Esophagus 1 Flashcards
the UES controls what
food entry into he esophagus
the LES prevents
reflux of gastric contents
relaxed during swallowing and under pressure at rest `
common infectious etiologies of esophagitis
fungal: candida
viral: CMV, HSV
patient demographics of esophagitis
immunosuppressed
patients with esophagitis present with Odynophagia, dysphagia, and possible fever and lymphadenopathy, which is the most significant symptom?
Odynophagia
esophagitis caused by CMV endoscopy shows
1 to several larger and deeper ulcers that are in a linear or longitudinal distribution
esophagitis caused by HSV endoscopy shows
multiple small shallow ulcers more clusters look “volcano-like” due to being well circumscribed
esophagitis caused by candida endoscopy shows
linear yellow white plaques that appear adherent to the esophagus
if someone comes in with esophagitis what should you test them for
HIV, if negative look for other underlying causes of immunodeficiency
definitive diagnosis for esophagitis
when getting an endoscope gather brushings and get at cytology or culture
treatment for esophagitis due to candida
fluconazole or ketoconazole
treatment for esophagitis due to HSV
acyclovir
treatment for esophagitis due to CMV
IV gancilovir or foscarnet
ingestion of household cleaners or bleach may lead to what
corrosive esophagitis
on endoscopy you see ulceration, necrosis and perforation in patches that extends from oropharynx to stomach, what is this?
corrosive esophagitis
2 complications of corrosive esophagitis
Healing may lead to fibrosis and stricture formation (dilate if present)
Increased risk of squamous cell carcinoma
corrosive esophagitis additional information
perforation may occur
obtain a CXRAY and CBC
patients abdomen will be rigid and they will often be unstable
a patient reports with retrosternal chest pain and odynophagia after taking doxy for a recent infection, what is a possible diagnosis?
medication induced esophagitis
3 common meds leading to medication induced esophagitis
NSAIDS, Bisphosphonates, Doxy
chronic injury without treatment of medication induced esophagitis may lead what 3 complications
severe esophagitis with stricture
hemorrhage
perforation
treatment for medication induced esophagitis
removal of medication, allow time to resolve, educate patient to take medication with enough fluid to clear medication
Brain stem dz or CN disease, CVA, Parkinson’s, myasthenia gravis, botulism, muscular dystrophy, polymyositis are causes of what type of esophageal dysmotility?
neurogenic
clinical symptoms of neurogenic esophageal dysmotility?
Dysphaisa, with possible olodyphasia
trouble with BOTH Liquids and solids
a patient comes in complaining of emesis consisting of liquids and undigested foods what do you suspect?
zenker’s diverticulum
where is the pouch located in zenker’s diverticulum
in the posterior hypopharynx above UES
a patient has trouble swallowing solids and not liquids on endoscopy you note webbing, what do you suspect?
esophageal stenosis
3 types of esophageal stenosis
webs rings and malignancy
esophageal manometry and barium esophagram may be used for visualization of what on zenker’s diverticulum
posterior pouch
Schatzki’s ring is a mechanical disorder that may be caused by GERD or congenital/devlopmental deformity may present with what 3 things?
Episodic dysphagia to solids (webs described as intermittent)
Large food boluses may become impacted
Abrupt onset of sub-sternal discomfort
Plummer- Vinson syndrome is associated with what?
esophageal webs
also difficulty swallowing, iron-deficiency anemia
Dilated esophagus tapering to distal obstruction the gives a parrot beak appearance on esophagus is related to what condition?
achalasia
which dysmotility disorder may mimic a heart attack and therefore must be ruled out?
diffuse spasm of the esophagus
patient presents with chest pain and difficulty swallowing after a stressful day at work, pain is radiating to arm and jaw, after ruling our a heart attack you perform a barium esophagram? you diagnosis your patient with a diffuse spasm, what did you see on the esophagram?
a corkscrew esophagus
a diffuse spasm may also be cause by drinking what?
cold liquids
how do you treat a diffuse spasm
smooth muscle relaxants
NTG: before meals and at bedtime
Isosorbide denigrate before meals
nifedipine before before meals
these may drop BP, warn patients
esophageal dysmotility is associated with what rheumatoid disorder from exam 2?
scleroderma - CREST syndrome
in what two ways does CREST syndrome lead to esophageal dysmotility?
1) atrophy and fibrous replacement of smooth muscle in distal esophagus
2) weakness of contraction in the lower esophagus and incompetence of LES
which imaging study allows you to directly see abnormalities and allow for biopsy
endoscopy
which imaging study can show structural and motor problems
barium swallow
esophageal manometry allows what two things?
1) assess strength and coordination of peristalsis
2) Assesses pressures of LES
aspiration pneumonia is common in which esophageal dysmotility?
neurogenic
what is the test of initial investigation for esophageal dysmotility?
barium esophargram (barium swallow), endoscopy then allows for treatment
a linear tear in the mucosa of the esophagus usually near the GE junction is refereed to as
a mallory Weiss tear and causes 10% of paper GI bleed
a 10 week pregnant patient comes in stating that she vomits multiple times a day but is concerned because this morning started to notice blood in the vomit however she is in no pain, what do you suspect?
a Mallory Weiss tear
a 23 year old female comes in a day after her birthday reporting that she blacked out while celebrating the night before, she states that her friends noticed blood in her vomit the night before, you suspect a a Mallory Weiss tear, how do you diagnosis and treat this patient?
dx- endoscopy
treatment- may resolve on its own, possible injection of epinephrine if bleeding persist, additionally might try thermal coagulation or surgery if the bleed is severe (arterial)
