Gastroenterology Flashcards
Differential Diagnosis for infectious esophagitis? Empiric treatment?
Oral ulcerations could be due to Candida (75% of cases), HSV or CMV (<50% of cases), or Histoplasma infection. Empirically treat for Candida Albicans with Fluconazole to assess for a response
Infection Esophagitis symptoms?
odynophagia, dysphagia (can’t swallow), and chest pain
DDx for esophagitis (odynophagia, dysphagia and chest pain)
Infectious Esophagitis: C albicans, HSV, CMV, Histoplasma. GERD, pill induced, caustic ingestion, radiation, eosinophilic, autoimmune (eg, Crohn’s, Behçet’s). Functional dyspepsia, esophageal stricture, mass lesion, motility disorders, graft-versus-host disease.
Dx workup of esophagitis?
Immunocompromised- fluconazole trial Immunocompetent with odynophagia and dysphagia (alarm sxs) then endoscopy.
What are the possible findings for c. albicans, CMV, HSV or AIDS in a patient with esophagitis on EGD?
C albicans: Linear, adherent plaques that may be yellow or white. CMV: Few large, superficial ulcerations. HSV: Numerous small, deep ulcerations. Idiopathic AIDS ulcers: Low CD4 count; large ulcerations.
Treatment for esophagitis if C Albicans?
Immunocompetent patients: Topical therapy; nystatin swish and swallow five times a day × 7-14 days. Test for HIV. Immunocompromised patients: Oral therapy, initially with fluconazole 100-200 mg/day. If the patient is unresponsive, try increasing fluconazole or giving itraconazole, other azoles, caspofungin, or amphotericin.
Treatment for esophagitis if CMV?
CMV: Ganciclovir IV x 3-6 weeks.
Treatment for esophagitis if HSV?
HSV: Acyclovir 200 mg PO five times a day or valacyclovir 1000 g PO BID.
Treatment for esophagitis if idiopathic ulcers?
Trial of Prednisone
What are the possible complications of infectious esophagitis?
stricture, malnutrition, hemorrhage.
Do you need to do an EGD to dx pill esophagitis?
No, hx is enough.
What is in the sxs for pill esophagitis?
Think painful swallowing. Also: dysphagia and possible chest pain.
Common causative agents for pill esophagitis?
NSAIDs: ASA, naproxen, ibuprofen, indomethacin. Antibiotics: Tetracyclines (especially doxycycline), clindamycin (look for a young patient with acne presenting with odynophagia). Antivirals: Foscarnet, AZT, ddC. Supplements: Iron and potassium. Cardiac medications: Quinidine, nifedipine, captopril, verapamil. Bisphosphonates: Alendronate, pamidronate. Antiepileptics: Phenytoin. Asthma/COPD medications: Theophylline.”
Trx plan for pill esophagitis?
Discontinue the suspected drug. Expect symptom relief within 1-6 weeks. Patients should drink eight ounces of water with each pill and remain upright at least 30 minutes afterward. Proton pump inhibitors (PPIs) may facilitate healing in the setting of concurrent GERD. Upper endoscopy: Evaluate for stricture or mass lesion (if no response is elicited to stopping the potentially offending agent).
What is the pathophys and epic of achalasia?
An idiopathic esophageal motility disorder with loss of peristalsis, high lower esophageal sphincter (LES) resting pressure, and failure of LES relaxation when swallowing. Age at onset is 25-60; incidence ↑ with age. Indistinguishable from esophageal dysmotility caused by Chagas’ disease.
