oral and esophageal conditions Flashcards
(23 cards)
What is the ddx for dysphagia?
neuromuscular disorders (achalasia, motility disorders, scleroderma) or obstruction (peptic strictures, esophageal webs or rings, CA, radiation fibrosis)
What are secondary causes of achalasia?
chagas disease (may also have dilated cardiomyopathy), neoplasm, scleroderma
What is the work up for achalasia?
manometry shows incr LES pressure, incomplete LES relaxation, decr peristalsis. barium swallow shows bird’s beak sign- you then need follow-up EGD to rule out cancer
What is the tx for achalasia?
CCBs/nitrates potentially used, though have CV side effects
otherwise try pneumatic dilation, botulinum injection, or myotomy
What is the treatment for diffuse esophageal spasms?
CCBs, nitrates, tricyclic antidepressants
What is the treatment and potential complications of zenker diverticulum?
tx: cricopharyngeal myotomy or diverticulectomy, but EGD can perforate weakness in esophageal wall and can potentially cause vocal cord paralysis and mediastinitis
What are the adverse effects of the antacids?
aluminum hydroxide can cause constipation; magnesium can cause diarrhea
What are the the adverse effects of the H2 antagonists for GERD?
headache, diarrhea, rare thrombocytopenia. cimetidine may cause gynecomastia and impotence
What are the adverse effects of PPIs?
may increase effects of warfarin, benzos, and phenytoin in some pts
What are the complications that can result from a hiatal hernia?
incarceration of stomach in the herniation with the paraesophageal type
What is gastritis?
inflammation of the gastric mucosa- may be acute or chronic
Where does chronic gastritis occur?
antrum or fundus of the stomach
What is type A gastritis and how is it treated?
atuoimmune disorder due to antibodies against parietal cells (decr. acid level and decr gastrin). causes pernicious anemia, achlorhydia, and thyroiditis.. tx requires B12 replacement
What is type B gastritis and how is it treated?
casued by H. pylori infection and is associated with MALT lymphoma and gastric adenocarcinoma. treat with PPI, clarithromycin and either amoxicillin or metrodiazole for 1-2 wks
What are radiographic findings that might suggest a malignant lesion associated with an ulcer?
barium swallow
see abnormal appearing mucosal folds, mass near the ulcer and irregular filling defects in the ulcer base
What is the appropriate work-up for a patient with a suspected ulcer?
If under 40, try noninvasive testing
If over 40 or pts with previous ulcer need EGD
pts with sx concerning for active bleed or sx lasting more than 2 months also need EGD
What is the tx for PUD?
address active bleeding, give PPI or H2 antagoist, protect mucosa with sucralfate, bismuth subsalicylate, or misoprostol, and eliminate H pylori. Acute perforations require surgical management. Persistent non-neoplastic ulcers may also require vagotomy or antrectomy
What are the complications of PUD?
hemorrhage, esp posterior ulcers (can erode gastroduodenal artery), perforation (usually anterior ulcers), lmyphoproliferative disease
What is zollinger ellison syndrome?
syndrome secondary to gastrin producing tumors most frequently located in the duodenum or pancreas; associated with malabsorption disorders
When should I suspect zollinger ellison syndrome?
refractory PUD, possible with steatorrhea, possible hx of other endocrine disorders
how is zollinger-ellison syndrome diagnosed?
increased fasting gastrin and positive secretin stimulation test (secretin causes higher than expected serum gastrin levels). gastrin sampling in the pancreas or abdominal veins can help localize the tumor. somatostatin receptor imaging with SPECT or angiography may also help localize tumors
What is the treatment for zollinger ellison syndrome?
surgical resection if nonmetastatic with localizable tumor; PPI/H2 and octreotide (somatostatin analog) may help reduce symptoms in metastatic disease
What are the complications of zollinger ellison?
occasionally seen with MEN1; 60% of lesions are malignant
