GI: esophagus Flashcards
Esophageal Atresia
- RF
- CM
- diagnosis/how to confirm
- atenatal diagnosis?
- TX
- later life complications
RF: maternal exposure to methimazole, exogenous sex hormones, infectious dz, ETOH, smoking, DM, adv age, maternal employment in agriculture
CM:
at the first few feedings baby will have choking or vomiting
Diagnose:
an attempt to pass catheter into the stomach does not work
*CONFIRMED: AP xray with catheter in place
Atenatal diagnosis:
-polyhydraminos–high amt of amniotic fluid because baby cannot swallow amniotic fluid
TX:
-surgical repair
Later life complications:
- dysphagia
- strictures
- peristalsis
- reflux
Infantile Hypertrophic Pyloric Stenosis
- RF
- CM
- when does it start
- PE
- confirm diagnosis?
- definitive tx
RF:
-incr freq in first born M
CM:
- postprandial vomiting
- forceful, NONBILIOUS vomiting immediately after meals
- starts around 2-3 weeks post birth
PE:
- weight loss
- electrolyte imbalances
- dehydration
- irritable infant bc they are hungry but have esophageal discomfort
- palpable olive shaped mass in RUQ (enlarged/thickened pylorus)
diagnosis:
* confirmed with US with target sign
TX:
-surgical pyloromyotomy
palpable olive shaped mass in RUQ
hypertrophic pylorus
target sign on US
infantile hypertrophic pyloric stenosis
Infantile GERD
- CM
- complications
- diagnosed
- TX (1st, 2dn, 3rd)
CM:
- excessive vom
- food refusal
- unexplained crying
- choking
- gagging
Complications
- esophagitis
- hemorrhage
- stricture
- Barrett Esophagus (RARE)
Diagnosed
*clinically
TX:
*1st: mom + baby dietary changes
2nd: H2 blockers and antacids
3rd or mod-severe: PPI
Dysphagia
- CM
- mangement
CM
- stabbing pain at the level of obstruction
- discomfort after swallowing
- regurg
- unpleasant taste sensation
- vomiting
- aspiration
- wt loss
Managed:
- eat small meals
- drink fluid with meals
- eat slowly
- sleep with head upright to prevent regurg and aspiration
- tx underlying etiology
PT has dysphagia with solids AND liquids–most likely due to?
motor disorder
- achalasia
- scleroderma
PT has dysphagia with only solids— most likely due to?
mechanical obstruction
- rings
- stricture
- CA
recent or rapid onset of dysphagia points to?
infections
persistent or intermittent dysphagia points to?
esophageal motility disorder
Progressive dysphagia points to?
progressive to just solids?
progressive to foods + liquid?
solids alone: stricture or esophageal CA
solids + liquids: scleroderma or achalasia
GERD
- CMs
- what are alarm symptoms?
- Diagnosis–1st line TOC
- treatment: 1st, 2nd, 3rd, refractory
- complictions from dz
CM: *retrosternal and postprandial pain-->heartburn*** HALLMARK *pain worse when laying flat *sometimes relieved by antacids \+regurgitation \+sour taste in mouth \+Cough/ dysphagia \+sore throat \+/- laryngitis \+asthma attacks
ALARM S/S:
- dysphagia
- odynophagia
- Wt loss
- bleeding
DIAGNOSIS:
- TOC: endoscopy with biopsy (but not necessary in uncomplicated cases)
- TX first with meds… and if refractory to meds…then order the endoscopy*
- GOLD STANDARD to diagnose: 24 hr pH monitoring
TREATMENT:
1st: *life style mods: elevate head of bed 6-8 inches, avoid lying flat for 3 hrs after eating, avoid fatty or spicy foods, chocolate, decrease ETOH
2nd: intermittent or mild–(<2 episodes/week).. PRN antacids and H2 receptor antagonists
3rd: PPI in moderate to severe (>2 episodes/week)
refractory: surgical with Nissen Fundoplication
Complications:
- Esophagitis
- stricture
- Barretts esophagus
- Esophageal adenocarcinoma
gastroparesis
CMs
TX
nausea
vomiting
abdominal pain
postprandial fullness or bloating
TX
- motility agents
- gastric “pacemaker”
Mallory Weiss Syndrome RF CM Diagnosis--TOC TX
RF: ETOH binges, retching, hiatal hernias
CM:
- Upper GIB after retching or vomiting–hematemesis, melena, hematochezia,
- syncope
- can develop abdominal pain, back pain or hydrophobia
Diagnosis:
TOC: Upper endoscopy will show the tears (superficial longitudinal mucosal erosions)
TX:
- not actively bleeding: supportive TX (PPIs, anti-emetics). Most resolve on their own
- Severe bleeding
* thermal coagulation
* hemoclips
* endoscopic band ligation (w or w.o epinephrine)
* balloon tamponade
Boerhaave Syndrome
- etiologies (MC?)
