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Flashcards in Gastro - Online MedEd - esophagitis Deck (24):
1

Esophagitis - what is it?

Inflammation of the esophagus
One must often do a biopsy to determine the cause/endoscopy: mnemonic to remember the causes: PIECE

2

Causes - esophagitis

P - pill-induced
I - infections
E - eosinophilic
C - caustic
E - GERD (common)

3

Presentation - esophagitis

Odynophagia
Dysphagia - difficulty swallowing

4

Dx - esophagitis

Endoscopy with biopsy

5

Treatment - esophagitis

Disease specific
Use some sort of antacid (PPI, H2 blocker)
PPI is more often correct

6

Pill-induced esophagitis - cause

Pill gets stuck
In contact with esophageal mucosa --> cause irritation and burns esophagus
-Patient feel the caustic/chemical reaction, not the pill because it has usually passed
-What type of pills: non-enteric coated NSAIDs, tetracyclines, bisphosphonates, HIV meds (ARTs) - large pills

7

Dx of pill-induced esophagitis

Endoscopy and biopsy

8

Treatment of pill-induced esophagitis

Often won't see pill, if can see, then remove it
Remove offending agent
Give time to heal
Give PPI

9

Follow-up of pill-induced esophagitis - how to avoid this in the future?

Avoid recumbency
Drink a glass of water with each pill

10

Infectious esophagitis - cause (types of organisms)

Candida (cottage cheese stuff in mouth - clinical dx, oral candidiasis)
HSV (oral lesions, herpes crusty etc.)
CMV
HIV (opportunistic infections)
*Many of these infections are in the immunocompromised state, so check HIV status

11

Presentation of infectious esophagitis

Esophagitis

12

Dx of infectious esophagitis

Endoscopy
Biopsy - will tell you what type of infection it is

13

Treatment of infectious esophagitis

Antibiotics - correspond to the organism

14

Oral thrush can be treated with

Nystatin swish and spit
-If patient has oral thrush and candida esophagitis, do not just use nystatin swish and swallow --> use systemic treatment, fluconazole

15

HSV treat with

Valcyclovir/acyclovir

16

CMV treat with

Valgancyclovir/agancyclovir

17

HIV treat with

HAART

18

Eosinophilic esophagitis* what is it

Allergic reaction to food that causes eosinophilia in the esophagus

19

Type of people who get eosinophilic esophagitis

Asthma
Allergies
Atopy

20

Dx of eosinophilic esophagitis

EGD and biopsy
>15 eos/high power field
*If not previously on PPI, now give PPI

21

Treatment of eosinophilic esophagitis

Once diagnosis made --> 1) place on 6 weeks PPI (treat the GERD)
2) If trial fails or previously on PPI --> use oral aerosolized steroids

22

Caustic ingestion - causes?

1) Kid with accident - drinking bad stuff
2) Adult - suicide
Very strong acid/base
Because ingested --> substance burns everything, including larynx - hoarse voice and stridor
If hear stridor --> intubate patient and make sure can breathe, handle burn later
Damage esophagus --> drooling

23

Dx of caustic esophagitis

Endoscopy
Often not a mystery
EGD is done to determine severity

24

Treatment of caustic esophagitis

Low severity --> liquid diet and observe
High severity (strictures) --> NPO, then repeat EGD to see when have food
-If early on, can do NGD tube with lavage (i.e. flush with water and suck it out)
*Do not neutralize the base! Can cause thermophilic reaction from the neutralization (never do this, not even on skin), NEVER induce emesis (but then it passes again over esophagus/larynx)