odynophagia

Question 1

define odynophagia

Answer 1

pain on swallowing

Question 2

list the three types of esophagitis

Answer 2

pill induced
infectious
eosinophilic
caustic

Question 3

describe the clinical presentation, causes, diagnostic methods and treatment of .. pill induced esophagitis

Answer 3

1. clin present= increased risk with hospitalized patients, severe retrosternal CP, dysphagia, begin hours after taking the pill, suddenly and persistent
2. cause = most commonly by NSAIDs, KCl pills, alendronate+risedronate, abx no swallowed without water or while supine
3. dx= endoscopy showing ulcers
4. trx= eliminate the offending agent and fix pill taking habits (sit up 30 minutes after have at least 4 oz of water)

Question 4

describe the clinical presentation, causes, diagnostic methods and treatment of ..
infectious esophagitis

Answer 4

1. clin present= dysphagia and substernal CP
2. cause = MOST COMMON= candida albicans
   also herpes, CMV,
   risk in immunocompromised, DM, systemic steroid use, radiation therapy, abx use
3. dx= endoscopy w brushings, biopsy, and culture
4. trx=
   CMV–> anti-retroviral therapy to increase immunity= gancyclovir
   HSV= treat symptomatically, oral acyclovir for immunosuppressed
   Candida= fluconazide

Question 5

what is the histologic presentation with CMV induced infectious esophagitis

Answer 5

large, shallow, superficial ulcerations in the esophagus

Question 6

what is the histologic presentation with HSV induced infectious esophagitis

Answer 6

multiple, small deep ulcers

Question 7

what is the histologic presentation with candida induced infectious esophagitis

Answer 7

diffuse, linear, yellow-white plaques to mucosa

Question 8

describe the clinical presentation, causes, diagnostic methods and treatment of ..
eosinophilic esophagitis

Answer 8

1. clin present= males, hx of food bolus impaction, heartburn
2. cause = eotaxin 3, GERD, PPI use, celiacs, crohn’s, allergies, dysphagia
3. dx= EGD showing multiple circular esophageal rings= corrugated ringed appearance/feline esophagus/tracheal esophagus
4. trx= PPI, glucocorticoid, refer to allergist, esophageal dilation

Question 9

describe the clinical presentation, causes, complications, diagnostic methods and treatment of ..
caustic esophagitis

Answer 9

1. clin present= near-immediate severe burning, CP, gagging, drooling, aspiration (stridor)
2. cause = either accidental or suicidal ingestion of alkali crystal or acid
   - complications= pneumonitis, perforation, stricture, carcinoma
3. dx= circulatory exam, airway assessment, laryngoscopy, radiography for complications
4. trx= ICU admisison, IVD, laryngoscopy, EGD, psych referral

CONTRAINDICATED= nasogastric lavage