104b Esophagus clinical Flashcards Preview

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Flashcards in 104b Esophagus clinical Deck (30):
1

globus

perception of a lump in throat even without swallowing

2

water brash

excessive salivation; response to reflux

3

structural abnormality vs propulsive disorder - presentation for solids and liquids

structural - solid food only usually
propulsive - solid and liquid

4

structural abnormality examples

EoE
tumor
stricture

5

propulsive disorder examples

GERD
achalasia

6

esophageal rings/webs

schatzki ring - lower esophageal mucosal ring
cervial web - higher in esophagus (part of plummer vinson syndrome)

7

GERD pathophys

90% transient LES relaxations
impaired salvation
impaired partistalitic empting

8

Possible GERD outcomes

Non-erosive GERD (EGD negative) - poor QOL
Esophagitis - stricture, bleeding, BE and adenocar.
Extra-esophagus GERD

9

GERD treatment

Pharm: PPI and H2RA blockers
Lifestyle mods: weight loss, avoid certain foods
surgical: nissen

10

EoE - history, symptims, endoscopy, pathology

history - atopy, food allergies
symptoms - dysphagia and food impaction
endoscopy - rings, furrows, exudates
path - biopsy with eosinophil inflammation
isolated to esophagus

11

EoE diagnosis, complications and outcomes

dx - biopsy (superficial eosinphils >15/hpf)
fibrosis in lamina propria, strictures, food impaction, NO CANCER

12

EoE treatment

medical - topical steroids (fluticasone, budesonide)
diet (6 food elimination diet)
endoscopic therapy

13

achalasia pathophys

loss of ganglion cells in esophagus myenteric plexus affects inhibitor neurons --> can't relax LES

13

achalasia pathophys

loss of ganglion cells in esophagus myenteric plexus affects inhibitor neurons --> can't relax LES

14

achalasia complications

progressive dilation and sigmoid deformity
bird's peak tapering at LES
dysphagia, regurg, weight loss, aspiration, stasis-->increased cancer risk

14

achalasia complications

progressive dilation and sigmoid deformity
bird's peak tapering at LES
dysphagia, regurg, weight loss, aspiration, stasis-->increased cancer risk

15

achalasia diagnosis

manometry (impaired LES relaxation and absent peristalsis)
radiography (barium swallow - bird's beak)

15

achalasia diagnosis

manometry (impaired LES relaxation and absent peristalsis)
radiography (barium swallow - bird's beak)

16

achalasia treatment

botox (cleaves SNAP25 and prevents ACh release)
pneumatic dilation
heller myotomy

16

achalasia treatment

botox (cleaves SNAP25 and prevents ACh release)
pneumatic dilation
heller myotomy

17

diffuse esophageal spasm

simultaneous contractions leading to episodes of chest pain and dysphagia
Rx-nitrates, ccb, botox

17

diffuse esophageal spasm

simultaneous contractions leading to episodes of chest pain and dysphagia
Rx-nitrates, ccb, botox

18

infectious esophagitis - causes

candidal - most common
herpetic
CMV

18

infectious esophagitis - causes

candidal - most common
herpetic
CMV

19

candidal esophagitis - presentation, findings, treatment

odynophagia and dysphagia
white plaques
oral fluconazole

19

candidal esophagitis - presentation, findings, treatment

odynophagia and dysphagia
white plaques
oral fluconazole

20

herpetic esophagitis - causes, findings, treatment

HSV 1 or 2
punched out ulcers
self limited or acyclovir/valcyclovir

20

herpetic esophagitis - causes, findings, treatment

HSV 1 or 2
punched out ulcers
self limited or acyclovir/valcyclovir

21

CMV esophagitis - patient type, findings, treatment

immunicompromised
linear/serpiginous ulcers
ganciclovir

21

CMV esophagitis - patient type, findings, treatment

immunicompromised
linear/serpiginous ulcers
ganciclovir