GI Flashcards
What medications may cause or worsen sxs of GERD?
Some antibiotics (tetracyclines), bisphophonates, iron, NSAIDs, anticholinergics, calcium channel blockers, narcotics, benzodiazepines, and others.
What is the (rare) complication of GERD?
Barrett’s Esophagitis (replacement of normal squamous epithelium with metaplastic columnar epithelium), which can predispose to malignancy
What are the sxs of GERD?
heart burn that is generally worse after meals and when lying down, and relieved with antacids. Regurgitation and dysphagia may occur.
less common sxs: hoarseness, halitosis, cough, hiccuping, sore throat, laryngitis, and atypical chest pain
When is endoscopy indicated for GERD?
more severe disease - confirm dx and assess for epithelial damage
if
Tx for GERD?
- Lifestyle modifications (stop smoking, avoid eating at bedtime, avoid large meals, avoid alcohol and foods that irritate like tomatoes, fried foods, caffeine, raising head of bed)
- antacid for mild sxs
- h2 blocker or PPI (omeprazole)
What are some meds to avoid in GERD because they decrease lower esophageal sphincter pressure?
b-agonists a-adrenergic antagonists nitrates CCBs anti-cholinergics theophylline morphine meperidine diazepam barbiturates
Infectious esophagitis tends to occur in what patient population?
Immunocompromised
What are causes of infectious esophagitis? How does it present?
fungal (candida), viral (CMV, HSV); other uncommon causes as well
odynophagia or dysphagia in immunocompromised
dx with endoscopy
Esophageal dysmotility disorders causes?
Neurologic, intrinsic or external blockage, or malfunction of esophageal peristalsis
what are some disorders of esophageal dysmotility?
neurogenic dysphagia, Zenker diverticulum, esophageal stenosis, achalasia, diffuse esophageal spasm, scleroderma
What is the most common presenting symptom of esophageal dysmotility disorders?
Dysphagia.
What is neurogenic dysphagia?
neurogenic: dysphagia with liquids and solids caused by injury or disease of brainstem or CN 9 or 10
What is Zenker diverticulum?
outputting of posterior hypo pharynx that can cause regurgitation of undigested food and liquid into pharynx several hours after eating
What is esophageal stenosis?
dysphagia with solid foods
slow progression of solid food indicates benign process whereas rapid progression indicates malignancy
What is achalasia?
global esophageal motor disorder in which peristalsis is decreased and LES tone is increased, causing slowly progressive dysphagia with episodic regurgitation and chest pain
dx: barium swallow produces “parrot beak” (dilated esophagus tapering to the distal obstruction)
What is diffuse esophageal spasm?
dysphagia or intermittent chest pain that may or may not be associated with eating
What is scleroderma?
Hardening or tightening of skin and connective tissue
eventually involves esophagus in most patients, causing decreased sphincter tone and peristalsis, predisposing to sxs and complications of reflux
Esophageal neoplasm types? Where might they spread?
Squamous cell carcinomas and adenocarcinomas most common
Barret is associated with adenocarcinomas in distal third of esophagus
SC lesions tend to occur in upper third
Common to spread to mediastinum since esophagus has no serosa
Pt presents with progressive dysphagia for solid food associated with marked weight loss. Heartburn, vomiting, and hoarseness may occur. What is the major concern? How to dx and treat?
Esophageal cancer.
- barium esophagram best initial test
- endoscopy with brushings to diagnose
- endoscopic sonography and CT for staging
Treat with surgery. May also do radiotherapy and adjunctive chemo with or without surgery.
Risk factors for esophageal cancer?
Frequently related to cigarette smoking and chronic alcohol use; also exposure to caustic agents, hot foods, mucosal abnormalities, poor oral hygiene and HPV
What is a mallory-weiss tear? What is it associated with?
Linear mucosal tear in esophagus, generally at gastroesophageal junction, that occurs with forceful vomiting or retching, causing hematemesis. 5-10% of upper GI bleeds.
Associated with alcohol use but consider for any upper GI bleed
dx and tx of mallory-wiess tear?
endoscopy
most resolve without treatment; a PPI may be used if active bleed is resolved
endoscopic injection of epinephrine or thermal coagulation if bleeding doesn’t resolve
What are esophageal varies and what causes them?
- Dilation of veins of esophagus, usually at distal end.
- Caused by portal hypertension (most commonly from cirrhosis either from alcohol abuse or from chronic viral hepatitis)
- Use of NSAIDs can exacerbate bleeding (hepatic vein obstruction)
- Budd-Chiari syndrome may cause thrombosis of portal vein, leading to esophageal varies
