NO Meds treat the symptoms - stop meds, pts will recur

L77 Flashcards by Logan Kolakowski

Medical term for heartburn. Where do pts describe this pain?

Pyrosis

“Substernal burning”

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Define dysphagia

Difficulty swallowing

Dx via history

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Define odynophagia

Pain w/ swallowing

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Describe a mechanical problem causing dysphagia

Tumor or stricture -> obstruction of esophageal lumen

Gradual onset: can’t do solids, THEN soft/liquids

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Describe a motor problem causing dysphagia

Can’t handle solids AND liquids from the start

Might be effected by temperatures -> hot/cold inducing spasm to get symptoms

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Define GERD

Reflux of normal gastric content (acid) damages esophagus

LES is too relaxed

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What is a hiatal hernia?

GE jxn + part of stomach herniate above the diaphragm

Won’t cause GERD, but can worsen existing GERD

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Treat GERD non-medically

Elevate head of bed
No food before bed
Decrease fat in diet // weight loss -> obesity issue

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Meds to treat GERD

Antacids
H2 receptor antagonists
PPIs - most effective

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How do you dx GERD?

History
NO tests
+ medications -> symptoms resolve
Increase meds if needed -> symptoms resolve
Only do tests for GERD if pts still have symptoms on BID PPI

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Do you cure GERD?

Meds treat the symptoms - stop meds, pts will recur

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If you DO need to perform tests to confirm a GERD dx, what are your 5 options?

Barium swallow + XR
Endoscopy
Esophogeal manometry
Ambulatory pH monitoring
Multichannel intraluminal impedance (MII) = pH monitoring

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What pts do you use barium swallow for? Who don’t you use for?

Yes: dysphagia b/c will show narrowing
No: GERD

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Why do you decide to scope for GERD?

Want to eval MUCOSAL INJURY
Ex:
- Erosive esophagitis
- Barrett’s esophagus

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Why would you do an ambulatory pH monitoring study?

Quantify amt acid reflux

ONLY detects acid in the esophagus

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Why would you do a MII-pH monitoring study?

To see acid AND non-acid reflux into esophagus

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4 complications of GERD

Ulcerative esophagitis
Peptic stricture
Barrett’s esophogus -> adenocarcinoma

What is a peptic stricture?

Acid refluxes from stomach -> esophagus

Injury, heal - over and over = NARROWING of DISTAL esophagus

Is a peptic stricture mechanical or motor?

Mechanical

Dysphagia to solids which progresses over time

Treat peptic stricture

Balloon to open stricture

Anti-reflux therapy (lifestyle + H2A or PPIs)

What is Barrett’s esophagus?

Reflux over time causes the epithelium of distal esophagus to change
Squamous (normal) -> columnar
Why? Better able to resist the acid
BIG DEAL b/c this metaplasia could progress to cancer

What type of cancer might Barrett’s progress to?

Adenocarcinoma
White MEN
Distal esophagus - makes sense b/c of pathophys of progression: GERD -> Barrett’s -> adeno

You can get squamous cell cancer of the esophagus. Who gets this? Where does it effect the esophagus?

Black men
H/o drinking, smoking
** MID esophagus **

Does esophageal cancer present as mechanical or motor?

Mechanical

Dysphagia progressing from solids to liquids

How do you det treatment course for esophageal cancer? What are the treatment options?

STAGE 1st Cure: radiation + chemo + surg If can't remove: palliative

What test is the gold standard for esophageal motility issues?

Manometry!!! | Conventional or high resolution

What is achalasia? Pathophys? Mechanical or motor?

LES can't relax -> food won't go down Motor - can't swallow solids or liquids ↓ganglion cells of LES

Usually achalasia is idiopathic. What are secondary causes?

Cancer | Chaga's disease

What's the main difference between achalasia and peptic stricture resulting from GERD

Achalasia = hypertensive LES + NO peristalsis - Absent peristalsis OR contractions are all at the same time which nets no perstalsis Stricture has normal peristalsis above it

2 treatment options for achalasia

Balloon dilation -> rupture Lapro to cut open Could also try drugs but not really effective

Spastic esophageal motility disorders - M v F - Co-existing conditions - Presenting symptoms - 2 example diseases you need to know

``` Female + IBS or psych Presents as CHEST pain 1. Nutcracker esophagus 2. Diffuse esophageal spasm Definitive test for either is **MANOMETRY** (manometry for motility issues!) ```

Manometry for nutcracker esophagus

See peristalsis -> wave amplitudes are HUGE | Normal sequence but just pushing very tightly

Manometry for DES

No peristalsis b/c simultaneous contractions W/ periods of normal peristalsis intermittently Looks like CORK SCREW!!!

How can you treat the motility disorders?

Smooth muscle relaxants = Ca CBs | Psychotropic meds for hypersensitivity = trazadone

What is scleroderma's connection to the esophagus?

= CT disorder | Smooth muscle atrophy -> fibrosis of esophagus

Scleroderma manometry

``` Hypotensive LES (**difference from achalasia) Aperistalsis in distal 2/3 esophagus ```

IC pt presents w/ dysphagia. Disease?

Candida | Treat w/ fluconazole

IC pt presents w/ odynophagia + chest pain. Disease options?

HSV - discrete ulcers CMV - ulcers that coalesce into giant ulcers Treat both w/ anti-virals

Young man w/ h/o allergies presents with dysphagia. Disease? Treat?

Eosinophilic esophagitis | Treat by removing allergic foods or PO steroids

Plummer Vinson syndrome - Pt profile - Pathophys - Where in esophagus

Post-menopausal women w/ Fe def anemia Intermittent solid food dysphagia = SEMI circum membranes, SQUAMOUS cells Close off UPPER esophagus

Schatzki's ring - Patho - Where in esophagus - 2 presentations

Total circum ring of mucosa tissue DISTAL esophagus Intermittent food dysphagia or meat gets stuck

Zenker's diverticulum

``` Old men Esophageal outpouching = motility issue due to UES dysfxn Present: 1. Dysphagia 2. Neck mass -> gurgling in throat 3. Regurg food into mouth ```