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Gastroenterology > Varices & Esophagitis > Flashcards

Varices & Esophagitis Flashcards

1
Q

dilated blood vessels that develop as a direct result of liver portal hypertension and an attempt to bypass congestion with collateral blood flow

A

esophageal varices

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2
Q

what are the 2 most common causes of portal hypertension?

A

liver disease
cirrhosis

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3
Q

50% of patients with esophageal varices have _____

A

cirrhosis

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4
Q

esophageal varices are asymptomatic until they start _____

A

bleeding

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5
Q

a patient presents with lower extremity swelling, abdominal distention, jaundice, easy bruising, and hemorrhoids. Dx?

A

esophageal varices

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6
Q

what kind of physical findings will be present in a patient with esophageal varices? (5)

A

liver disease findings -

peripheral edema
ascites
spleen enlargement
jaundice
telangiectasias

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7
Q

what is the gold standard for diagnosing and treating esophageal varices?

A

upper endoscopy

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8
Q

patients should be screened for _____ with ____ when diagnosed with cirrhosis

A

varices
EGD

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9
Q

what is the treatment for patients with chronic liver disease and esophageal varices?

A

prophylactic nonselective beta blocker

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10
Q

what medication should be used to prevent the 1st bleed in non-bleeding esophageal varices?

A

propranolol

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11
Q

what are 2 surgical treatments for non-bleeding esophageal varices?

A

endoscopic varicocele ligation
transvenous intrahepatic portosystemic shunt (TIPS)

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12
Q

what is the management for bleeding esophageal varices? (2)

A

airway management
balloon tube tamponade for hemorrhage control

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13
Q

what medication can be used to prevent infection due to open portal to vascular from GI tract in bleeding esophageal varices?

A

ceftriaxone

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14
Q

what medication can be used to constrict splenic vessels and reduces blood inflow to liver in bleeding esophageal varices?

A

octreotide
OR
somatostatin

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15
Q

what medication prevents gastric reflux from worsening variceal irritation in bleeding esophageal varices?

A

omeprazole (PPI)

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16
Q

what treatment prevents vomiting and disruption of clot in bleeding esophageal varices?

A

anti-emetic

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17
Q

what is the definitive treatment of bleeding esophageal varices?

A

emergent endoscopy + ligation

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18
Q

what are 3 infectious causes of esophagitis?

A

candidiasis
HSV
CMV

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19
Q

what are 3 caustic causes of esophagitis?

A

GERD
pill-induced
ingestion of chemicals

20
Q

what is the hallmark symptom of esophagitis?

A

odynophagia

21
Q

a patient presents with odynophagia, dyspepsia, dysphagia, and chest pain. Dx?

A

esophagitis

22
Q

what is the gold standard diagnostic for esophagitis?

A

upper endoscopy

23
Q

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?

A

candidal esophagitis

24
Q

what diagnostic will confirm diagnosis of candidal esophagitis?

A

KOH / gram stain

25
Q

what is the outpatient treatment for candidal esophagitis?

A

oral fluconazole x 7-14 days

26
Q

what is the inpatient treatment for candidal esophagitis?

A

IV fluconazole then oral fluconazole x 14-21 days

27
Q

a patient presents with fever, fatigue, body aches, odynophagia, dysphagia, and multiple, small deep ulcerations in the esophagus are seen on upper endoscopy. Dx?

A

HSV esophagitis

28
Q

what are 3 diagnostics that can be used for HSV esophagitis?

A

upper endoscopy
viral PCR
culture

29
Q

what is the treatment for a patient with HSV esophagitis that is not immunocompromised and symptoms are improving?

A

supportive tx only

30
Q

what is the treatment for a patient with HSV esophagitis that is not immunocompromised and symptoms are not improving?

A

oral acyclovir x 5-7 days

31
Q

what is the outpatient treatment for a patient with HSV esophagitis that is immunocompromised?

A

oral acyclovir x 14-21 days

32
Q

what is the inpatient treatment for a patient with HSV esophagitis that is immunocompromised?

A

IV acyclovir then oral for total of 14-21 days

33
Q

what is considered an AIDs defining illness?

A

cytomegalovirus (CMV) esophagitis

34
Q

a patient presents with odynophagia, dysphagia, fever, nausea, stomach pains, malabsorption with diarrhea, and oral/anal ulcers. Dx?

A

cytomegalovirus (CMV) esophagitis

35
Q

what is CMV esophagitis characterized by?

A

large, shallow, superficial ulcerations

36
Q

what diagnostic confirms CMV esophagitis?

A

biopsy

37
Q

what is the treatment for CMV esophagitis in a patient that is not immunocompromised?

A

supportive tx only

38
Q

what is the treatment for CMV esophagitis in a patient that is immunocompromised?

A

IV ganciclovir
alteration of HAART therapy for concurrent HIV/AIDS infection

39
Q

which patients are at greater risk for pill-induced esophagitis? (2)

A

hospitalized
bed-bound

40
Q

what are common medications that cause esophageal irritation? (6)

A

NSAIDs
potassium supplements
alendronate
iron
vitamin C
antibiotics

41
Q

what are 2 symptoms a patient will present with if they have pill-induced esophagitis?

A

odynophagia
dysphagia

42
Q

what diagnostic can be used for pill-induced esophagitis?

A

upper endoscopy

43
Q

what is the treatment for pill-induced esophagitis?

A

eliminate med
take med upright with enough water

44
Q

when can we expect the pill-induced esophagitis to heal with proper medication-taking techniques?

A

in 48-72 hours

45
Q

damage of esophagus with ingestion of irritants is directly related to what? (2)

A

time in contact with tissues
pH of offending agent

Gastroenterology (26 decks)

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