GI - 3 Esophagus pt 4 Flashcards
Dilated submucosal veins (in esophagus) due to portal hypertension, can result in major UGI bleed,
Esophageal varices
What will confirm that bloody vomit is from an UGI bleed?
NG (nasogastric) tube
How are varices treated?
banding
Meds for Esophageal varices:
IV qinolong b/c of high risk of infection (peritonitis)
Octreotide, somatostatin, vasopressin - reduce portal pressure
If medication treatment fails for esophageal varices, what can help stop the bleeding?
Balloon Tampanode (applies pressure)
Signs and symptoms of Eosinophilic Esophagitis:
Dyaphagia for solid food, heartburn, vomiting, elevatead igE
Diagnosis of Eosinophil Esophagitis
Barium swallow (for new patients complaining of dysphagia)
Barium swallow shows multiple concentric rings and eosinophils in mucosa of proximal esophagus
That’s how you diagnose Eosinophil Esophagitis
What are 2 types of Esophageal Cancer?
Squamous cell and Adenocarcinoma
Barrett’s is associated with what?
Adenocarcinoma esophageal cancer
Alcohol and tobacco are more associated with
Squamous cell esophageal cancer
Symptoms of Esophageal cancer
Progrssive dysphagia (solids then even liquids)
Weight loss
Coughing with swallowing or pneumonia
Why does Esophageal Cancer spread fast?
B/c there is no mucosa protecting the esophagus
Diagnosis of Esophageal cancer
Barium Esophagram (new patient comes and complains ofdysphagia) Upper endoscopy allows to biopsy area
Anything beyond Stage IIIa is:
Too advanced for surgery to cure
Idiopathic. Loss of peristalsis in distal 2/3 of esophagus. Impaired relaxation of LES, gradual onset of dysphagia for solids and liquids. Regurgitating undigested food hours later, coughing, aspiration, weight loss
Achalasia
How is Achalasia diagnosed? (2 tests, 4 signs)
Barium Esophagram: Absent peristalsis, dilated esophagus, smooth symmetric beak appearance
CXR: Air fluid level in enlarged esophagus.
How is Achalasia CONFIRMED?
Esophageal Manometry. The Barium is only suggestive. This actually confirms there isn’t peristalsis, there is incomplete relaxation of LES, and intraesophageal pressure > gastric pressure
What is the treatment for Achalasia? (2)
- Balloon Dilitation of LES
- Laproscopic Myotomy (cut out and remove LES)
- Botulinum toxin injection – reduces LES pressure (for ppl that can’t handle invasive procedures like 1&2
Nonpropulsive/hyperdynamic/irritable contractions in esophagus. Chest pain, dysphagia (solids and liquids)
Diffuse Esophageal Spasm
Barium Esophagram shows poor progression of bolus, disordered contraction
Diffuse Esophageal Spasm
How is Diffuse Esophageal Spasm diagnosed?
Barium Esophagram shows poor progression of bolus, disordered contraction
How is Diffuse Esophageal Spasm treated?
Anticholinergics (antispasmotics)
Esophageal Manometry must be done to confirm:
Achalasia
