Esophageal disorders Flashcards
1
Q
GERD- Eti
A
- 20% of adults
- reflux esophagitis develops in 1/3
2
Q
GERD- Sx
A
- Heartburn 30-60 min after meals & reclining
- Relief with antacids
- Regurgitations- sour or bitter
- Dysphagia
3
Q
GERD- Dx
A
- Treat empirically with PPI 4-8 wks
- If symptoms persist then endoscopy to determine contributing or complicating symptoms
4
Q
GERD- Tx
A
- Eliminate acidic foods
- Antacids
- PPI
5
Q
Infections esophagitis- Eti
A
- Immunosupressed
- Candida albicans, herpes, CMV
- Herpes can affect normal host
6
Q
Infections esophagitis- Sx
A
- Odynophagia
- Dysphagia
- Oral thrush
- Substernal chest pain
7
Q
Infections esophagitis- Dx
A
- Endoscopy with biopsy
8
Q
Infections esophagitis- Tx
A
- Empiric- Tx causative organism
9
Q
Pill induced esophagitis- Eti
A
- More likely in hospital pts.
- NSAIDs, Abx, most common
10
Q
Pill induced esophagitis- Sx
A
- Severe retrosternal chest pain
- Odynphagia
- Dysphagia
11
Q
Pill induced esophagitis-Dx
A
- Endoscopy- discrete shallow or deep ulcers
12
Q
Pill induced esophagitis- Tx
A
- Take pills with H20, remain upright for 30 min
- Don’t give agents to people with dysmotiity
13
Q
Caustic esophageal injury- Eti
A
- Accidental or deliberate ingestion to alkali or acid
14
Q
Caustic esophageal injury- Sx
A
- Severe burning, chest pain, gagging, dysphagia & drooling
- Aspiration- stridor & wheezing
15
Q
Caustic esophageal injury- Dx
A
- Endoscopy
- Assess circulatory status, perforation
16
Q
Caustic esophageal injury- Tx
A
- Supportive
- PPI
- severe injury must be closely monitored for strictures- surgery
17
Q
Barrett esophagus- Eti
A
- Complication of GERD
- Up to 10% of pts
- Change from squamous epithelium to columnar
18
Q
Barrett esophagus- Sx
A
- Orange, gastic epithelium on endoscopy
- No specific sx
- Long term GERD
- May lead to adenocarcinoma
19
Q
Barrett esophagus- Dx
A
- Endoscopy- change from white squamous epithelium to orange columnar epithelium
20
Q
Barrett esophagus-Tx
A
- PPI
- Surveillance to determine endoscopy
- Ablation
21
Q
Esophageal stricture- Eti
A
- 5% of patients with esophagitis
- Gradual solid food dysphagia over months to years
- Located at gastroesophageal junction
22
Q
Esophageal stricture- Sx
A
- Reduction in heartburn due to barrier
- Solid food dysphagia
23
Q
Esophageal stricture- Dx
A
Endoscopy with biopsy
24
Q
Esophageal stricture- Tx
A
- Dilation with graduated catheters
- PPI
25
Schatzki ring- Eti
- Thin mucosal strictures at distal esophagus
| - Hiatal hernia & reflux symptoms
26
Schatzki ring- Sx
> 20 mm = asymptomatic
| - <13 mm= solid food dysphagia
27
Schatzki ring- Dx
Barium esophagram
28
Schatzki ring- Tx
- Dilation
| - acid suppression therapy
29
Achalasia- Eti
- Increased incidence with advancing age
- idiopathic motility disorder
- Loss of peristalsis in esophageal smooth muscle
- Impaired relaxation in lower sphincter
30
Achalasia- Sx
- Gradual onset of dysphagia
- Symptoms for months to years
- Subseternal chest pain, discomfort, fullness
- Regurg undigested food- nocturnal
31
Achalasia- Dx
- Esophageal manometery
| - Endoscopy to exclude distal stricture
32
Achalasia- Tx
- CCB
- Botox injection
- Surgical myotomy
- Pneumatic dilation
33
Zenker diverticula- Eti
- Protrusion of pharyngeal mucosa at Pharyngoesophageal junction
- Loss of elasticity in esophageal sphincter
34
Zenker diverticula- Sx
- Insidious dysphagia & regurg
- Coughing & throat discomfort
- Halitosis, spontaneous regurgitation
- Nocturnal choking
- Neck protrusion
35
Zenker diverticula- Dx
Barium esophagram
36
Zenker diverticula- Tx
- Observation for small
- Myomety
- Diverticulectomy
37
Mallory-Weiss syndrome- Eti
- Alcoholics
- Events raising transabdominal pressure- lifting, retching or vomiting
- 5% of upper GI bleed
38
Mallory-Weiss syndrome- Sx
- Hx of vomiting, hematemesis or melena
39
Mallory-Weiss syndrome- Dx
Endoscopy- linear mucosal tear at gastroesophageal junction or gastric mucosa
40
Mallory-Weiss syndrome- Tx
- Endoscopic hemostatic therapy
41
Esophageal varices- Eti
- Secondary to portal HTN
- Dialted submucosal veins- may lead to upper GI bleed
- 50% pts with cirrhosis
42
Esophageal varices- Sx
- Acute, severe GI hemorrhage leading to hypovolemia
| - Red wale markings on varix
43
Esophageal varices- Dx
- Endoscopy
| - Assess hemodynamic status
44
Esophageal varices- Tx
- Abx- fluroquinalones
| - Vasoactive agents to encourage
45
Esophageal malignancy- Eti
```
Squamous cell: most common
- Smoking, blacks> white
Adenocarcinoma
- Reflux + smoking, obesity
- Whites> blacks
- 50-70
- M>W
```
46
Esophageal malignancy- Sx
- Dysphagia
- Wt loss
- Chest or back pain
- Hoarseness
- Lymphadenopathy
47
Esophageal malignancy- Dx
- Barium endoscopy + biopsy
| - Distal 3rd most common
48
Esophageal malignancy- Tx
- I: Surgery
| II-IV: chemo +/- surgery
49
Esophageal spasm- Eto
- Unknown
| - Usually triggered- temp or reflux
50
Esophageal spasm- Sx
Chest pain
- Dysphagia
- May be precipitated by reflux, foods, stress
51
Esophageal spasm- Dx
Manometry- high amplitude, repetitive contraction
| - Nutcracker esophagus
52
Esophageal spasm- Tx
- CCB
| - NTG
