esophageal disorders Flashcards

Question

most serious GERD/Barrett Esophagus complication | monitor how??

Answer 1

Most serious potential complication is esophageal CA | EGD every 3-5 years recommended to look for changes

Answer 2

Stricture formation occurs in about 5% of those with chronic esophagitis Usually presents with gradual solid food dysphagia over months to years Usually located at the GE junction -Patients usually require, and benefit from, dilation with gradual catheters inserted over guide wires or balloon procedures (be careful not to perf) -A luminal diameter of ~15mm is needed to relieve dysphagia -Long term PPI use is required to try and reduce the chance of relapse (but almost always relapse)

Answer 3

Lifestyle modifications Avoid bothersome foods (citrus, tomatoes, coffee, spicy foods, chocolate, fatty foods, peppermint, alcohol) Antacids are the mainstay of therapy for rapid relief OTC oral H2-receptor blockers – cimetidine, ranitidine, famotidine

Answer 4

PPIs become the mainstay of therapy Take 30min before breakfast for 4-8 weeks Some patients may require BID therapy

Answer 5

Many patients experience relapse and begin continuous PPI therapy

Answer 6

Nissen fundoplication has an 85% success rate in controlling symptoms and ultimately healing esophagitis SEs however, including dysphagia, bloating, flatulence, dyspepsia and diarrhea happen in over 30% of patients Not recommended in patient currently well controlled with PPIs (only refractory cases) -grab on fundus of stomach and wrap around LES creating more pressure, limits reflux but changes anatomy (slide 21)

Answer 7

* Most common cause of odynophagia and dysphagia* - Often present with substernal chest pain or discomfort - Oral thrush is a poor indicator, however should be assessed for possible clues (but may imply yeast in oropharynx) - Also look for oral ulcers or consideration for CMV infection in other sites (retina, colon) esp. in HIV pts - Serologic testing: HSV, CMV ("CMV colitis")

Answer 8

pill ulcer: Pill induced esophagitis doxycycline (for Lyme): ulcer inducing get EGD, may find pill, ulcer may feel like a lump

Answer 9

Caused by numerous medications, classically NSAIDs, potassium, iron, Vitamin C, and antibiotics (especially tetracycline and doxycline - More likely to occur if pills are swallowed without water or with minimal water - May occur suddenly and persist for days - Chronic injury can result in severe esophagitis, hemorrhage, or even perforation

Answer 10

Suicide attempts or accidental consumption by children Burning, pain, gagging, dysphagia, drooling -dishwater pods look like gummies

Answer 11

A non-penetrating mucosal tear at the G-E junction that generally results from increased transabdominal pressure What patient population might you classically see this in? alcoholics, bulimics -Sometimes can present with hematemesis or melena too (typ. blood tinged vomit)

Answer 12

Treated with injection of epinephrine or cautery if there is active bleeding that does not spontaneously resolve

Answer 13

protrusion of pharyngeal mucosa at the pharyngoesophageal junction - Symptoms include dysphagia, halitosis (bad breath), and regurgitation of undigested food - Often occurs in the elderly and complications can include aspiration pneumonia and lung abscesses as well - Curative treatment is a surgical diverticulectomy

Answer 14

Esophageal Varices

Answer 15

Dilated submucosal veins that develop in patients with serious portal hypertension - Severe upper GIB may occur - Bleeding varices can present with severe hematemesis and shock - 50% of all cirrhotics have esophageal varices, and 30% of them will experience bleeding at some point - Tx can be multifactorial depending on the severity of the varices and the severity of the underlying disease

Answer 16

- Antibiotic prophylaxis: High risk of SBP (spont. bac. peritonitis) or pneumonia - Vasoactive drugs: Somatostatin and octreotide – reduce splanchnic and hepatic blood flow - Vitamin K - Lactulose for encephalopathy which can complicate an acute variceal bleeding episode - Emergent endoscopy: Banding or balloon tamponade

Answer 17

Over a wire that is passed through the jugular vein, a mesh stent is passed through the liver parenchyma crating a shunt from the portal vein to the hepatic vein Can control acute hemorrhage 90% of the time. Also a strategy for the prevention of re-bleeding in those with severe bleeds slide 29 pic

Answer 18

When TIPS procedure is unavailable, shunt surgery can be performed to create similar shunting from the portal vein to the hepatic vein 40-60% mortality when done in emergency situations

Answer 19

Gradual, progressive dysphagia for solids and liquids - Loss of peristalsis in the distal 2/3rds (smooth muscle) of the esophagus - 50% experience substernal chest pain - Regurgitation of undigested food - Patients may lift their chins or throw their shoulders back to get food to move through - Barium esophagram with “bird’s beak” appearance to the distal esophagus (also looks like esophageal ca, but w. less systemic symps) - Diagnosis confirmed with esophageal manometry

Answer 20

Results in marked reduction in LES pressure with initial improvement in symptoms in the majority of patients Relapse reoccurs almost universally by 2 years

Answer 21

Less effective in younger patients, but the majority get a long lasting response Relapse common around the 10 year mark

Answer 22

Excellent improvement in 90% of patients however GERD is a common side effect of the procedure Fundoplication often performed at the same time