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PPT - Corrosive injury to upper gastrointestinal tract

PPT - Corrosive injury to upper gastrointestinal tract

Download presentationWe think you have liked this presentation. If you wish to download it, please recommend it to your friends in any social system. Share buttons are a little bit lower. Thank you!Buttons: Presentation is loading. Please wait. To view this video please enable JavaScript, and consider upgrading to a web browser that supports HTML5 video Published byCharlene Cummings Modified over 2 years ago 1 CAUSTIC INGESTION AND FOREIGN BODIES OF THE AERODIGESTIVE TRACTAbie Mendelsohn UCLA Head & Neck Surgery Resident Lecture Series March 25, 2009 { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/6069660/18/images/1/CAUSTIC+INGESTION+AND+FOREIGN+BODIES+OF+THE+AERODIGESTIVE+TRACT.jpg", "name": "CAUSTIC INGESTION AND FOREIGN BODIES OF THE AERODIGESTIVE TRACT", "description": "Abie Mendelsohn. UCLA Head & Neck Surgery. Resident Lecture Series. March 25, 2009.", "width": "800" } 2 FOREIGN BODIES According to Chik et. al., what object together with peanuts comprises for 85% of foreign body aspirations? { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/6069660/18/images/2/FOREIGN+BODIES+According+to+Chik+et..jpg", "name": "FOREIGN BODIES According to Chik et.", "description": "al., what object together with peanuts comprises for 85% of foreign body aspirations.", "width": "800" } 3 FOREIGN BODIES According to Chik et. al., what object together with peanuts comprises for 85% of foreign body aspirations? WHO CARES????? Watermelon Seeds (in Hong Kong Children) { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/6069660/18/images/3/FOREIGN+BODIES+According+to+Chik+et.+al.%2C+what+object+together+with+peanuts+comprises+for+85%25+of+foreign+body+aspirations.jpg", "name": "FOREIGN BODIES According to Chik et. al., what object together with peanuts comprises for 85% of foreign body aspirations", "description": "WHO CARES Watermelon Seeds (in Hong Kong Children)", "width": "800" } 4 FOREIGN BODIES Cummings:“Foreign body removal has been greatly facilitated by the introduction of foreign body extraction forceps that have a central channel for an extra-long Hopkins rod telescope. Different forceps are available to remove friable foreign bodies such as peanuts and solid material such as plastic. The use of adrenaline before any attempt at removal shrinks the mucosa and reduces bleeding.” { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/6069660/18/images/4/FOREIGN+BODIES+Cummings%3A.jpg", "name": "FOREIGN BODIES Cummings:", "description": "Foreign body removal has been greatly facilitated by the introduction of foreign body extraction forceps that have a central channel for an extra-long Hopkins rod telescope. Different forceps are available to remove friable foreign bodies such as peanuts and solid material such as plastic. The use of adrenaline before any attempt at removal shrinks the mucosa and reduces bleeding.", "width": "800" } 5 FOREIGN BODIES What is it? Or Everything else { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/6069660/18/images/5/FOREIGN+BODIES+What+is+it+Or+Everything+else.jpg", "name": "FOREIGN BODIES What is it Or Everything else", "description": "FOREIGN BODIES What is it Or Everything else", "width": "800" } 6 FOREIGN BODIES Radiography 25% have normal radiographyPA & lateral views of chest & neck Inspiration & expiration Lateral decubitus views Airway fluoroscopy 25% have normal radiography { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/6069660/18/images/6/FOREIGN+BODIES+Radiography+25%25+have+normal+radiography.jpg", "name": "FOREIGN BODIES Radiography 25% have normal radiography", "description": "PA & lateral views of chest & neck. Inspiration & expiration. Lateral decubitus views. Airway fluoroscopy. 