Esophagitis, Esophageal Stricture, Esophageal Spasm

Question 1

Pertinent Anatomy

Answer 1

Esophagus……

Question 2

What functions to promote motility, via peristalsis, to introduce ingested food
to the stomach

Answer 2

Esophagus

Question 3

What issue describes a subset of patients with GERD who have endoscopic
evidence of esophageal inflammation.

Answer 3

Reflux esophagitis

Question 4

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.

Answer 4

medication-induced esophagitis

Question 5

The hallmark of Candida esophagitis is what?

Answer 5

odynophagia(pain on swallowing)

Question 6

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.

Answer 6

white mucosal plaque-like lesions
HIV-infected patients

Question 7

Treatment for esophagitis

Answer 7

Treat the underlying cause

Question 8

Treatment for Pill induced esophagitis

Answer 8

1) Stop taking offensive medication
2) Take with water

Question 9

TX for Candida Esophagitis

Answer 9

Evaluate for immunocompromised conditions: HIV, Cancer, Diabetes

Question 10

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.

Answer 10

2) endoscopy with biopsy
3) fever and elevated WBC

Question 11

__________ are likely caused as a result to esophageal irritation from chronic
GERD.

Answer 11

Esophageal strictures

Question 12

Stricture formation happens to ______ the volume of reflux in the esophagus to reduce symptoms of GERD.

Answer 12

lower

Question 13

Eosinophilic esophagitis is a more commonly recognized cause of esophageal strictures, particularly in what demographic?

Answer 13

young men

Question 14

S/S of what issue
(1) Localized substernal chest pain
(2) Heartburn
(3) Dysphagia is the cardinal feature of this issue

Answer 14

esophageal stricture

Question 15

RADs for Esophageal Stricture

Answer 15

1) Endoscopy
2) Barium study

Question 16

Treatment for esophageal stricture
(1) Mild symptoms- _________
(2) Severe symptoms- __________
(3) Refer all patients to Gastroenterology for __________.

Answer 16

1) treat for GERD as the causative factor
2) consider MEDEVAC for potential surgery
3) Dilation and evaluation

Question 17

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.

Answer 17

1) GERD
a) MEDIVAC

Question 18

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

Answer 18

Esophageal Spasm

Question 19

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.

Answer 19

Esophageal Spasm

Question 20

Treatment for Esophageal Spasm

Answer 20

(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)

Question 21

Initial Care for Esophageal spasm

Answer 21

(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.

Question 22

When would you MEDIVAC a suspected esophageal spasm

Answer 22

oral feeding becomes problematic