Varices & Esophagitis Flashcards
dilated blood vessels that develop as a direct result of liver portal hypertension and an attempt to bypass congestion with collateral blood flow
esophageal varices
what are the 2 most common causes of portal hypertension?
liver disease
cirrhosis
50% of patients with esophageal varices have _____
cirrhosis
esophageal varices are asymptomatic until they start _____
bleeding
a patient presents with lower extremity swelling, abdominal distention, jaundice, easy bruising, and hemorrhoids. Dx?
esophageal varices
what kind of physical findings will be present in a patient with esophageal varices? (5)
liver disease findings -
peripheral edema
ascites
spleen enlargement
jaundice
telangiectasias
what is the gold standard for diagnosing and treating esophageal varices?
upper endoscopy
patients should be screened for _____ with ____ when diagnosed with cirrhosis
varices
EGD
what is the treatment for patients with chronic liver disease and esophageal varices?
prophylactic nonselective beta blocker
what medication should be used to prevent the 1st bleed in non-bleeding esophageal varices?
propranolol
what are 2 surgical treatments for non-bleeding esophageal varices?
endoscopic varicocele ligation
transvenous intrahepatic portosystemic shunt (TIPS)
what is the management for bleeding esophageal varices? (2)
airway management
balloon tube tamponade for hemorrhage control
what medication can be used to prevent infection due to open portal to vascular from GI tract in bleeding esophageal varices?
ceftriaxone
what medication can be used to constrict splenic vessels and reduces blood inflow to liver in bleeding esophageal varices?
octreotide
OR
somatostatin
what medication prevents gastric reflux from worsening variceal irritation in bleeding esophageal varices?
omeprazole (PPI)
what treatment prevents vomiting and disruption of clot in bleeding esophageal varices?
anti-emetic
what is the definitive treatment of bleeding esophageal varices?
emergent endoscopy + ligation
what are 3 infectious causes of esophagitis?
candidiasis
HSV
CMV
what are 3 caustic causes of esophagitis?
GERD
pill-induced
ingestion of chemicals
what is the hallmark symptom of esophagitis?
odynophagia
a patient presents with odynophagia, dyspepsia, dysphagia, and chest pain. Dx?
esophagitis
what is the gold standard diagnostic for esophagitis?
upper endoscopy
a patient presents with odynophagia, dysphagia, pain/discomfort in the mouth and angles of the lips or beneath their oral prosthesis. during endoscopy, oral thrush that scrapes off, is seen in esophagus. Dx?
candidal esophagitis
what diagnostic will confirm diagnosis of candidal esophagitis?
KOH / gram stain
what is the outpatient treatment for candidal esophagitis?
oral fluconazole x 7-14 days
what is the inpatient treatment for candidal esophagitis?
IV fluconazole then oral fluconazole x 14-21 days
a patient presents with fever, fatigue, body aches, odynophagia, dysphagia, and multiple, small deep ulcerations in the esophagus are seen on upper endoscopy. Dx?
HSV esophagitis
what are 3 diagnostics that can be used for HSV esophagitis?
upper endoscopy
viral PCR
culture
what is the treatment for a patient with HSV esophagitis that is not immunocompromised and symptoms are improving?
supportive tx only
what is the treatment for a patient with HSV esophagitis that is not immunocompromised and symptoms are not improving?
oral acyclovir x 5-7 days
what is the outpatient treatment for a patient with HSV esophagitis that is immunocompromised?
oral acyclovir x 14-21 days
what is the inpatient treatment for a patient with HSV esophagitis that is immunocompromised?
IV acyclovir then oral for total of 14-21 days
what is considered an AIDs defining illness?
cytomegalovirus (CMV) esophagitis
a patient presents with odynophagia, dysphagia, fever, nausea, stomach pains, malabsorption with diarrhea, and oral/anal ulcers. Dx?
cytomegalovirus (CMV) esophagitis
what is CMV esophagitis characterized by?
large, shallow, superficial ulcerations
what diagnostic confirms CMV esophagitis?
biopsy
what is the treatment for CMV esophagitis in a patient that is not immunocompromised?
supportive tx only
what is the treatment for CMV esophagitis in a patient that is immunocompromised?
IV ganciclovir
alteration of HAART therapy for concurrent HIV/AIDS infection
which patients are at greater risk for pill-induced esophagitis? (2)
hospitalized
bed-bound
what are common medications that cause esophageal irritation? (6)
NSAIDs
potassium supplements
alendronate
iron
vitamin C
antibiotics
what are 2 symptoms a patient will present with if they have pill-induced esophagitis?
odynophagia
dysphagia
what diagnostic can be used for pill-induced esophagitis?
upper endoscopy
what is the treatment for pill-induced esophagitis?
eliminate med
take med upright with enough water
when can we expect the pill-induced esophagitis to heal with proper medication-taking techniques?
in 48-72 hours
damage of esophagus with ingestion of irritants is directly related to what? (2)
time in contact with tissues
pH of offending agent
