L12: Esophageal Diseases Flashcards
(91 cards)
1
Q
Def of GERD
A
- A condition which develops when the reflux of stomach contents causes troublesome symptoms and/or complications.
2
Q
Incidence of GERD
A
- It is one of the most common conditions affecting the gastrointestinal system.
- Anywhere from 36-77% of people have symptoms of GERD (heartburn, regurgitation of acid etc.)
- Spread equally between men and women.
3
Q
Normally, esophageal reflux is prevented by the following mechanisms …..
A
4
Q
Etiology & Pathogenesis of GERD
A
5
Q
Contributing Factors to GERD
A
6
Q
Factors that Decrease LES Pressure
A
7
Q
Factors that directly irritate gastric mucosa
A
8
Q
Other Conditions Associated with GERD
A
9
Q
CP of Classic GERD
A
Heartburn sensation
- Mainly Epigastric & may radiate retro-sternal even to the lower jaw
- It occurs 30 - 60 m after meals
10
Q
what increases symptoms of GERD?
A
bending, straining, lying down & pregnancy
11
Q
what Decreases symptoms of GERD?
A
Standing, oral intake of water or alkali
12
Q
Extra esophageal Manifestations of GERD
A
13
Q
Barret’s Esophagus is thought to be caused by ……
A
Ongoing injury.
Inflammation.
Damage to the lining of the esophagus.
14
Q
Symptoms of complicated GERD
A
15
Q
Def of Barret’s Esophagus
A
a change from the normal (squamous) mucosa to a specialized intestinal type (columnar metaplasia).
16
Q
Barret’s Esophagus is associated with ……..
A
increased risk of esophageal adenocarcinoma.
(Risk of cancer per year in Barrett’s esophagus 0.5% )
17
Q
Are Investigations needed for GERD?
A
Usually not needed (clinical diagnosis) but may be indicated in:
- Red-flags (bleeding, weight loss, dysphagia etc.)
- Persistent symptoms after therapeutic trial of 4-8 weeks of PPI twice daily.
- High risk for Barrett’s (male, age >50, obese, white, tobacco use, long history of symptoms).
18
Q
Investigations of GERD
A
- Barium swallow
- Endoscopy
- 24-hr pH Monitoring
- Esophageal Manometry
19
Q
Barium Swallow in GERD
A
20
Q
Endoscope in GERD
A
21
Q
24-Hr pH Monitoring in GERD
A
22
Q
DDx in GERD
A
23
Q
Esophageal Manometry in GERD
A
24
Q
TTT of GERD
A
- Lifestyle Modification
- Drugs
- Surgery
25
Indications of Pharmacologic Therapy in **GERD**
if no response to lifestyle modifications
26
Lifestyle modification in **GERD**
**cornerstone**
Diet control
Weight reduction
Raising head during sleep
Take dinner 2-4 h before sleeping
Avoid Tight corset
27
Categories of drugs in **GERD**
- Antacids
- Prokinetic
- Acid Suppression Therapy
- Baclofen
28
Examples of antacids in **GERD**
Aluminum hydroxide & Magnesium hydroxide (help symptoms, not the disease).
29
Prokinetic Drugs in **GERD**
Itopride, metoclopramide & Domperidone
30
Acid suppression therapy in **GERD**
31
MOA of **baclofen** in **GERD**
GABA B agonist, reduces the transient LES relaxations that enable reflux episodes.
32
SE of **Baclofen**
Usage is limited by side effects of dizziness, somnolence, and constipation
33
Pharmacokinetics of H2 antagonist
34
Absorbtion of **H2 antagonist**
Well absorbed → oral and IV doses similar.
35
Peak of **H2 antagonist**
Peak 1-3 hours.
36
Metabolism & Elimination of **H2 antagonist**
- Hepatic metabolism (cimetidine and ranitidine).
- Renal elimination → famotidine and nizatidine.
37
SE of **H2 antagonist**
- Most common side effects→ diarrhea, constipation, CNS (mental confusion, headaches, dizziness).
- Especially at risk → elderly, high doses, renal dis.
38
Pharmacokinetics of Proton Pump Inhibitors
39
Effect of **PPI**
Inhibit > 90% of gastric acid secretion within 24 hours.
40
Preparations of **PPI**
Unstable in acid media so they are enteric coated.
41
Absorbtion & Peak of **PPI**
Rapidly absorbed and peak 2-4 hours.
42
Elimination & Metabolism of **PPI**
Eliminated hepatically and plasma T½ ~ 1-2 hours, antisecretory effect is 1 ½ to 3 days.
43
SE of **PPI**
- GI (nausea, diarrhea), CNS (dizziness, headache) skin rash, gynecomastia, increase liver enzymes.
