OnlineMedEd: Gastroenterology - "Esophagitis" Flashcards
What is the mnemonic for causes of esophagitis?
PIECE •Pill-induced •Infectious •Eosinophilia •Caustic •gErd
What is the difference between dysphagia and odynophagia?
- Dysphagia: difficulty swallowing
* Odynophagia: painful swallowing
Typically, ____________ is required to diagnose esophagitis.
endoscopy
List the four types of medicines that are the most common causes of esophagitis.
- Non-enteric-coated NSAIDs
- Bisphosphonates
- HAART
- Tetracycline
How is pill-induced esophagitis treated?
- Endoscopy (remove pill if still there)
- Remove offending agent or deliver another way
- PPI and time to recover
What four infections can cause esophagitis?
- HSV
- Candida
- HIV opportunistic infections
- CMV
True or false: nystatin can treat esophageal candidiasis.
False
Nystatin swishes are for oral candidiasis only. Oral fluconazole is needed for esophageal candidiasis.
Oral lesions in the presence of odynophagia are suggestive of what type of esophagitis?
HSV esophagitis
Go through the diagnostic/treatment paradigm for eosinophilic esophagitis.
- 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.
What cases should make you think of caustic esophagitis?
- Little kids who drink drain cleaner
* Adults who ingest acid/alkaline substances in a suicide attempt
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?
- Mild (evidenced by no necrotic areas or strictures): fluid diet
- Severe (evidenced by necrotic areas or strictures): NPO
What two things should you never do in caustic esophagitis?
- Induce emesis –this just redamages the esophagus
* Neutralize the pH –this creates a thermal reaction that re-burns the esophagus
Caustic esophagitis presents with what unique physical exam findings?
- Hoarseness
- Stridor
The caustic substance also burns the airway.