25% have normal radiography.", "width": "800" } 7 FOREIGN BODIES Common esophageal locations CricopharyngeusAorta/left mainstem bronchus Gastroesophageal junction { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/6069660/18/images/7/FOREIGN+BODIES+Common+esophageal+locations+Cricopharyngeus.jpg", "name": "FOREIGN BODIES Common esophageal locations Cricopharyngeus", "description": "Aorta/left mainstem bronchus. Gastroesophageal junction.", "width": "800" } 8 FOREIGN BODIES { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/6069660/18/images/8/FOREIGN+BODIES.jpg", "name": "FOREIGN BODIES", "description": "FOREIGN BODIES", "width": "800" } 9 FOREIGN BODIES { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/6069660/18/images/9/FOREIGN+BODIES.jpg", "name": "FOREIGN BODIES", "description": "FOREIGN BODIES", "width": "800" } 10 FOREIGN BODIES { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/6069660/18/images/10/FOREIGN+BODIES.jpg", "name": "FOREIGN BODIES", "description": "FOREIGN BODIES", "width": "800" } 11 FOREIGN BODIES { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/6069660/18/images/11/FOREIGN+BODIES.jpg", "name": "FOREIGN BODIES", "description": "FOREIGN BODIES", "width": "800" } 12 FOREIGN BODIES { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/6069660/18/images/12/FOREIGN+BODIES.jpg", "name": "FOREIGN BODIES", "description": "FOREIGN BODIES", "width": "800" } 13 FOREIGN BODIES { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/6069660/18/images/13/FOREIGN+BODIES.jpg", "name": "FOREIGN BODIES", "description": "FOREIGN BODIES", "width": "800" } 14 FOREIGN BODIES It’s 3:11am on Saturday night, June 17th, at Harbor.4 year old boy was playing with beans, was witnessed choking and is now coughing. { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/6069660/18/images/14/FOREIGN+BODIES+It%E2%80%99s+3%3A11am+on+Saturday+night%2C+June+17th%2C+at+Harbor..jpg", "name": "FOREIGN BODIES It’s 3:11am on Saturday night, June 17th, at Harbor.", "description": "4 year old boy was playing with beans, was witnessed choking and is now coughing.", "width": "800" } 15 Get the Pediatric Anesthesiologist or I’m not coming inFOREIGN BODIES Get the Pediatric Anesthesiologist or I’m not coming in Damn I’m tired Let’s do what’s best for the patient { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/6069660/18/images/15/Get+the+Pediatric+Anesthesiologist+or+I%E2%80%99m+not+coming+in.jpg", "name": "Get the Pediatric Anesthesiologist or I’m not coming in", "description": "FOREIGN BODIES. Get the Pediatric Anesthesiologist or I’m not coming in. Damn I’m tired. Let’s do what’s best for the patient.", "width": "800" } 16 FOREIGN BODIES Good History but normal lungs sounds and CXR = 45% of children actually had foreign bodies. VS Harbor midnight pediatric airway anesthesia mortality. J of Pediatric Surg ;7: { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/6069660/18/images/16/FOREIGN+BODIES+Good+History+but+normal+lungs+sounds+and+CXR+%3D+45%25+of+children+actually+had+foreign+bodies..jpg", "name": "FOREIGN BODIES Good History but normal lungs sounds and CXR = 45% of children actually had foreign bodies.", "description": "VS. Harbor midnight pediatric airway anesthesia mortality. J of Pediatric Surg 2005. 