Itis Lecture Flashcards
Factors leading to GERD
(1) decreased LES resting pressure (impaired smooth muscle ton and abnormal transient LES relaxation)
(2) hiatal hernia
(3) impaired esophageal clearance
(4) impaired distal esophageal mucosal defense
(5) delayed gastric emptying (fatty meals, tobacco, alcohol, chocolate)
Results of untreated esophagitis?
Esophageal stricture, gastrointestinal bleeding and anemia, barrett esophagus and adenocarcinoma
Treatment for stricture
dilation
Treatment GI bleed/anemia
dietary changes (decrease caffeine, not eating before bed) and decrease acid production (proton pump inhibit - omeprozole or H2 blocker - rantidine)
What is Barrett esophagus?
intestinal metaplasia; replacement of normal squamous epithelium with specialized columnar epithelium (can lead to adenocarcinoma)
Surveillance for Barrett’s esophagus
Male >50, long standing GERD
Dysphagia
difficulty with shallowing
Odynophagia
painful swallowing
Case one
55 year old man with heartburn of 20 years duration … Barrett’s esophagus
What is infectious esophagitis?
Esophagitis caused by infection (candid albicans, HSV 1, CMV) - occurs in immuno-suppressed individuals
What is pill esophagitis?
Pill gets stuck in the esophagus, but that would cause an acute problem
What is eosinophilic esophagitis?
a type of white blood cell (eosinophil) builds up in the lining of the tube that connects your mouth to your stomach. associated with systemic allergy and asthma
Murphy’s sign
sign of acute inflammation of the gall bladder; placing the hand under the right upper quadrant , the patient is asked to inspire
Biliary colic vs. acute cholecystitis
biliary colic: RUQ pain lasting less than 4 hours (transient obstruction in the cystic duct)
acute cholecystitis: constant pain RUQ> 4 hours, + murphy’s sign, signs of inflammation elevated WBC, ALT/AST
Formation of gallstones
bile is supersaturated with cholesterol
what is acute cholecystitis
occurs when bile becomes trapped in the gall bladder - gall bladder contractility poor, thickening of gall bladder wall with chronic inflammation, stone becomes lodged in cystic
Review - acute cholecystitis
damage to mucosa, which is caused by bile salts - leads to an inflammatory response in gall bladder wall
When does gallstone formation occur?
Gallstone formation occurs when the bile becomes supersaturated with cholesterol
How does acute cholecystitis result?
Acute cholecystitis results from chemical irritation and inflammation of the obstructed gall bladder
Relationship between acute cholecystitis and biliary colic
Acute cholecystitis develops in approximately 20% of patients with biliary colic if they are left untreated
Treatment for acute cholecystitis
removal of the gall bladder
Cause of acute pancreatitis
cholelithiasis (gall stones) 50%, alcohol 40%, blunt trauma
Treatment for acute pancreatitis
gut rest, intravenous fluid support and replacement
