/ obstruction, strangulation, perf
what is Borchardt’s triad indicative of?
an incarcerated intrathoracic stomach – Surgical emergency
what are the three aspects of Borchardt’s triad?
chest pain
retching w/ inability to vomit
inability to pass an NGT
diagnosis for non-ermegency hiatal hernia
CXR (retrocardiac air bubble)
barium swallow
upper endoscopy
often found incidentaly on CT
before hiatal hernia what needs to be done?
esophageal motility study
pH probe not needed
Present with dysphagia, regurgitation, chest pain and heartburn
esophageal motility disorders
what must be done w/ eosphageal motility disorder
esophageal manometry