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