Varices & Esophagitis

Question 1

dilated blood vessels that develop as a direct result of liver portal hypertension and an attempt to bypass congestion with collateral blood flow

Answer 1

esophageal varices

Question 2

what are the 2 most common causes of portal hypertension?

Answer 2

liver disease
cirrhosis

Question 3

50% of patients with esophageal varices have _____

Answer 3

cirrhosis

Question 4

esophageal varices are asymptomatic until they start _____

Answer 4

bleeding

Question 5

a patient presents with lower extremity swelling, abdominal distention, jaundice, easy bruising, and hemorrhoids. Dx?

Answer 5

esophageal varices

Question 6

what kind of physical findings will be present in a patient with esophageal varices? (5)

Answer 6

liver disease findings -

peripheral edema
ascites
spleen enlargement
jaundice
telangiectasias

Question 7

what is the gold standard for diagnosing and treating esophageal varices?

Answer 7

upper endoscopy

Question 8

patients should be screened for _____ with ____ when diagnosed with cirrhosis

Answer 8

varices
EGD

Question 9

what is the treatment for patients with chronic liver disease and esophageal varices?

Answer 9

prophylactic nonselective beta blocker

Question 10

what medication should be used to prevent the 1st bleed in non-bleeding esophageal varices?

Answer 10

propranolol

Question 11

what are 2 surgical treatments for non-bleeding esophageal varices?

Answer 11

endoscopic varicocele ligation
transvenous intrahepatic portosystemic shunt (TIPS)

Question 12

what is the management for bleeding esophageal varices? (2)

Answer 12

airway management
balloon tube tamponade for hemorrhage control

Question 13

what medication can be used to prevent infection due to open portal to vascular from GI tract in bleeding esophageal varices?

Answer 13

ceftriaxone

Question 14

what medication can be used to constrict splenic vessels and reduces blood inflow to liver in bleeding esophageal varices?

Answer 14

octreotide
OR
somatostatin

Question 15

what medication prevents gastric reflux from worsening variceal irritation in bleeding esophageal varices?

Answer 15

omeprazole (PPI)

Question 16

what treatment prevents vomiting and disruption of clot in bleeding esophageal varices?

Answer 16

anti-emetic

Question 17

what is the definitive treatment of bleeding esophageal varices?

Answer 17

emergent endoscopy + ligation

Question 18

what are 3 infectious causes of esophagitis?

Answer 18

candidiasis
HSV
CMV

Question 19

what are 3 caustic causes of esophagitis?

Answer 19

GERD
pill-induced
ingestion of chemicals

Question 20

what is the hallmark symptom of esophagitis?

Answer 20

odynophagia

Question 21

a patient presents with odynophagia, dyspepsia, dysphagia, and chest pain. Dx?

Answer 21

esophagitis

Question 22

what is the gold standard diagnostic for esophagitis?

Answer 22

upper endoscopy

Question 23

a patient presents with odynophagia, dysphagia, pain/discomfort in the mouth and angles of the lips or beneath their oral prosthesis. during endoscopy, oral thrush that scrapes off, is seen in esophagus. Dx?

Answer 23

candidal esophagitis

Question 24

what diagnostic will confirm diagnosis of candidal esophagitis?

Answer 24

KOH / gram stain

Question 25

what is the outpatient treatment for candidal esophagitis?

Answer 25

oral fluconazole x 7-14 days

Question 26

what is the inpatient treatment for candidal esophagitis?

Answer 26

IV fluconazole then oral fluconazole x 14-21 days

Question 27

a patient presents with fever, fatigue, body aches, odynophagia, dysphagia, and multiple, small deep ulcerations in the esophagus are seen on upper endoscopy. Dx?

Answer 27

HSV esophagitis

Question 28

what are 3 diagnostics that can be used for HSV esophagitis?

Answer 28

upper endoscopy viral PCR culture

Question 29

what is the treatment for a patient with HSV esophagitis that is not immunocompromised and symptoms are improving?

Answer 29

supportive tx only

Question 30

what is the treatment for a patient with HSV esophagitis that is not immunocompromised and symptoms are not improving?

Answer 30

oral acyclovir x 5-7 days

Question 31

what is the outpatient treatment for a patient with HSV esophagitis that is immunocompromised?

Answer 31

oral acyclovir x 14-21 days

Question 32

what is the inpatient treatment for a patient with HSV esophagitis that is immunocompromised?

Answer 32

IV acyclovir then oral for total of 14-21 days

Question 33

what is considered an AIDs defining illness?

Answer 33

cytomegalovirus (CMV) esophagitis

Question 34

a patient presents with odynophagia, dysphagia, fever, nausea, stomach pains, malabsorption with diarrhea, and oral/anal ulcers. Dx?

Answer 34

cytomegalovirus (CMV) esophagitis

Question 35

what is CMV esophagitis characterized by?

Answer 35

large, shallow, superficial ulcerations

Question 36

what diagnostic confirms CMV esophagitis?

Answer 36

biopsy

Question 37

what is the treatment for CMV esophagitis in a patient that is not immunocompromised?

Answer 37

supportive tx only

Question 38

what is the treatment for CMV esophagitis in a patient that is immunocompromised?

Answer 38

IV ganciclovir alteration of HAART therapy for concurrent HIV/AIDS infection

Question 39

which patients are at greater risk for pill-induced esophagitis? (2)

Answer 39

hospitalized bed-bound

Question 40

what are common medications that cause esophageal irritation? (6)

Answer 40

NSAIDs potassium supplements alendronate iron vitamin C antibiotics

Question 41

what are 2 symptoms a patient will present with if they have pill-induced esophagitis?

Answer 41

odynophagia dysphagia

Question 42

what diagnostic can be used for pill-induced esophagitis?

Answer 42

upper endoscopy

Question 43

what is the treatment for pill-induced esophagitis?

Answer 43

eliminate med take med upright with enough water

Question 44

when can we expect the pill-induced esophagitis to heal with proper medication-taking techniques?

Answer 44

in 48-72 hours

Question 45

damage of esophagus with ingestion of irritants is directly related to what? (2)

Answer 45

time in contact with tissues pH of offending agent