OnlineMedEd: Gastroenterology - "Esophagitis" Flashcards

1
Q

What is the mnemonic for causes of esophagitis?

A
PIECE
•Pill-induced 
•Infectious 
•Eosinophilia 
•Caustic 
•gErd
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2
Q

What is the difference between dysphagia and odynophagia?

A
  • Dysphagia: difficulty swallowing

* Odynophagia: painful swallowing

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3
Q

Typically, ____________ is required to diagnose esophagitis.

A

endoscopy

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4
Q

List the four types of medicines that are the most common causes of esophagitis.

A
  • Non-enteric-coated NSAIDs
  • Bisphosphonates
  • HAART
  • Tetracycline
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5
Q

How is pill-induced esophagitis treated?

A
  • Endoscopy (remove pill if still there)
  • Remove offending agent or deliver another way
  • PPI and time to recover
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6
Q

What four infections can cause esophagitis?

A
  • HSV
  • Candida
  • HIV opportunistic infections
  • CMV
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7
Q

True or false: nystatin can treat esophageal candidiasis.

A

False

Nystatin swishes are for oral candidiasis only. Oral fluconazole is needed for esophageal candidiasis.

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8
Q

Oral lesions in the presence of odynophagia are suggestive of what type of esophagitis?

A

HSV esophagitis

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9
Q

Go through the diagnostic/treatment paradigm for eosinophilic esophagitis.

A
  • First, do a biopsy (like with all cases of odynophagia with suspected esophagitis)
  • Second, for those with greater than 15 eosinophils per HPF, trial a PPI. GERD can cause eosinophilia.
  • Lastly, if they fail the trial then give oral aerosolized steroids.
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10
Q

What cases should make you think of caustic esophagitis?

A
  • Little kids who drink drain cleaner

* Adults who ingest acid/alkaline substances in a suicide attempt

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11
Q

In caustic esophagitis, you need to do an EGD to assess the severity of the injury. What should you do in mild and severe cases?

A
  • Mild (evidenced by no necrotic areas or strictures): fluid diet
  • Severe (evidenced by necrotic areas or strictures): NPO
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12
Q

What two things should you never do in caustic esophagitis?

A
  • Induce emesis –this just redamages the esophagus

* Neutralize the pH –this creates a thermal reaction that re-burns the esophagus

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13
Q

Caustic esophagitis presents with what unique physical exam findings?

A
  • Hoarseness
  • Stridor

The caustic substance also burns the airway.

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