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27 Cards in this Set
- Front
- Back
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Normal esophageal anatomy
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1/3 striated, 2/3 SM, UES and LES
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Primary Peristalsis
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peristalsis associated w/ a swallow
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LES
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thickened circular muscle innervated by Vagal pre-ganglionic and sympathetic post-ganglionic neurons.
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Relaxation of LES
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Relaxes w/ onset of swallowing and intermittently throughout the day
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GERD
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upward displacement of gastric contents into esophagus causing either tissue damage or sx
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Sx of GERD
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substernal chest burning, often accompanied by regurgitation, belching or dysphagia. Can be "silent"
**specific, not sensitive **usually doesn't manifest as belly pain** |
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atypical reflux sx
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hoarseness, asthma, chronic cough, sinusitis, bronchitis, bronchiectasis, erosion of dental enamel
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GERD epidemiology
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increases w/ age, more common in males. Other risk factors include: obesity, pregnancy, smoking, collagen vascular dz, alcohol use, hiatal hernia
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Why don't we all get GERD?
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LES limits reflux, salivary glands secrete bicarb, peristalsis carries refluxate back to stomach, esophageal cells form barrier against diffusion
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Physiologic contributors to GERD
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loose LES, too many/prolonged tLESR's, poor peristalsis, decreased gastric emptying, weak epithelial resistance.
**increased potency of refluxate is rarely the reason for GERD sx. |
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Erosive esophagitis
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seen in 10-40% of those w/ reflux sx; due to high amt of acid/pepsin, more common in pt w/ hiatal hernia, may present as chest pain, dysphagia, etc.
-increased chance of stricture or Barrett's esophagus |
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Stricture
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secondary to severe circumferential mucosal damage; presents as dysphagia,
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Barrett's Esophagus
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metaplastic change of mucosa from stratified squamous to specialized columnar; premalignant condition for adenoCA of esoph.
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Barrett's risks and sx
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risk of cancer is low; may be asx
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empiric tx for GERD
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Acid suppression as a test and a tx. Good result means no further testing.
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Alarm sx for GERD
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weight loss, dysphagia, anemia, early satiety, bleeding
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EGD
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good for look for complications of GERD (stricture, BE, esophagitis) but bad for looking for GERD itself
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best test for diagnosing GERD
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24 hr pH probe; goes through nose and sits in esoph for 24 hours. constantly monitors pH
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Barium Swallow
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best test for dysphagia, esp if EGD not available. Bad test to diagnose GERD - not sens nor spec.
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1st line treatment for GERD
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"conservative:" elevate head of bed, stop smoking, stop alcohol, reduce diatary fat, lose weight, avoid chocolate, peppermint, caffeine, citrus, tomato-based foods
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Treating mild disease
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prn baking soda, antacids, H2 blockers
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treating severe disease
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2x daily H2 blockers up to 3x recommended dose
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for healing erosive esophagitis or really severe disease
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PPI
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Proton Pump Inhibitors
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irreversibly block H/K ATPase, and are most potent acid-suppressing agents. Safe for long-term use
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Other causes of esophagitis
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eosinophilic esophagitis, candida, herpes, CMV, radiation, HIV, drugs
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eosinophilic esophagitis
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infiltration of esoph mucosa secondary to chronic allergic rxn. Presents w/ dysphagia
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Dx and appearance
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characteristic endoscopic picture is "ringed esophagus" dx made w/ endoscopy and biopsy
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