GI- Esophagus & Pancreas Flashcards
Define Dysphagia
What are alarm symptoms?
Difficulty swallowing (vs. odynophagia- ow pain) If blood in stool, anemia, or weight loss preform endoscopy to rule out cancer.
What are the symptoms of hiatal hernia?
How is it diagnosed?
Heartburn, chest pain, dysphagia, obesity.
Diagnosis is made by endoscopy or barium study
What is the best initial treatment for hiatal hernia?
weight loss and PPIs.
If persist: Nissen Fundoplication.
Define Achalasia
symptoms?
Aperistalsis and inability of the lower esophageal sphincter to relax due to loss of the nerve plexus. Idiopathic or Chagas. Increased risk for esophageal carcinoma.
Intermittent dysphagia for solids and liquids but no heart burn (GEJ tightly closed)
All diagnostic testing for achalasia
- Birds Beak on Barium swallow.
- Manometry
- CXR widening os esophagus (not specific or sensitive)
- Endoscopy: normal mucosa (exclude malignancy)
Most accurate test for achalasia (aka confirms diagnosis)
Manometry: shows failure of LES to relax.
Treatment Achalasia
Calcium channel blockers.
Mechanical dilation:
- Pneumatic dilation (3% perforation. safer than surg, less effective)
- Surgical sectioning or myotomy (last resort)
-Botulinum Toxin injection (lasts 3-6 months)
Typical features of a patient with esophageal cancer
Age >50
Dysphagia: solids then liquids
Prolonged alcohol and tobacco use
>5-10 yr of GERD symptoms
Best initial test for esophageal cancer?
Most accurate?
Barium swallow
Endo with biopsy
Treatment for esophageal cancer
Surgical resection- curative
for lesions that can’t be resected stent placement can keep the esophagus open for palliation and improve dysphasia- not curative.
What are the two types of esophageal spasms?
Diffuse esophageal spasm
Nutcracker esophagus
Clinically indistinguishable from each other.
Additionally initially indistinguishable from atypical coronary artery spasm or unstable angina.
Symptoms of esophageal spasms?
- Sudden onset, severe chest pain.
- Precipitated by drinking cold liquids.
- irregular forceful esophageal contractions
- Normal EKG and stress test
- Normal esophagram and endoscopy
- Barium “corkscrew”
Most accurate test for diagnosis of esophageal spasms
MANOMETRY
shows a different pattern os abnormal contraction distinguishing between diffuse and nutcracker
Tx esophageal spastic disorders
- CCBs; TCA as alternative; if both fail sildenafil
- Nitrates (think Prinzmetal Tx)
- PPIs in some cases
- Surgery myotomy
Eosinophilic esophagitis
Symptoms
Tests
Hx of asthma or allergic diseases. Dysphagia, food impaction, heartburn.
Most accurate test: endoscopy with biopsy (multiple concentric rings)
Tx eosinophilic esophagitis
Best initial treatment is PPIs and elimination of allergenic foods
if no response swallowing steroid inhalers
What is the main organism responsible for esophageal infection?
> 90% of esophageal infections in patients with AIDS are caused by Candida.
CMV and herpes
(does not need to have oral thrush)
Tx esophageal candidiasis
Fluconazole
IV amphotericin for confirmed candidiasis (endoscope)
What are the possible findings for esophagitis in endoscope?
Large Ulcerations= CMV (tx foscarnet)
Small Ulcerations= HSV (tx acyclovir)
White plaque like lesions= Candida
Prolonged use of what medications can cause esophagitis?
Doxycycline
Alendronate
Potassium Chloride.
What is steakhouse syndrome?
Dysphagia from solid food caused by Schatzki rings
What is associated withs schatcki ring?
- Often caused by acid reflux
- Associated with hiatal hernia
- A type of scarring or tightening (“peptic stricture”) of the distal esophagus
- Intermittent dysphagia
What is associated with Plummer- Vinson syndrome
- Associated with Iron deficiency Anemia (not caused by blood loss)
- More proximal than Schatzki ring.
- easily detected on barium studies.
- rarely transform into SCC
Tx for Schatcki Ring and Plummer- Vinson syndrome
Schatcki- pneumatic dilation.
Plummer Vinson- Iron replacement
