esophageal disorders Flashcards
(40 cards)
2 classic sx of GERD and 5 ‘Atypical’ sx
- classic: heartburn (pyrosis) & regurg.
- atypical: chest pain, globus sensation, nausea, LPR, dental erosions
4 complications/progessive dz of GERD
- esophagitis
- scarring (rings, strictures)
- barretts esophagus
- esophageal cancer
esophagitis + strictures» B.E + dysplasia»_space; adenocarcinoma
3 surgical options to treat GERD
- fundoplication– dysphagia, bloat as complications
- LINX: strong of magnes; not for hiatal hernia
- Roux-en-y: surgery of choice for anti-reflux if BMI > 35
who should be screen for BE?
chronic or frequent sx of GERD + at least 2 risk factors
list 4 risk factors for barretts esophagus
over 50
central obesity
smoking hx
family hx of BE or esophageal adenocarcinoma
4 ways to treat Barretts esophagus including dysplasia treatment
- acid suppression w/ PPI forever
- endoscopy surveillance Q 3-5 yrs
- pathologist if low grade dyplasia
- surgery or RFA if high grade dysplasia
gold standard for diagnosing esophagitis
Endoscopy
what do you do it patient has alarming sx
screen for barretts esophagitis & refer
list 5 alarming sx of GERD
dysphagia or odynophagia
GI bleeding or anemia
weight loss
sx over 5 yrs
relapses or does not respond to PPI
when do you do 24 hr pH monitoring
- to quanitfy reflux if unresponsive to empiric therapy and may have non-acid reflux
first thing you can do if patient has classic sx of GERD without alarming sx
2 month PPI trial
What is this condition & how is it evaluated?
- neurogenic + myogenic d/o
- difficulty initating swallowing
- coughing, choking, nasal regurgitation
- voice changes with or after meal
oropharyngeal dysphagia
evaluate w/ video swallow study
what is this condition?
- food moving slowly or getting stuck in esophagus seconds after swallowing;
- affects solids & liquids = motility d/o
- solids only= mechanical obstruction
- progressive= cancer or stricture or achalasia
esophageal dysphagia
- painful swallowing related to pill esophagitis, infectious diseases, radiation therapy
odynophagia
what is achlasisa and what is the key term for what it looks like on imaging?
- uncurable, progressive LES impaired relaxation and abnormal esophageal peristalsis WITHOUT structural explanation
- looks like birds beak
though uncurable, what are 4 ways to treat achalasia
- smart eating habits
- CCB/NTG (less effective)
- surgical myotomy or balloon dilation with controlled tear
- endoscopic botox injection into LES if not surgical candidate
when evaluating dysphagia, how do you rule out mechanical lesions as the cause?
mechanical lesions- esophagitis, cncer, eosinophilic esophagitis
endoscopy
barium esophogram– indirect inspection for mechanical or functional cause of dysphagia
a way to do motility testing for hyper or hypocontractile peristalsis
esophageal manometry
what is the condition?
diffuse spasm
nutcracker esophagus
hypertensive LES
hypercontractile peristalsis
what is the condition?
scleroderma
inefficient motility disorder
hypocontractile peristalsis
what is eosinophilic esophagitis?
chronic allergic inflammation that can affect anyone but esp. in mid 30 white males with atopic dz
how is eosinophilic esophagitis diagnosed (1) and treated (3)?
- endoscopy w/ Biopsy (over 15 is positive)
- PPI, topical steroids or diet therapy; dilation if those fail
inhibits histamine stimulation from parietal cells; can be used both sporadically or regularly
what is the class? what are the side effects?
- H2 antagonists–famotidine(pepcid), ranitidine (zantac), cimetidinie (tagamet)
- ADRs include bowel habits and drug intrxns with warfarin,phenytoin and propranolol
MOA: irreversible inhibits H-K ATPase of parietal cell; works best taken 30mins before meals regularly
what is the class? what are the side effects?
- PPI– ometrazole (prilosec), lansoprazole, pantoprazole
- ADR: low profile; achlorhydria
achlorhydria– calcium malabsorption & hypoMg» infection