- mortality rate
- CM
- PE findings
- Diagnosis–TOC
- management: stable vs unstable
Etiologies:
- iatrogenic perf of esophagus during endoscopy (MC)
- repeated forceful retching or vom (ETOH, bulimia)
40% mortality rate
CM:
- Severe retrosternal CP–worse with deep breathing & swallowing
- vom
- hematemesis
PE:
- crepitus on chest palpation (subcutaneous emphysema)
- crunching sound on auscultation–Hamman’s Sign (pneumomediasteinum)**
Diagnosis:
- TOC–Esophagram with GASTROGRAFIN (not barium–bc it is caustic and will cause problems where it leaks out of esophagus)
- CXR or CT scan: left sided hydropneumothorax (MC), pneumomediastimum (air in mediastinum)
TX:
- Small and stable: IV fluids, NPO, BS ABX, H2 rec Blockers
- Large or severe: surgical repair
what is Hamman’s sign
indicative of?
crunching sound on ausculation when PT is in Left lateral decubitus position–pneumomediasteinum
Boerhaave Syndrome **
Medication/pill induced esophagitis
*CM
CM:
- odynophagia
- dysphagia
Diagnosis:
*Endoscopy: singular, small, well defined ulcers of varying depths
TX:
- take pills with at least 4 ounce of water
- avoid laying down for 30-60 mins after taking pill
Infectious Esophagitis
- etiologies
- CM
- diagnosis and specific findings for each etiology
etiologies:
* candida–MC
* CMV
* HSV
CM:
- Odynophagia (hallmark)
- retrosternal CP
- dysphagia
Diagnosis: TOC--endoscopy 1.Candida--linear, yellow-white plaques 2. CMV--large superficial shallow ulcers 3. HSV--small (many) deep ulcers
TX:
- *tx underlying cause**
1. Candida–PO fluconazole
2. CMV–Ganciclovir
3. HSV–Acyclovir
Eosinophilic esophagitis
*Mc in who
MC in kids with atopic Dz (asthma, eczema)
CM:
- dysphagia to solids
- odynophagia
- reflux/feeding difficulties in kids
Diagnosis:
TOC–endoscopy: normal or will show Corrugated rings with white exudates
*biopsy: abundance of eosinophils
TX
- Remove foods that cause allg response
- PPIs PRN
- inhaled topical cortcosteroids WITHOUT spacer so it can penetrate
endoscopy of throat shows Corrugated rings with white exudates
Eosinophilic esophagitis
caustic esophagitis CM diagnosis complications tx
CM:
- odynophagia
- dysphagia
- hematemesis
- dyspnea
Diagnosis:
- ednoscopy–will see the extent of damage–look for complications
1. esophageal perforation
2. stricture
3. esoph fistula
tx
- supportive–pain meds, fluids
- very very severe– with necrotic tissue +edema present on endoscopy–ICU*****
Barretts esophagus
*diagnosis + follow-up tx for each of the different findings o
Diagnosis: UPPER ENDOSCOPY w. BIOPSY
Follow up TXs:
1. Barretts esophagus only (metaplasia): PPIs + rescope every 3-5 yrs
- Low-grade dysplasia: PPIs and rescope every 6-12 MO
- High grade dysplasia: ablation with endoscopy or mucosal resection
Achalasia CM etiologies (3) diagnosis--most accurate test? tx--definitive?
CM
- dyphagia to both solids and liquids
- regurgiation
- CP
- weight loss
- cough
- dehydration
etiologies:
* MCC idiopathic
* 2nd MC: proximal stomach CA
* worldwide cause–CHAGAS dz (tropical dz–kissing bugs)
Diagnosis:
1. barium esophagram will show BIRDS BEAK of the LES (LES narrowing) with proximal esophageal dilation + loss of peristalsis
- Manometry–MOST ACCURATE TEST– shows increased LES pressure and lack of peristalsis
- Endoscopy–usually performed prior to initiating TX to r/o esophageal squamous cell carcinoma (bc achalasia is a RF)
TX:
- decrease the LES pressure–botulinum toxin injections, nitrates, surgery is most effective
- Pneumatic dilation of LES
- Esophagomyomectomy (definitive)
- adaptive measures–chewing food fully b4 swallowing etc
CHAGAS DZ can cause
Achalasia
