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GI I: Esophagus Cheat Sheet by

Gastroenterology
medical     medicine     gerd     physiology     gastroenterology

GERD

Definition
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 Tear

Definition
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 Esopha­gitis

Seen 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 Varices

Definition
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 Neoplasms

Most 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 Dysmot­ility

Definition
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

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