44
Def of **Refractory Esophagitis**
persistent heartburn and/or regurgitation despite 8 weeks of double-dose PPI therapy
45
Types of Surgery in **GERD**
- Laparoscopic Nissen fundoplication gold standard surgical treatment
- Laparoscopic anterior 180° fundoplication (180° LAF)
- Bariatric surgery in obese patients Roux-en-Y gastric bypass
46
Indications of Surgery in **GERD**
47
Incidence of **Achalasia**
Affects all ages and both genders.
48
what ia another name for **Achalasia**?
Cardiospasm
49
Def of **Achalasia**
Rare, chronic disorder.
50
Pathophysiology of **Achalasia**
Failure of relaxation of LES & loss of peristalsis in the distal esophagus
51
Etiology of **Achalasia**
**Degeneration of the Auerbach's plexus**
1) Idiopathic
2) pseudo-achalasia: e.g. malignancy,
3) Chagas disease (Trypanosoma cruzi)
52
CP of **Achalasia**
53
Typical Patient with **Achalasia**
adults aged 25-60 years, equally in both males & females.
54
Dysphagia in **Achalasia**
- Early intermittent then progressive
- Early liquids > solids then both solids & liquids
55
Globus Sensation in **Achalasia**
Substernal chest pain ---> during / after a meal
56
Investigation for **Achalasia**
- Barium swallow
- Esophageal manometry: definitive diagnosis.
57
Barium Swallow in **Achalasia**
esophagus terminates in narrowing at LES (Bird’s beak - parrot peak)
58
Manometry in **Achalasia**
Absent or incomplete LES relaxation.
Loss peristalsis.
59
Endoscopic pneumatic dilation in **Achalasia**
LES disrupted using balloons of progressively larger diameters.
Repeat dilations are often required.
60
Goals of TTT of **Achalasia**
1. Relieve symptoms & improve esophageal emptying.
2. Prevent development of mega esophagus.
61
Surgery in **Achalasia**
**Heller myotomy:**
Done laparoscopically.
LES surgically disrupted.
Often has antireflux surgery at same time.
1 to 2 weeks for recovery
62
Drug Therapy in **Achalasia**
**Smooth muscle relaxants.**
- Botulinum toxin injection 1 to 2 years relief.
**Drugs:**
- nifedipine, Nitrates or sildenafil (relax LES)
63
Symptomatic TTT in **Achalasia**
Semisoft diet.
Eating slowly.
Drinking with meals.
Sleeping with HOB elevated
64
Def of ****Hiatus Hernia****
- Protrusion of the upper part of the stomach upward through diaphragmatic esophageal hiatus
65
Types of **Hiatus Hernia**
- Type I ( Sliding)
- Type II ( Para-esophageal or rolling hernia )
- Type III ( Mixed )
66
Def of ****Sliding Hiatus Hernia****
Herniation of the GEJ through the esophageal hiatus into the thorax
67
CP of **Sliding Hiatus Hernia**
asymptomatic or heart burn
68
Investigations in **Sliding Hiatus Hernia**
Barium swallow & Upper endoscopy
69
TTT of **Sliding Hiatus Hernia**
Weight reduction, small meals, sleeping in semi-sitting position, PPI & Prokinetics.
Fundoplication indicated in resistant cases
70
Def of **Para-esophageal or rolling hernia**
small part of the fundus of the stomach rolls up alongside the esophagus
71
CP of **Para-esophageal or rolling hernia**
asymptomatic, No GERD symptoms
72
Investigations of **Para-esophageal or rolling hernia**
Barium swallow & Upper endoscopy
73
Complications of **Para-esophageal or rolling hernia**
Mediastinal compression, Volvulus of the stomach can occur
74
Stages of **Swallowing**
75
Def of **Dysphagia**
- Sensation that food is hindered in its passage from the mouth to the stomach.
- Most patients complain that food “sticks” “hangs up” “stops”
76
Def of **Odynophagia**
painful swallowing
77
Intaluminal Causes of **oropharyngeal dysphagia**
78
Extraluminal Causes of **oropharyngeal dysphagia**
79
Neuromuscular Causes of **oropharyngeal dysphagia**
80
CNS Causes of **oropharyngeal dysphagia**
81
PNS Causes of **oropharyngeal dysphagia**
82
MEP Causes of **oropharyngeal dysphagia**
83
Muscle Causes of **oropharyngeal dysphagia**
84
Metabolic Causes of **oropharyngeal dysphagia**
85
intraluminal Causes of **Esophageal dysphagia**
86
Extraluminal Causes of **Esophageal dysphagia**
87
Neuromuscular Causes of **Esophageal dysphagia**
88
Primary Causes of neuromuscular **Esophageal dysphagia**
89
Secondary Causes of Neuromuscular **Esophageal dysphagia**
90
Algorithm for dysphagia
91
Done
..
