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55 Cards in this Set
- Front
- Back
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dysphagia |
difficulty swallowing, food stuck |
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odynophagia |
pain with swallowing |
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metaplasia |
adaptive transformation of differentiated cells to another differentiated cells |
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dysplasia |
expansion of immature cells, early neoplastic change |
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NERD |
non-erosive esophagitis |
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EE |
erosive esophagitis redness at distal site under microscope |
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tachyphylaxis |
rapid development of tolerance or immunity to a drug |
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PPI |
proton pump inhibitor omeprazole |
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melena |
black, tarry stools like jello, broken down blood is cathartic- NO solid stool and foul UGI bleed |
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hematochezia |
bright red blood per rectum, lower GI bleed or a very brisk bleed that travels out fast |
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hematemesis |
vomit blood |
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slide 26
Tx for scleroderma |
-relfux: PPI only, monitor for Barrett's esophagus -hypomotility: pro kinetic drugs (metoclopramide, erythromycin) -stricture -candida: from chronic acid suppression, off meds recurrence high |
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sx of diffused esophageal spasm |
chest pain |
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how do you dx diffused esophageal spasm |
manometry barium swallow (corkscrew, rosary beads, pseudodiverticula) |
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DES tx |
unsure of whats best: Ca channel blocker antidepressant botulinum toxin sildenafil nitrates |
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etiology of Zenker's diverticulum |
unknown hernia immediately above UES >60 y/o mostly male |
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s/s of zenker's diverticulum |
dysphagia (98%) halitosis regurgitation food struck in throat aspiration |
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tx for zenker's diverticulum |
surgery |
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what are esophageal webs and rings and what is MC |
thin delicate structure that partially or completely block esophageal lumen
schatzki's |
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what is schatzki's rings |
found in barium swallow <12mm occurs at GE junction solid food dysphagia usually associated with hiatus hernia |
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what is achalasia esophageal dysmotility |
lack of relaxation in LES solid/liquid food dysphagia bird's beak XR |
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what is scleroderma esophageal dysmotility |
fibrosis reflux |
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what are some causes of esophagitis |
GERD: hiatus hernia, barrett's esophagus med induced infx caustic |
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how do you work up someone with esophagitis |
hx and PE barium swallow: cheaper upper endoscopy: direct visualization, biopsy |
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RF for reflux |
-abnl LES: decreased tone, inappropriate sphincter relaxation, food, drugs, alcohol, NG tube, hiatus hernia, pyloric surgery -increased abd pressure: obesity, pregnancy -NOT related to smoking or NSAID |
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sx of reflux |
-heart burn (pyrosis): post prandial, change in position (recline or bending over), relieved by antacid -regurg of bitter and sour tastes -chest pain with radiation to neck -wheezing/coughing -aspiration |
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alarming sx |
chest pain CA: weight loss, anemia, dysphagia, odynophagia |
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how to dx GERD |
emirical trial: PPI
endoscopy: only shows 1/3 24-h esophageal pH test barium swallow: not sensitive or specific berstein test |
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complications of reflux |
barretts esophagus stricture ulcer asthma |
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tx for reflux |
lose weight bed elevation with nocturnal sx dietary: reduce fat, alcohol, caffeine drugs: minimize PPI use, antacid, H2blockers (not for maintanence), PPI surgery: Nissen Fundoplicaiton |
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how to take PPI |
take half hr before meal or qhs NOT PRN |
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why is GERD hard to tx |
relapse: 2/3 NERD, all EE when stop PPI |
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what are possible reasons for rx failure |
-functional heart burn : MC rome III definition -compliance proper dosing |
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what is hiatus hernia |
herniation of abd thru diaphragm |
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what are the types of hiatus hernia |
type 1: sliding type 2-4: hernia |
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how do dx hiatus hernia |
barium swallow |
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tx for hiatus hernia |
nothing is asx tx underlying GERD |
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what is barretts esophagus |
-chronic GERD causing metaplastic columnar epithelium to replace squamous epithelial cells in distal esophagus (GE junction) -risk of esophageal adenoCA |
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risk for barrettes esophagus |
white, male, smoker, duration, obesity |
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what is protective of barrett's |
ASA, NSAIDs, H. pylori |
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when do we screen puts with barretts for CA |
chronic GERD, hiatus, hernia, >50 y/o, male, white, obesity |
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tx for barretts |
intestense surveillance PPI endoscopic ablation esophagectomy |
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what is med-induced esophagitis |
local, direct irritants: acid burn- doxycycline, asorbic acid, ferrous sulfate, KCL, bisphosphonate
systemic: reflux or infx- Ca channel blockers, steroid |
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sx of med-induced esophagitis |
asx retrosternal pain odynophagia dysphagia location- near aortic arch |
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how do dx med-induced esophagitis |
endoscopy |
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how do tx med-induced esophagitis |
stop offending meds anti acid |
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how to prevent med-induced esophagitis |
bisphosphonate- sit up for 30m and drink 8oz of water |
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risk for infx esophagitis |
IC, inhalational steroids |
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sx of candida esophagitis |
asx cottony feeling odynophagia |
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RF for candida esophagitis |
infants, older adults with denture, abx, AIDS, RT |
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dx for candida esophagitis |
pseudomembrane can be scraped off KOH |
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what virus cause viral esophagitis |
HSV: MC in solid organ transplant CMV: MC in AIDS |
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tx for viral esophagitis |
acyclovir/gancyclovir x 2-3w viscous lidocarine resolve spontaneously in healthy puts |
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are are caustic esophagitis occur? |
accidents: <5yr intentional: adolescents, adults MC: strong alkalii (KOH,NaOH), drain cleaner, battery, lye |
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what are complications of caustic esophagitis |
ulceration, perforation stricture |
