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STEP 2 GI > Esophagitis 10-30 (1) > Flashcards

Esophagitis 10-30 (1) Flashcards

1
Q

esophagitis. causes abbreviation?

A

PIECE

Pill induced, infection, eosinophilic, caustic, GERD

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1
Q

esophagitis. CP?

A

Odynophagia, dysphagia

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2
Q

esophagitis. diagnosis?

A

endoscopy and biopsy

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3
Q

esophagitis. treatment/=?

A

disease specific
Antacid: PPI or H2 blocker

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4
Q

Pill induced. mechanism?

A

Pills getting stuck in esophagus.

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5
Q

Pill induced. what pills?

A

Acid effect of tetracyclines.
Osmotic tissue injury of potassium chloride.
Disrupted normal GI mucosa of NSAIDs.

Also: iron, bisphosphonates - alendronate, risedronate

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6
Q

Pill induced. CP?

A

esophagitis. Usually in the mid-esophagus.

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7
Q

Pill induced. diagnosis?

A

endoscopy and biopsy.

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8
Q

Pill induced. treatment?

A

Remove pill. Give them time to heal. Give antacids.

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9
Q

Pill induced. prevention?

A

Avoid recumbency, take water with the pill.

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10
Q

Infectious. candida? CP and treatment

A

Oral thrush and symptoms of esophagitis; treat as candida - oral flukonazole

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11
Q

Infectiuos. HSV CP and treatment?

A

HSV: Oral lesions and symptoms of esophagitis: treat as HSV.

val or acyclovir.

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12
Q

Infecitous. CMV CP and treatment?

A

CMV: No oral lesion.
val or gancyclovir.

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13
Q

Infectious. HIV CP and treatment?

A

HIV: Opportunistic infection.
treatment HAART.

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14
Q

Infectious in general. CP, diagnosis, treatment?

A

C/P: esophagitis.
Diagnosis: endoscopy and biopsy.
Treatment: depends on the organism.

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15
Q

Eosinohilic. Its ,,allergic reaction”.
Pathogenesis?

A

Chronic, immune-mediated esophageal inflammation

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16
Q

Eosinohilic. clinical presentation?

A

Dysphagia (solid food), inability to tolerate fluids (throwing up) –> can lead to fibrosis and strictures –> progressive dysphagia and food impaction.

chest/epigastric pain
reflux/vomiting
Associated atopy

Cardinal symptoms: drooling, hypersalivation

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17
Q

Eosinohilic. diagnosis?

A

endoscopy and biopsy (>= 15 eos/hpf)

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18
Q

Eosinohilic. what is seen on endoscopy?

A

Linear furrows and circular rings.
Trachealization of the esophagus.

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19
Q

Eosinohilic. treatment?

A

Dietary modification
Trial PPI for 6 weeks
if it fails, +/- topical glucocorticoids (topical tai blet oral aerosolized)

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20
Q

Caustic. etiology?

A

kid - accidentaly
adults - suicide

acid or base

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21
Q

Caustic. CP?

A

hoarse voice/stridor. Stridor –> pending airway collapse –> intubate

drooling, facial burns

22
Q

Caustic. diagnosis?

A

endoscopy and biopsy

23
Q

Caustic. treatment?

A

low severity: liquid diet
High severity: NPO for 72h. Then EGD to see if they can accept food.
NGT and lavage if caught early.

24
Q

Caustic. what NOT to do in treatment?

A

do not neutralize the pH
Never induce emesis

25
Q

GERD. pathophysiology? 3

A

decr. tone or excessive transient relaxation of LES
Anatomic disruption to gastro-eso junction (eg hiatal hernia)
incr. risk with obesity, pregnancy, smoking, alcohol intake

26
Q

GERD. CP. typical?

A

Burning chest pain. Made worse by laying down and spicy food. Better by sitting up and antacids.
Regurgitation
Odynophagia (often indicates reflux esophagitis

27
Q

GERD. CP atypical? extraesophageal

A

cough, hoarseness, wheezing, nocturnal asthma

28
Q

GERD. complications? eso ir extraeso

A

eso - erosive esophagitis, barret esophagus, strictures
extraeso - asthma, laryngitis

29
Q

GERD. initial treatment?

A

Lifestyle (eg weight loss) and dietary changes
H2R blocker or PPI

30
Q

GERD. diagnosis. initial?

A

PPI and lifestyle for 6 month –> gets better

31
Q

GERD. diagnosis. what ligestyle?

A

avoid chocolate, coffe, smoking

32
Q

GERD. diagnosis. if no response to initial?

A

no response –> EGD and biopsy

33
Q

GERD. diagnosis. when skip PPI and directly do EGD?

A

Skip PPI and directly to EGD IF ALARM SYMPTOMS or men age >50 with chronic (>5 years) symptoms or cancer risk factors (tobacco use).

34
Q

GERD. diagnosis. what other 2 methods?

A

24-hour pH monitoring.
Manometry.

35
Q

GERD. treatment. if normal GERD?

36
Q

GERD. treatment. if normal GERD and more than 2 episodes per week?

A

Fewer than 2 episodes of symptoms per week –> lifestyle changes (weight loss, head of bed elevation) and histamine 2 receptor antagonists (lamotidine, rantidine

37
Q

GERD. treatment. if normal GERD ans more severe symptoms or esophagitis, laryng involvement?

A

managed with 8-week course of a PPI

38
Q

GERD. treatment. refractory GERD?

A

higher dose of PPI.

39
Q

GERD. treatment. persistent GERD

A

endoscopy or esophageal pH monitoring.

40
Q

GERD. treatment. what application aka technique?

A

Nissen fundoplication: cannot tolerate PPI or doesn’t want to.

41
Q

GERD. treatment. barrets?

A

higher dose of PPI; twice a day.

42
Q

GERD. treatment. dysplasia?

A

local ablative therapy. Radiofrequency ablation, laser, or cryotherapy.

43
Q

GERD. treatment. adenocarcinoma?

A

stage and resect.

44
Q

GERD. treatment. one of method ,,do surveilance EGD”

45
Q

GERD. algorithm.
1. PPI and lifestyle for 6 months: improves vs noimprovement

A

a. Improves –> GERD: PPI.
b. No improvement –> EGD and biopsy.

46
Q

GERD. algorithm.
2. EGD and biopsy: improves vs noimprovement

A

a. No improvement on PPI and lifestyle.
b. Alarm symptoms: nausea and vomiting, anemia, and weight loss.

47
Q

GERD. algorithm. pagal findings ,,gydymas”. GERD?

48
Q

GERD. algorithm. pagal findings ,,gydymas”. metaplasia?

A

high doses PPI

49
Q

GERD. algorithm. pagal findings ,,gydymas”. dysplasia?

A

local ablation plus PPI

50
Q

GERD. algorithm. pagal findings ,,gydymas”. adneocarcinoma?

A

staging, resection, chemo, and radiation.

51
Q

GERD. algorithm.

d. Keep doing endoscopies to check for worsening condition.

52
Q

Yra algoritmas, atspausdintas

STEP 2 GI (32 decks)

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