40;7:1122-7.", "width": "800" } 17 FOREIGN BODIES It’s 10:38pm the next night.4 year old boy was eating watermelon, now can’t breathe too good. CXR shows hyperinflated lung. { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/6069660/18/images/17/FOREIGN+BODIES+It%E2%80%99s+10%3A38pm+the+next+night..jpg", "name": "FOREIGN BODIES It’s 10:38pm the next night.", "description": "4 year old boy was eating watermelon, now can’t breathe too good. CXR shows hyperinflated lung.", "width": "800" } 18 FOREIGN BODIES I”ll be right in, but get the patient in the room.Make Sure Everything is setup and ready to go. { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/6069660/18/images/18/FOREIGN+BODIES+I+ll+be+right+in%2C+but+get+the+patient+in+the+room..jpg", "name": "FOREIGN BODIES I ll be right in, but get the patient in the room.", "description": "Make Sure Everything is setup and ready to go.", "width": "800" } 19 FOREIGN BODIES You get to the OR and you find the airway supply drawer. The scrub tech and circulator look at the equipment and you get this… { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/6069660/18/images/19/FOREIGN+BODIES+You+get+to+the+OR+and+you+find+the+airway+supply+drawer..jpg", "name": "FOREIGN BODIES You get to the OR and you find the airway supply drawer.", "description": "The scrub tech and circulator look at the equipment and you get this… .", "width": "800" } 20 { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://images.slideplayer.com/18/6069660/slides/slide_21.jpg", "name": "", "description": "", "width": "800" } 21 FOREIGN BODIES Age Inner Diameter Outer Diameter Bronch Size26cm Length 30cm Length 40cm Length 2.5 3.5mm 4.2mm x 3 4.3mm 5.0mm 3.5 5.7mm 3.7 6.4mm 4 6.0mm 6.7mm 4.5 6.6mm 7.3mm 5 7.1mm 7.8mm 6 7.5mm 8.2mm Age Inner Diameter Outer Diameter Bronch Size 0-3 months 3.5mm 4.8mm 3 3-9 months 4.0mm 5.5mm 3.5 9-24 months 4.5mm 6.2mm 3.7 2 years 5.0mm 6.8mm 4.5 4 years 7.6mm 5 6 years 6.0mm 8.2mm 6 { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/6069660/18/images/21/FOREIGN+BODIES+Age+Inner+Diameter+Outer+Diameter+Bronch+Size.jpg", "name": "FOREIGN BODIES Age Inner Diameter Outer Diameter Bronch Size", "description": "26cm Length. 30cm Length. 40cm Length. 2.5. 3.5mm. 4.2mm. x. 3. 4.3mm. 5.0mm. 3.5. 5.7mm. 3.7. 6.4mm. 4. 6.0mm. 6.7mm. 4.5. 6.6mm. 7.3mm. 5. 7.1mm. 7.8mm. 6. 7.5mm. 8.2mm. Age. Inner Diameter. Outer Diameter. Bronch Size. 0-3 months. 3.5mm. 4.8mm. 3. 3-9 months. 4.0mm. 5.5mm. 3.5. 9-24 months. 4.5mm. 6.2mm. 3.7. 2 years. 5.0mm. 6.8mm. 4.5. 4 years. 7.6mm. 5. 6 years. 6.0mm. 8.2mm. 6.", "width": "800" } 22 FOREIGN BODIES { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/6069660/18/images/22/FOREIGN+BODIES.jpg", "name": "FOREIGN BODIES", "description": "FOREIGN BODIES", "width": "800" } 23 FOREIGN BODIES OR When to bridge…. { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/6069660/18/images/23/FOREIGN+BODIES+OR+When+to+bridge%E2%80%A6..jpg", "name": "FOREIGN BODIES OR When to bridge….", "description": "FOREIGN BODIES OR When to bridge….", "width": "800" } 24 FOREIGN BODIES { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/6069660/18/images/24/FOREIGN+BODIES.jpg", "name": "FOREIGN BODIES", "description": "FOREIGN BODIES", "width": "800" } 25 CAUSTIC INGESTION 3 year old boy arrives in ER after drinking unknown substance What do you want to ask on history? { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/6069660/18/images/25/CAUSTIC+INGESTION+3+year+old+boy+arrives+in+ER+after+drinking+unknown+substance..jpg", "name": "CAUSTIC INGESTION 3 year old boy arrives in ER after drinking unknown substance.", "description": "What do you want to ask on history.", "width": "800" } 26 Amount Type Concentration Time of contactCAUSTIC INGESTION Amount Type Concentration Time of contact { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/6069660/18/images/26/Amount+Type+Concentration+Time+of+contact.jpg", "name": "Amount Type Concentration Time of contact", "description": "CAUSTIC INGESTION. Amount. Type. Concentration. Time of