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Flashcards in Itis Lecture Deck (23):
1

Factors leading to GERD

(1) decreased LES resting pressure (impaired smooth muscle ton and abnormal transient LES relaxation)
(2) hiatal hernia
(3) impaired esophageal clearance
(4) impaired distal esophageal mucosal defense
(5) delayed gastric emptying (fatty meals, tobacco, alcohol, chocolate)

2

Results of untreated esophagitis?

Esophageal stricture, gastrointestinal bleeding and anemia, barrett esophagus and adenocarcinoma

3

Treatment for stricture

dilation

4

Treatment GI bleed/anemia

dietary changes (decrease caffeine, not eating before bed) and decrease acid production (proton pump inhibit - omeprozole or H2 blocker - rantidine)

5

What is Barrett esophagus?

intestinal metaplasia; replacement of normal squamous epithelium with specialized columnar epithelium (can lead to adenocarcinoma)

6

Surveillance for Barrett's esophagus

Male >50, long standing GERD

7

Dysphagia

difficulty with shallowing

8

Odynophagia

painful swallowing

9

Case one

55 year old man with heartburn of 20 years duration ... Barrett's esophagus

10

What is infectious esophagitis?

Esophagitis caused by infection (candid albicans, HSV 1, CMV) - occurs in immuno-suppressed individuals

11

What is pill esophagitis?

Pill gets stuck in the esophagus, but that would cause an acute problem

12

What is eosinophilic esophagitis?

a type of white blood cell (eosinophil) builds up in the lining of the tube that connects your mouth to your stomach. associated with systemic allergy and asthma

13

Murphy's sign

sign of acute inflammation of the gall bladder; placing the hand under the right upper quadrant , the patient is asked to inspire

14

Biliary colic vs. acute cholecystitis

biliary colic: RUQ pain lasting less than 4 hours (transient obstruction in the cystic duct)

acute cholecystitis: constant pain RUQ> 4 hours, + murphy's sign, signs of inflammation elevated WBC, ALT/AST

15

Formation of gallstones

bile is supersaturated with cholesterol

16

what is acute cholecystitis

occurs when bile becomes trapped in the gall bladder - gall bladder contractility poor, thickening of gall bladder wall with chronic inflammation, stone becomes lodged in cystic

17

Review - acute cholecystitis

damage to mucosa, which is caused by bile salts - leads to an inflammatory response in gall bladder wall

18

When does gallstone formation occur?

Gallstone formation occurs when the bile becomes supersaturated with cholesterol

19

How does acute cholecystitis result?

Acute cholecystitis results from chemical irritation and inflammation of the obstructed gall bladder

20

Relationship between acute cholecystitis and biliary colic

Acute cholecystitis develops in approximately 20% of patients with biliary colic if they are left untreated

21

Treatment for acute cholecystitis

removal of the gall bladder

22

Cause of acute pancreatitis

cholelithiasis (gall stones) 50%, alcohol 40%, blunt trauma

23

Treatment for acute pancreatitis

gut rest, intravenous fluid support and replacement