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17 Cards in this Set
- Front
- Back
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Type of muscle in esophagus
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Proximal 1/3 = striated
Distal 2/3 = smooth |
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Most common presentation of esophageal disease with PAIN
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Gastroesophageal Reflux Disease (GERD)
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Definition of GERD
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When reflux of gastric contents causes symptoms or complications
(Normal population has acid in esophagus 4% of the time--but do not have symptoms or complications) |
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Primary mediator of pathophysiology in GERD
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ACID
Mucosal defenses are minimal and easily overwhelmed in ESOPHAGUS |
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Most common pathophysiological problem with GERD
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EXCESSIVE transient lower esophageal sphincter relaxation
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Hiatal hernia
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Herniation of stomach through diaphragmatic hiatus cuases:
Decreased LES pressure Gastric pouch Decreased aid of hte diaphragm in reinforcing the LES |
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2 deficient mechanisms that lead to decreased esophageal acid clearance
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1. Decreased peristalsis
2. Decreased salivary gland function (Sjogrens-- autoimmune attack of salivary glands) |
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What determines the severity of symptoms with decreased esophageal acid clearance?
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Dwell time of acid in the esophagus
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2 most common symptoms of GERD
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Pyrosis (heartburn)
Regurgitation CLINICAL DIAGNOSIS! |
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Does reducing acid in esophagus affect progression of Barrett's esophagus to cancer?
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NO
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Most common cancer for Barrett's esophagus to progress to
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Adenocarcinoma
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Pathophysiology of Barrett's esophagus
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Intestinal metaplasia of esophagus
Normal squamous epithelium replaced with columnar epithelium (with goblet cells, etc) |
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Cimetidine, Ranitidine, Nizatidine, Famotidine
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H2 Receptor Antagonists
(Histamine Receptor antagonists) Reduce acid production in the stomach |
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"Prazoles"
Omeprazole, esomeprazole, etc. |
Proton Pump Inhibitors
Reduce acid production in the stomach |
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Indication for SURGERY with GERD patients (wrapping fundus of stomach around esophagus)
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Only when patients are refractory to treatment with medication
(proton pump inhibitors -- prazoles and histamine antagonists -- itidine) |
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3 Most common causes of infectious esophagitis
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Candida
HSV CMV |
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Which esophagitis can happen in immunocompromised AND competent? Which only in compromised?
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Both = candida and HSV
Only compromised = CMV |
