Flashcards in Esophageal Disorders Deck (58)
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1
Symptoms of esophagitis
Dysphagia (difficulty swallowing), odynophagia (painful swallowing), GERD/”heartburn” symptoms almost always indicate a primary esophageal disorder
2
Causes of esophageal dysphagia via mechanical obstruction
Solids worse than liquids (in beginning)
3
Schatzki ring
-mechanical
intermittent dysphagia, not progressive; band around esophagus that sometimes spasms in, impinges esophagus, then releases
-know what this looks like on barium swallow
-tiny band of esophagus that pinches esophagus
-may vomit up food because it can’t go down
-next bite of food may go down fine
4
Peptic stricture
-mechanical causes dysphagia
-from chronic heartburn, progressively worse
5
Esophageal cancer
-mechanical causes dysphagia
-progressively worse, usually age >50yo, smoker/drinker (extraluminal mass may impinge)
6
Eosinophilic esophagitis
-mechanical causes dysphagia
-young adults, strictures, papules
7
Motility disorders
Solid and liquid foods equally affected
8
Achalasia
-motility cause of dysphagia
-progressive dysphagia
**Birds beak appearance**
9
Diffuse esophageal spasm
-motility cause of dysphagia
-intermittent, presents with chest pain (swallow something cold, have substernal chest pain; or when vomiting)
10
Scleroderma
-motility cause of dysphagia
-chronic heartburn, substernal discomfort (autoimmune disease)
11
Case: A 68yo woman with a h/o rheumatoid arthritis presents to your office with a c/o painful swallowing which is becoming worse over the past 2 weeks. She also complains of some substernal burning. Raynauds issues in past, worse when laying down, ask if pt is taking meds (naproxen) or steroids (both can effect esophagus)
Think odynophagia
12
Odynophagia is
a sharp, substernal pain on swallowing
13
Usual cause of odynophagia
Often due to infectious etiologies such as esophageal candida, herpes, or cytomegalovirus
*This should be in the differential for immunocompromised patients, HIV patients, etc.
14
______ is the study of choice for evaluating persistent GERD, dysphagia, odynophagia, and structural abnormalities
Upper Endoscopy (EGD)
-Biopsy, cultures, and intervention can be performed if warranted
15
When is Barium esophagography performed?
-Dysphagia patients often evaluated via barium swallow first before EGD is performed
-If a high suspicion exists for a mechanical lesion, EGD often is done first
16
Esophageal manometry is used to
Determine the etiology of dysphagia in patients where there is no obvious mechanical obstruction
-Done pre-op as well prior to anti-reflux surgeries (Nissen fundoplication)
17
Esophageal pH recording provides information regarding
esophageal reflux
18
Case: A 56yo man who smokes 1PPD and drinks 2 beers/night comes into your office complaining of a chronic cough. His wife reports he sometimes coughs himself awake at night.
Think GERD
This is reflux- tobacco and alcohol make it worse (especially if consumed close to bedtime, meals before med too; pregnancy causes loss of LE tone too)
Aging- lose some lower esophageal tone.
19
GERD is a condition that develops when
the reflux of stomach contents causes substernal burning, chronic cough, foul taste, etc.
20
Cause of GERD is
Impaired lower esophageal sphincter
-This is essentially a barrier to reflux when functioning properly; normal pressure is 10-30mmHg
-Patients with severe erosive GERD often have a sphincter tone of
21
Irritants from GERD cause
Mucosal damage, gastric acid often with a pH
22
GERD can also be from __________, associated with more severe esophagitis, especially Barrett esophagus
Hiatal hernias
(stomach is sliding through diaphragm, this causes chronic s/s)
23
S/S of GERD
-Typical symptom is heartburn
-Usually 30-60min after eating and while reclining
-Relief with antacids, patients will often report taking daily
24
Occasionally can diagnose GERD with a trial of
PPIs
-Essentially a clinical diagnosis and empiric therapy
-The “purple pill” 14 day challenge
-EGD or Esophageal pH testing can be considered as well
-Biopsy can help delineate the extend of mucosal damage
25
One complication of GRED is
**Barrett Esophagus**
26
Barrett Esophagus is a condition where
the squamous epithelium of the esophagus is replaced by columnar epithelium containing goblet and columnar cells
-This is essentially a metaplastic process and can lead to malignancy (esophageal cancer)
-Present in up to 10% of those with severe, chronic reflux induced injury
27
Hallmark of Barretts Esophagus is ________
the presence of orange, gastric type epithelium that extends from the stomach into the esophagus in a circumferential manner
KNOW HISTO PIC
(clinical pic too, esophagus appears "orange")
28
With Barretts esophagus diagnosis, EGD every _________
3-5 years recommended to look for changes
29
Barretts esophagus presents with no skip lesions or ulcers, crawls up esophagus homogenously, treated with
2x PPI for life
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