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Tintinalli Section 9 - Gastrointestinal Emergencies > S09C80 - Esophageal emergencies, GERD, Swallowed FB > Flashcards

S09C80 - Esophageal emergencies, GERD, Swallowed FB Flashcards

1
Q

How long is the esophagus?

A

20-25cm

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2
Q

3 constrictions of esophagus:

A
  • cricopharyngeus muscle (C6)
  • aortic arch (T4)
  • gastroesophageal junction (T10/T11)

(peds eso also contricted at thoracic inlet and tracheal bifurcation)

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3
Q

Dysphagia: 2 types

A
  • transfer: early in swallowing, difficulty initiating
  • transport: impaired movement of the bolus down the esophagus and through the lower sphincter, usually felt 2-4s after swallowing
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4
Q

Transfer Dysphagia: causes

A

Neuromuscular:

  • CVA
  • polymyositis or dermatomyositis
  • scleroderma
  • myasthenia
  • tetanus
  • parkinson’t dz
  • botulism
  • lead poisoning
  • thyroid dz

Localized Dz:
-pharyngitis, ulcer, candida, peritonsiallar/retropharyngeal abscess, carcinoma, zenker diverticulum, cricopharyngeal bar, cervical osteophytes

-scleroderma

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5
Q

Transport Dysphagia: Causes

A
  • FB
  • carinoma
  • webs/stricutures
  • thyroid enlargement
  • diverticulum
  • large-vessel abnormality

-motor d/o: achalasia, peristaltic dysfxn (nutcracker esophagus), diffuse esophageal spasm, scleroderma

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6
Q

Risk factors for esophageal cancer

A
  • alcohol
  • smoking
  • achalasia
  • ingestion of caustic material with lye

-barretts esophagus predisposes to adenocarcinoma

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7
Q

Esophageal stricture

A
  • often from GERD or inflm
  • usually distal eso, may interfere with sphincter fxn
  • tx: dilatation
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8
Q

Schatzki ring

A
  • most common cause of intermittent dysphagia with solids
  • fibrous diaphragmatic stricture near the GE jxn
  • often asymptomatic
  • tx: dilation
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9
Q

Esophageal web

A
  • thin mucosa/submucosa in mid eso
  • assoc with plummer-vinson syndrome and pemphigoid and epidermolysis bullosa
  • tx: dilatation
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10
Q

Diverticula

A
  • zenker diverticulum (pharyngoesophageal) is a progressive out-pouching of pharyngeal mucosa just above the upper sphincter caused by incr pressures during swallowing
  • usually >50y
  • pt c/o transfer dysphagia, halitosis, neck mass
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11
Q

Neuromuscular dysphagia

A

-often more difficulty with liquids and often intermittent

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12
Q

Achalasia

A
  • unknown cause
  • impaired relaxation of lower sphincter
  • absence of esophageal peristalsis
  • onset 20-40yo
  • assoc with eso spasm and c/o and odynophagia
  • eso can dilate enough to impinge on trachea
  • tx: meds to relax lower sphincter, botox, surgical myotomy
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13
Q

Diffuse esophageal spasm

A
  • interruption of normal peristalsis by nonperistaltic contraction
  • intermittent non-progressive dysphagia
  • c/p
  • tx: decr acid reflux, smooth msc relaxant, antidepressant
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14
Q

GERD: pathophys

A
  • hiatal hernia
  • prolonged gastric emptying (anticholinergics, outlet obstruction, diabetic gastroparesis, fatty food)
  • decr lower eso sphincter pressure: fatty food, nicotine, ethanol, caffeine, mitrates, CCB, Pg, Eg, anticholinergics, pregnancy
  • decr eso motility: achalasia, scleroderma, DM, presbyesophagus
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15
Q

GERD: complications

A
  • strictures
  • dysphagia
  • esophagitis
  • barrett eso (10% of pts with GERD)
  • dental erosions
  • worsening of asthma from minute aspirations
  • vocal cord ulcers
  • laryngitis
  • chronic sinusitis
  • chronic cough
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16
Q

GERD: tx

A
  • decrease acid: histamine-2 blocker, PPI
  • enhance upper tract motility
  • eliminate risk factors: ethanol, caffeine, nicotine, chocolate, fatty food
  • sleep with head elevated
  • avoid eating w/in 3h of bed
17
Q

Esophagitis

A
  • tx: acid-suppressants, surguery
  • causes: NSAIDs, KCl-, Abx (doxy, tetra, clinda)

-acquired causes: HIV (HSV, candida, EBV)

18
Q

Nutcracker esophagus

A

-periods of high amplitude, long-duration peristaltic contractions in distal body of esophagus or lower sphincter

19
Q

Esophageal perforation`

A
  • iatrogenic cause is most common
  • boerhaave syndrome causes 10% of cases
  • complications: mediastinitis, penumonitis, peritonitis, shock, pleural effusion
  • tx: resuscitate, Abx, surgery
20
Q

Boerhaave syndrome

A
  • full-thickness perf of eso after sudden rise in eso pressure (Often from emesis but also coughing, straining, seizures, childbirth)
  • usually distal eso on L side
21
Q

FB complications

A
  • airway obstruction
  • stricture
  • perforation
  • erosion
  • obstruction
22
Q

FB: children

A

Sx:

  • refusal to eat
  • n/v
  • gagging
  • stridor
  • drooling
    • high degree of suspicion for
23
Q

FB: coins

A

-if in esophagus then will be circular on AP film and if in trachea the circle will be on the lateral film

24
Q

FB: bones

A
25
Q

Indications for urgent endoscopic evaluation for ingestion of FB

A
  • sharp or elongated object
  • ingestion of multiple FB
  • button batteries
  • concern for perforation
  • coin at cricopharyngeus muscle in a child
  • airway compromise
  • presence of a FB >24h
26
Q

FB: meat bolus

A
  • emergent endoscopy if complete obstruction or contains bony fragments
  • otherwise can treat expectantly for
27
Q

FB: coin ingestion

A

-tx: IR can remove with a foley

28
Q

FB: Button battery

A
  • may induce mucosal injury and necrosis
  • perforation can occur w/in 6h
  • if past eso then manage expectantly with f/u in 24h, rpt films at 48h to ensure battery past pylorus
  • most batteries pass though GIT in 48-72h
29
Q

FB: sharp object

A
  • if in eso they need immediate removal
  • remove with endoscopy if in eso, stomach, duo
  • if past duo, daily AXR
  • surgery if >3d duration and no passage of object or if GI Sx
30
Q

FB: packers

A
  • rupture of one packet can be fatal

- endoscopy contraindicated b/c of risk of packet rupture

Tintinalli Section 9 - Gastrointestinal Emergencies (17 decks)

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