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DU PA Dz of the Esop

Duke PA Diseases of the Esophagus

substernal burning, epigastric pain radiating to the neck heartburn
substernal burning, epigastric pain radiating to the neck pyrosis
dysphagia difficulty in swallowing-liquids/solids
odynodphagia painful swallowing-reflects erosive esophageal disease
infectious causes of odynophagia CMV, herpes, candida, HIV
__ of adults report occasional heartburn 1/3
__ of adults report daily heartburn 7%
etiologies of GERD incompetent lower esophageal sphincter, transient lower esophageal sphincter relaxation, irritant effects of the refluxate, delayed gastric emptying, abnormal esophageal clearance
heartburn 30-60 minutes after meal, regurgitation, sour brash, dysphageia, relieft with antacids, severity does not correlate with esophagitis, asthma flairs, non-cardiac chest pain, laryngitis, hoarsness, loss of dental enamel symptoms of GERD
treatment for uncomplicated GERD conservative-PPI empirically, no need for further investigation unless treatment failure
symptoms of GERD after age __ warrants furhter investigation 50
complicated GERD alarm symptoms dysphagia, weight loss, hematemesis, melena
__ has a limited role in investigation of reflux barium swallow
indications for ambulatory pH monitoring refractory symptoms and normal EGD, atypical symptoms, failure to respond to pharmacology therapy, patients considered fro antireflux surgery
tests the function of the esophageal muscel contractions and esophageal sphincters manometry
occurs in 10-20% of GERD patients, change fro squamous to columnar epithelium in esophagus Barrett's esophagus
Barrett's esophagus predisposes to __ adenocarcinoma of the esophagus
lifestyle modifications for GERD elevated the head of the bed, lose excess weight, eliminate: tobacco, late night meals, ETOH, fatty foods, chocolate, caffeine
Medical treatment for GERD acid suppression (PPI's), motility agents (not used as much anymore)
Surgical treatment for GERD Nissen fundoplication
__ increases the risk of esophageal cancer 30-60 times the general population Barret's esophagus
heartburn, regurgitation or both greater than or equal to once per week increases cancer risk __ times 8
frequent sever heartburn and regurgitation for >20 years increases cancer risk by __ times 44
GERD is a __ disease chronic
complications of GERD Barrett's esphagus, esophageal cancer, stricture
most GERD patients will eventually be sent for __ endoscopic evaluation
signs and symptoms of infectious esophagitis odynophagia, dysphagia, chest pain
treatment for candida esophagitis fluconozole for 14 days
HSV, HIV and CMV will cause __ in the esophagus ulcerations
occurs secondary to portal hypertension esophageal varices
treatment for esophageal varices banding, shunt procedure, meds
secondary to repeated retching Mallory Weiss tear
patients with a caustic injury to esophagus need to have endoscopy withing the first __ hours 24
outpouchings of upper esophagus, always involves the posterior wall of the pharynx, most common cause of transfer dysphagia. Symptoms are regurgitation, dysphagia, halitosis Zenker's diverticulum
esophageal motility disorders achalasia, diffuse esophageal spasm, nutcracker esophagus, scleroderma esophagus
means- failure to relax achalasia
one identifiable cause of achalasia, not prevalent in this country Chagas disease
gradual progressive dysphagia for solids and liquids, regurgitation of undigested foods, develops at 25-60 y/o, symptoms usually lasted months to years, substernal discomfort or fullness after eating, poor esoph emptying, nocturnal regurg achalasia clinical presentation
gold standard for diagnosis of achalasia manometry
on manometry in achalasia you will see complete absense of peristalisis, with simultaneous, low amplitude waves. Incomplete LES relaxation
chest x-ray finding in achalasia air fluid level
barium swallow finding in achalasia bird's beak, esophageal dilation, loss of peristalsis
achalasia therapy pharmacologic therapy to relax smooth muscle, pneumatic dilation, surgical myotomy, botox
treatment of choice for achalasia surgical myotomy-85% success rate with a mortality <1%
achalasia treatment with __ is highly variable and usually doesn't work very well medications (nifedipine, calcium channel blockers, nitrates)
simultaneous, nonperistaltic contractions of the esophagus, provoked by stress, large food boluses, hot or cold liquids (carbonation), anterior chest pain unrelated to exertion or eating diffuse esophageal spasm
barium esophagography reveals simultandeous cork screw contractions, "rosary bead" appearance diffuse esophageal spasm
common in patients with progressive systemic sclerosis, raynaud's phenomena, or CREST, atrophy and fibrosis of the esophageal smooth muscle scleroderma esophagus
causes of esophageal stenoses rings and webs, reflux esophagitis, tumors, caustic ingestions, infections
iatrogenic causes of esophageal stenoses pill-induced, radiation, sclerotherapy
presents with progressive solid food dysphagia, weight loss, most present in late stages, seen in 50-70 y/o esophageal cancer
predisposing factors for squamous cell carcinoma alcohol, tobacco, achalasia, caustic induced esophageal injury, head and neck cancers, plummer-vinson syndrome. African American, male
develops as a complication of Barrett's esophagus, more common in whites than blacks, lower third of esophagus adenocarcinoma
complications of esophageal cancer local tumor extension into the trachobronchial tree, chest or back pain, laryngeal nerve involvement-hoarsness, pneumonia, malnutrition
treatment for unresectable esophageal cancer for palliation radiation, stenting
chemotherapy for esophageal cancer cisplatin/5 FU
Created by: bwyche