Flashcards in Clinical Approach - Esophageal Dz Deck (12)
1
How does serious disease of the gut easily elude diagnosis until advanced?
mucosa of esophagus has sensation and can feel pain but past that no sensation
2
What are the manifestations of systemic sclerosis in the esophagus?
weak or absent LES w poor esophageal motility
dysphagia and possible esophageal stricture
LES hypotension
3
How can achalasia be recognized?
LES won't relax and poor peristalsis
dysphagia for BOTH liquids and solids
caused by t. cruzi in S. america
LES hypertension and simultaneous esophageal contractions --> aperistalsis
4
When is fundoplication used to treat GER?
when patients respond well to PPI to begin with
when gastric contents encroach on upper airway in spite of aggressive PPI therapy
5
What can make GER worse but does not cause it, and so is not an indication for surgery?
mere presence of hiatal hernia
6
What are the four structural complications of GER?
esophagitis
Barrett - biopsy surveillance every 3 yrs
stricture - heal w fibrotic peptic stricture in distal
mucosal rings - lower boundary of LES and symptomatic once lumen narrows to 13 mm, almost always seen on barium swallow above hiatal hernia
7
What is one possible way to treat Barrett?
ablate metaplastic mucosa and hopefully normal will grow back
may need multiple treatments but can prevent surgery
8
Why do lots of patients w strictures not know for a while?
line where they lose sensation moves higher so they don't feel heartburn - don't feel the stricture developing
9
What are ways to evaluate the esophagus based on symptoms?
EGD - for dysphagia, selected GERD, *odynophagia and bleeding
dysphagiagrams - look for oropharyngeal dysfunction causing dysphagia or aspiration
manometry - if achalasia or systemic sclerosis suspected
10
What are symptoms of eosinophilic esophagitis?
children - chest pain w muscle infiltration of eosinophils
adults - severe dysphagia
11
What are the risks of management of eosinophilic esophagitis?
clearing meat impactions can cause perf
systemic steroids are effective but have lots of side effects
12