GERDDefinition Recurrent reflex of gastric contents into the distal esophagus d/t mechanical or functional abnormality of the lower esophageal sphincter (LES) | Normal protectant factors of the esophagus Gravity, LES tone, esophageal motility, salivary flow, gastric emptying, tissue resistance | What can chronic reflux cause? Barrett's esophagitis (replacement of normal squamous epithelium with metaplastic columnar epithelium) | Barrett's esophagitis can predispose Malignancy | Clinical Features Heartburn (worse after meals + lying down), hoarseness, halitosis, cough, hiccuping, atypical chest pain | Sx of more severe GERD Occurs spontaneously when supine, sign of severe impairment of lower esophageal sphincter tone | Sx of less severe disease Pattern of heartburn following meals, but no PM sx | Lab Studies Clinical usually, can do endoscopy, EKG r/o MI if needed, | When is endoscopy indicated? >45 yo w/ new onset of sx, long-standing or frequent sx and failure to respond to therapy, anemia, dysphagia, or recurrent vomiting | Treatment Lifestyle modifications, antacids, H2-blockers 1st line, PPI most powerful, surgery/endoscopy available last resort |
Mallory-Weiss TearDefinition Linear mucosal tear in the esophagus, generally at the gastroesophageal junction, that occurs with forceful vomiting, causing hematemesis | Most commonly associated with Alcohol use but should be considered in all cases of upper GI bleeding | Diagnosis Endoscopy | Treatment Most cases resolve on their own, but may need endoscopic injx of epinephrine or thermal coagulation |
| | Infectious EsophagitisSeen in what patient population? Rare except in immunocompromised | Etiology Fungal: Candida, Viral: CMV and HSV, other (HIC, M. tuberculosis, EBV) | Clinical Features Odynophagia (painful swallowing), or dysphagia (difficulty swallowing) in an immunocompromised patient | Lab Findings Endoscopy shows large deep ulcers (CMV, HIV), or multiple shallow ulcers (HSV), or white plaques (Candida) | What is needed for definitive dx? Cytology or culture from endoscopic brushings | Treatment Candida-->fluconazole, HSV-->acyclovir, CMV-->ganciclovir |
Esophageal VaricesDefinition Dilations of the veins of the esophagus, usually at the distal end | Etiology Underlying portal HTN, most commonly from cirrhosis (EtOH abuse or chronic viral hepatitis); NSAIDs can exacerbate bleeding | Budd-Chiari Syndrome May cause thrombosis of the portal vein, leading to esophageal varicose | Diagnosis Patient with signs of cirrhosis + hematemesis (varicose can be asymptomatic until they bleed at which time they can be life-threatening) | Treatment Hemodynamic support w/ high-volume fluid replacement, vasopressors, immediate control of bleeding! (Bleeding = high mortality). Preferred therapies: endoscopic therapy + pharm. vasoconstriction (i.e. octreotide) |
| | Esophageal NeoplasmsMost common types SCC and adenocarcinomas | Barrett's esophagitis associated with Adenocarcinoma in the distal 1/3 of the esophagus | Squamous cell lesions associated with Proximal 2/3 of the esophagus | Why is local spread to the mediastinum common Esophagus has no serosa | Risk factors esophageal cancer Smoking, EtOH, exposures (HPV, poor dental hygiene) | Clinical Features Progressive dysphagia for solid foods assoc. w/ weight loss (also heartburn, hoarseness, vomiting) | Best initial lab test to visualize Biphasic barium esophagram | Best lab test to diagnose Endoscopy with brushings | Treatment Surgical |
Esophageal DysmotilityDefinition Inclues neurogenic dysphagia, Zenker's diverticulum, esophageal stenosis, achalasia, diffuse esophageal spasm, scleroderma | Etiology Neurologic factors, intrinsic or external blockage, malfunction of esophageal peristalsis | Clinical features Dysmotility most common | Lab Findings Barium swallow, can show achalasia (parrot-beak) | Treatment Benign strictures-->dilation, Malignant strictures-->resection |
|
Created By
Metadata
Favourited By
Comments
No comments yet. Add yours below!
Add a Comment
Related Cheat Sheets
More Cheat Sheets by ksellybelly