SECRETS GI - Esophagus Flashcards
GERD sx
heartburn
regurg sour material into mouth
chronic cough
hoarse voice
sliding hiatal hernia
GE jxn herniates upward through esophageal hiatus in diaphragm
loss of sphincteric pressure of diaphragm –> reflux
paraseophageal hiatal hernia
gastric fundus rolls up and herniates through diaphragm, but GE jxn remains in place
more serious = incarcerated
GERD causes
abnormal transient relaxation of LES
increased intra-abdominal pressure
increased gastric volume
GERD tx
H2 receptor antagonist (-tidine)
Antiemetic prokinetic (metoclopramide)
PPI (-prazole)
H2 receptor antagonist
- tidine
inhibit His stimulated release of HCl by blocking H2 receptors on parietal cells
cimetidine ADR
gynecomastia
inhibit CYP450
Metoclopramide
antiemetic
prokinetic
increase gastric emptying & LES tone via cholinergic ADR
ADR parkinsonian sx, seizures
PPI
- prazole
irreversibly inhibit parietal cell H/K ATPase
ADR hypergastrinemia
GERD tx contraindicated in bowel obstruction?
prokinetics (metoclopramide) will worsen obstruction –> perforation
GERD complications
esophageal stricture
Barrett’s esophagus
Adenocarcinoma
adenocarcinoma vs squamous cell in esophagus
adeno = lower 1/3
risk factors = barrett’s & chronic irritation
squamous cell = upper 2/3
smoking, alcohol
both = dysphagia to solids
Sjogren’s
autoimmune dz
lymphocytic infiltration of lacrimal/salivary glands
dry eyes, dry mouth
no bicarb to neutralize acid in esophagus –> esophageal damage
more susceptible to GERD
dysphagia - oropharyngeal vs. esophageal
oro = cant initiate swallow reflex
neuro or muscular
assoc with coughing, choking
eso = food gets ‘stuck’
mechanical (obstruction) - solids only
or dysmotility - solids and liquids
‘birds beak’
achalasia
food accumulates & dilates lower esophagus
