Esophagus Flashcards
Replacement of normal squamous epithelium with metaplastic columnar epithelium
Barrett esophagitis
Medications that may worsen GERD
Tetracycline Bisphosphonates Iron NSAIDs Anticholinergics (Atropine, Scopalamine) Ca Channel blockers Narcotics Benzodiazepines
When is Endoscopy warranted for GERD
Severe disease (spontaneous supine occurrences) to assess for epithelial damage
Patients older than 45 yrs with new onset of symptoms, frequently recurring symptoms, failure to respond to therapy
Recurrent vomiting, dysphagia, anemia
Workup for GERD should always include
Cardiac workup, for ischemia (EKG)
Additional testing in severe / refractory cases, or to prep for operation
Manometry (pre op, motility testing)
24 hr pH testing
Barium swallow
Treatment for patients with significant nighttime GERD symptoms
H2 blocker at bedtime w PPI in the daytime
Drugs that decrease lower esophageal sphincter pressure
Beta Agonists Alpha adrenergic agonists Nitrates CCBs Anticholinergics Opiates Barbituates
Common causes of esophagitis
CMV
HSV
Candida
Odynophagia and dysphagia in an immunocompromised patient indicates
Esophagitis
Endoscopy of an immunocompromised patient shows large, deep ulcers of the esophagus. What might be the case
CMV or HIV
Endoscopy of an immunocomproimsed patient shows multiple shallow ulcers in the esophagus. What might be the cause
HSV
Definitive diagnosis for esophagitis
Cytology or culture from endoscopic brushings
Most common presenting symptom for all motility disorders
Dysphagia
Patient with a history of trauma to brain stem or cranial nerves IX, X who has trouble swallowing both solids and liquids
Neurogenic dysphagia
Outpouching of posterior hypo pharynx that can cause regurgitation of undigested food and liquid into pharynx several hours after eating
Zenker Diverticulum
Dysphagia with solid foods. Can progress slowly (more benign process) or rapidly (indicates malignancy)
Esophageal stenosis
Global esophageal motor disorder in which peristalsis is decreased and lower esophageal sphincter tone is increased, causing slowly progressive dysphagia with episodic regurgitation and chest pain
Achalasia
Dysphagia or intermittent chest pain that may or may not be associated with eating
Diffuse esophageal spasm
Diagnostic study that can reveal structural and motor abnormalities of the esophagus
Barium swallow
Disorder that has a “parrot beak” appearance (i.e., a dilated esophagus tapering to the distal obstruction) on barium swallow
Achalasia
Diagnostic study that allows for direct observation and biopsy of abnormalities
Endoscopy (EGD)
Diagnostic study that can be used to assess the strength and coordination of peristalsis
Esophageal manometry
Treatment for esophageal strictures
most treated by Dilation (balloon)
*Malignant strictures must be resected
Management for diverticula, achalasia, stenosis
Surgical! (Endoscopic dilation, resection) if condition is severe enough to warrant intervention. Medical therapies are not proven effective.
Most common types of esophageal neoplasms
Squamous cell carcinomas and Adenocarcinomas Barretts)
Where in the esophagus do squamous cell carcinomas tend to occur
Proximal 2/3rds of esophagus
Where in the esophagus to adenocarcinomas tend to occur
Barretts in distal 1/3rd
Where to esophageal neoplasms tend to spread, and why
Mediastinum, because the esophagus has no SEROSA
Factors that contribute to esophageal cancers
Cigarette Smoking, Chronic Alcohol use
HPV
Main clinical feature of esophageal cancer
Progressive dysphagia w solid food PLUS marked weight loss
Heartburn, vomiting, hoarseness may occur
Best initial test to visualize esophageal lesion
Biphasic barium esophagram
Diagnostic test for esophageal neoplasm
Endoscopy w brushings
Linear mucosal tear in the esophagus, generally at the gastroesophageal junction
Mallory-Weiss Tear
Common cause of Mallory Weiss tear>
Forceful vomiting or retching
Often associated with alcohol abuse, but should be considered in all upper GI bleeds
Causes 5-10% of upper GI bleeds
Mallory-Weiss tear
Diagnosis of Mallory Weiss tear
Endoscopy
Treatment for Mallory Weiss tear
Most resolve without treatment
PPI may be used
Endoscopic injection of epinephrine or thermal coagulation if bleeding does not resolve
Newborn presenting with excessive saliva, choking, coughing when attempting to feed
Esophageal atresia (commonly w tracheoesophageal fistulae)
Diagnosis and treatment of congenital esophageal atresia
Inability to pass nasogastric tube establishes diagnosis
Treatment is surgical
Bowel sounds heard in the chest of a newborn
Diaphragmatic hernia
Progressive, nonbilious, often projectile vomiting in a newborn 4-6 weeks old. Weight loss and dehydration common.
Pyloric stenosis
PE finding in pyloric stenosis
olive-shaped mass felt to the right of the umbilicus
Rare autosomal recessive inability to metabolize the protein phenylalanine - accumulation of phenylalanine in brain causes mental retardation and movement disorders
Phenylketonuria
Management of PKU
low-phenylalanine diet, tyrosine supplements, strict control of protein intake
