GI Disorders.pptVIP

Internal Medicine Board Review:Luminal I Brian Behm April 20, 2006 Overview Upper GI Disorders Esophagus Motility Disorders Dysphagia/Odynophagia GERD Barrett’s / CA Stomach Gastritis PUD H.Pylori ZE GC IBD Crohn’s vs. UC Treatment Options Extraintestinal Manifestations Trigger Words:Procedure of Choice UGIB Odynophagia Ingested Foreign Body Dysphagia Case #1 Achalasia: Clinical Pearls Solid and liquid dysphagia common 90% Regurgitation, weight loss, chest pain 40-60% Barium Study: Accuracy ~95% Endoscopy Decreased Sensitivity retained food Necessary to r/o pseudoachalasia Esoph AC/SCC, GC, amyloid, sarcoid, eosinophilic esophagitis More rapid onset of symptoms Late onset age 60 Difficult to pass scope through EGJ Manometry Gold Standard ↑LES tone, ↓LES relaxation, aperistalsis distal 2/3 esophagus Achalasia: Clinical Pearls, cont. Treatment Medical don’t usually work Nitrates CCB Botox Injection Pneumatic Dilation Surgical Myotomy Achalasia + Megacolon? Chagas’ Disease Case #2 Diffuse Esophageal Spasm DES Barium Study Corkscrew pattern Manometry 20% simultaneous nonperistaltic contractions 30mmHg Related Disorders of Esophageal Hypermotility Nutcracker Esophagus Distal esoph pressure 180mmHg Hypertensive LES 45mmHg Potential Therapeutic options most ineffective Medical TCAs, Nitrates, CCBs Dilation Botox Injection Case #4 65yoF with: -Fe2+- deficiency anemia -Several year h/o mild dysphagia -EGD Case #5 45yoM with longstanding GERD p/w 6mos. progressive solid food dysphagia Solid Food Dysphagia Plummer-Vinson Syndrome Middle aged women Fe deficiency Cervical webs ? risk SCCA Young person ? Old person ? Scleroderma 80% have esophageal involvement Manometry: ? peristalsis, ? LES Severe GERD Case #6 and #7 18 yo male who is being treated for acne and… 65 yo woman on treatment for osteoporosis who… Alendronate-Induced Esophageal Ulceration Case #8 34 yo male with AIDS presents with increasing severe odynophagia w/o prior h/o hear