Esophagitis, Esophageal Stricture, Esophageal Spasm Flashcards
Pertinent Anatomy
Esophagus……
What functions to promote motility, via peristalsis, to introduce ingested food
to the stomach
Esophagus
What issue describes a subset of patients with GERD who have endoscopic
evidence of esophageal inflammation.
Reflux esophagitis
What issue?
Usually present with retrosternal pain or heartburn (60 percent), odynophagia (50 percent), and dysphagia (40 percent).
-In some cases, the pain may be so severe that swallowing saliva is difficult. -Patients often have a history of swallowing a pill without water, commonly at bedtime.
medication-induced esophagitis
The hallmark of Candida esophagitis is what?
odynophagia(pain on swallowing)
The diagnosis of Candida esophagitis is usually made when ______ lesions are noted on endoscopy.
Esophageal candidiasis is most common in ________, and in patients with hematologic malignancies.
white mucosal plaque-like lesions
HIV-infected patients
Treatment for esophagitis
Treat the underlying cause
Treatment for Pill induced esophagitis
1) Stop taking offensive medication
2) Take with water
TX for Candida Esophagitis
Evaluate for immunocompromised conditions: HIV, Cancer, Diabetes
Initial Care
(1) Determine the underlying cause and treat.
(2) Most infectious manifestations require _______ to confirm diagnosis.
(3) Broad spectrum antibiotic should be considered in those who present with _________.
(4) Pill induced patients should d/c oral medications unless absolutely necessary, then reduced dose should be considered.
2) endoscopy with biopsy
3) fever and elevated WBC
__________ are likely caused as a result to esophageal irritation from chronic
GERD.
Esophageal strictures
Stricture formation happens to ______ the volume of reflux in the esophagus to reduce symptoms of GERD.
lower
Eosinophilic esophagitis is a more commonly recognized cause of esophageal strictures, particularly in what demographic?
young men
S/S of what issue
(1) Localized substernal chest pain
(2) Heartburn
(3) Dysphagia is the cardinal feature of this issue
esophageal stricture
RADs for Esophageal Stricture
1) Endoscopy
2) Barium study
Treatment for esophageal stricture
(1) Mild symptoms- _________
(2) Severe symptoms- __________
(3) Refer all patients to Gastroenterology for __________.
1) treat for GERD as the causative factor
2) consider MEDEVAC for potential surgery
3) Dilation and evaluation
Initial Care for esophageal stricture
(1) For mild symptoms, treat patient as you would a patient with ______ .
(2) For more severe symptoms, such as dysphagia, food impactions, and asphyxiation
(a) Monitor patient, stabilize and consider ______ regardless of
hemodynamic stability.
(b) Unresolved issue could lead to declining patient in a short period of time that would be in need of surgical intervention.
1) GERD
a) MEDIVAC
S/S of what issue
(1) Gradual onset of dysphagia with solid foods and some liquids
(2) Can be present for months
(3) Substernal discomfort/ fullness
(4) Lifting neck or throwing shoulders back to enhance gastric emptying
(5) Regurgitation is common
(6) Substernal chest pain
Esophageal Spasm
Pathophysiology of what issue
(1) Idiopathic motility disorder which causes loss of peristalsis in the distal two-thirds of the esophagus and impaired relaxation of the LES, could be caused by GERD.
(2) It is thought to be a consequence of impaired inhibitory innervation, leading to premature and rapidly propagated contractions in the distal esophagus.
Esophageal Spasm
Treatment for Esophageal Spasm
(1) Proton Pump Inhibitor (PPI) medications if GERD is present.
(2) Symptom reduction is the goal
(3) Eat smaller bites of food
(4) Invasive procedures (endoscopic injection of botulinum toxin)
Initial Care for Esophageal spasm
(1) Treat symptoms associated with spasm.
(2) Check for underlying cause as treatment of cause would eliminate symptoms.
(3) Monitor for improvement.
(4) If oral feeding becomes problematic, refer to parental IV, NPO and prepare patient for MEDEVAC.
When would you MEDIVAC a suspected esophageal spasm
oral feeding becomes problematic
