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GM 2 > Esophageal disorders > Flashcards

Esophageal disorders Flashcards

1
Q

GERD- Eti

A
  • 20% of adults

- reflux esophagitis develops in 1/3

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2
Q

GERD- Sx

A
  • Heartburn 30-60 min after meals & reclining
  • Relief with antacids
  • Regurgitations- sour or bitter
  • Dysphagia
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3
Q

GERD- Dx

A
  • Treat empirically with PPI 4-8 wks

- If symptoms persist then endoscopy to determine contributing or complicating symptoms

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4
Q

GERD- Tx

A
  • Eliminate acidic foods
  • Antacids
  • PPI
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5
Q

Infections esophagitis- Eti

A
  • Immunosupressed
  • Candida albicans, herpes, CMV
  • Herpes can affect normal host
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6
Q

Infections esophagitis- Sx

A
  • Odynophagia
  • Dysphagia
  • Oral thrush
  • Substernal chest pain
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7
Q

Infections esophagitis- Dx

A
  • Endoscopy with biopsy
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8
Q

Infections esophagitis- Tx

A
  • Empiric- Tx causative organism
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9
Q

Pill induced esophagitis- Eti

A
  • More likely in hospital pts.

- NSAIDs, Abx, most common

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10
Q

Pill induced esophagitis- Sx

A
  • Severe retrosternal chest pain
  • Odynphagia
  • Dysphagia
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11
Q

Pill induced esophagitis-Dx

A
  • Endoscopy- discrete shallow or deep ulcers
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12
Q

Pill induced esophagitis- Tx

A
  • Take pills with H20, remain upright for 30 min

- Don’t give agents to people with dysmotiity

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13
Q

Caustic esophageal injury- Eti

A
  • Accidental or deliberate ingestion to alkali or acid
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14
Q

Caustic esophageal injury- Sx

A
  • Severe burning, chest pain, gagging, dysphagia & drooling

- Aspiration- stridor & wheezing

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15
Q

Caustic esophageal injury- Dx

A
  • Endoscopy

- Assess circulatory status, perforation

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16
Q

Caustic esophageal injury- Tx

A
  • Supportive
  • PPI
  • severe injury must be closely monitored for strictures- surgery
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17
Q

Barrett esophagus- Eti

A
  • Complication of GERD
  • Up to 10% of pts
  • Change from squamous epithelium to columnar
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18
Q

Barrett esophagus- Sx

A
  • Orange, gastic epithelium on endoscopy
  • No specific sx
  • Long term GERD
  • May lead to adenocarcinoma
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19
Q

Barrett esophagus- Dx

A
  • Endoscopy- change from white squamous epithelium to orange columnar epithelium
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20
Q

Barrett esophagus-Tx

A
  • PPI
  • Surveillance to determine endoscopy
  • Ablation
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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
Q

Schatzki ring- Eti

A
  • Thin mucosal strictures at distal esophagus

- Hiatal hernia & reflux symptoms

26
Q

Schatzki ring- Sx

A

> 20 mm = asymptomatic

- <13 mm= solid food dysphagia

27
Q

Schatzki ring- Dx

A

Barium esophagram

28
Q

Schatzki ring- Tx

A
  • Dilation

- acid suppression therapy

29
Q

Achalasia- Eti

A
  • Increased incidence with advancing age
  • idiopathic motility disorder
  • Loss of peristalsis in esophageal smooth muscle
  • Impaired relaxation in lower sphincter
30
Q

Achalasia- Sx

A
  • Gradual onset of dysphagia
  • Symptoms for months to years
  • Subseternal chest pain, discomfort, fullness
  • Regurg undigested food- nocturnal
31
Q

Achalasia- Dx

A
  • Esophageal manometery

- Endoscopy to exclude distal stricture

32
Q

Achalasia- Tx

A
  • CCB
  • Botox injection
  • Surgical myotomy
  • Pneumatic dilation
33
Q

Zenker diverticula- Eti

A
  • Protrusion of pharyngeal mucosa at Pharyngoesophageal junction
  • Loss of elasticity in esophageal sphincter
34
Q

Zenker diverticula- Sx

A
  • Insidious dysphagia & regurg
  • Coughing & throat discomfort
  • Halitosis, spontaneous regurgitation
  • Nocturnal choking
  • Neck protrusion
35
Q

Zenker diverticula- Dx

A

Barium esophagram

36
Q

Zenker diverticula- Tx

A
  • Observation for small
  • Myomety
  • Diverticulectomy
37
Q

Mallory-Weiss syndrome- Eti

A
  • Alcoholics
  • Events raising transabdominal pressure- lifting, retching or vomiting
  • 5% of upper GI bleed
38
Q

Mallory-Weiss syndrome- Sx

A
  • Hx of vomiting, hematemesis or melena
39
Q

Mallory-Weiss syndrome- Dx

A

Endoscopy- linear mucosal tear at gastroesophageal junction or gastric mucosa

40
Q

Mallory-Weiss syndrome- Tx

A
  • Endoscopic hemostatic therapy
41
Q

Esophageal varices- Eti

A
  • Secondary to portal HTN
  • Dialted submucosal veins- may lead to upper GI bleed
  • 50% pts with cirrhosis
42
Q

Esophageal varices- Sx

A
  • Acute, severe GI hemorrhage leading to hypovolemia

- Red wale markings on varix

43
Q

Esophageal varices- Dx

A
  • Endoscopy

- Assess hemodynamic status

44
Q

Esophageal varices- Tx

A
  • Abx- fluroquinalones

- Vasoactive agents to encourage

45
Q

Esophageal malignancy- Eti

A 
Squamous cell: most common
- Smoking, blacks> white
Adenocarcinoma
- Reflux + smoking, obesity
- Whites> blacks
- 50-70
- M>W
46
Q

Esophageal malignancy- Sx

A
  • Dysphagia
  • Wt loss
  • Chest or back pain
  • Hoarseness
  • Lymphadenopathy
47
Q

Esophageal malignancy- Dx

A
  • Barium endoscopy + biopsy

- Distal 3rd most common

48
Q

Esophageal malignancy- Tx

A
  • I: Surgery

II-IV: chemo +/- surgery

49
Q

Esophageal spasm- Eto

A
  • Unknown

- Usually triggered- temp or reflux

50
Q

Esophageal spasm- Sx

A

Chest pain

  • Dysphagia
  • May be precipitated by reflux, foods, stress
51
Q

Esophageal spasm- Dx

A

Manometry- high amplitude, repetitive contraction

- Nutcracker esophagus

52
Q

Esophageal spasm- Tx

A
  • CCB

- NTG

GM 2 (15 decks)

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