contact.", "width": "800" } 27 CAUSTIC INGESTION EVIDENCE BASEDDo not order barium swallow Will delay OR time Can not diagnose Grade 1-2 injuries Friedman E M. Caustic ingestions and foreign bodies in the aerodigestive tract of children. Pediatr Clin North Am 1989; 6: 1403–10. { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/6069660/18/images/27/CAUSTIC+INGESTION+EVIDENCE+BASED.jpg", "name": "CAUSTIC INGESTION EVIDENCE BASED", "description": "Do not order barium swallow. Will delay OR time. Can not diagnose Grade 1-2 injuries. Friedman E M. Caustic ingestions and foreign bodies in the aerodigestive tract of children. Pediatr Clin North Am 1989; 6: 1403–10.", "width": "800" } 28 CAUSTIC INGESTION EVIDENCE BASEDEverybody gets esophagoscopy for prognosis Katzka D.A.: Caustic injury to the esophagus. Curr Treat Options Gastroenterol 4. (1): { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/6069660/18/images/28/CAUSTIC+INGESTION+EVIDENCE+BASED.jpg", "name": "CAUSTIC INGESTION EVIDENCE BASED", "description": "Everybody gets esophagoscopy for prognosis. Katzka D.A.: Caustic injury to the esophagus. Curr Treat Options Gastroenterol 4. (1): 59-66.2001.", "width": "800" } 29 CAUSTIC INGESTION Esophagoscopy in virtually all patients at hours post-ingestion < 24 hours – underestimation of injury > 72 hours with risk of iatrogenic perforation – barium swallow Endoscopy to upper limit of severe burn Want to do anything else??? { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/6069660/18/images/29/CAUSTIC+INGESTION+Esophagoscopy+in+virtually+all+patients+at+24-48+hours+post-ingestion.+%3C+24+hours+%E2%80%93+underestimation+of+injury..jpg", "name": "CAUSTIC INGESTION Esophagoscopy in virtually all patients at 24-48 hours post-ingestion. < 24 hours – underestimation of injury.", "description": "> 72 hours with risk of iatrogenic perforation – barium swallow. Endoscopy to upper limit of severe burn. Want to do anything else", "width": "800" } 30 CAUSTIC INGESTION Nasogastric tubePrevent adherence of esophageal walls Allow for nutrition { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/6069660/18/images/30/CAUSTIC+INGESTION+Nasogastric+tube.jpg", "name": "CAUSTIC INGESTION Nasogastric tube", "description": "Prevent adherence of esophageal walls. Allow for nutrition.", "width": "800" } 31 CAUSTIC INGESTION Grade 1 - superficial injuryGrade 2 – transmucosal injury Grade 3 – transmural injury Circumferential vs. localized injury { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/6069660/18/images/31/CAUSTIC+INGESTION+Grade+1+-+superficial+injury.jpg", "name": "CAUSTIC INGESTION Grade 1 - superficial injury", "description": "Grade 2 – transmucosal injury. Grade 3 – transmural injury. Circumferential vs. localized injury.", "width": "800" } 32 Goal Preventing permanent injury or stricture in esophagusCAUSTIC INGESTION Goal Preventing permanent injury or stricture in esophagus { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/6069660/18/images/32/Goal+Preventing+permanent+injury+or+stricture+in+esophagus.jpg", "name": "Goal Preventing permanent injury or stricture in esophagus", "description": "CAUSTIC INGESTION. Goal. Preventing permanent. injury or stricture in. esophagus.", "width": "800" } 33 CAUSTIC INGESTION EVIDENCE BASEDNo benefit from steroid use NEJM n = 60 Prospective, Randomized, Controlled Anderson K D, Rouse T M, Randolph J G. A controlled trial of corticosteroids in children with corrosive injury of the esophagus. N Engl J Med 1990; 323: 637. { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/6069660/18/images/33/CAUSTIC+INGESTION+EVIDENCE+BASED.jpg", "name": "CAUSTIC INGESTION EVIDENCE BASED", "description": "No benefit from steroid use. NEJM. n = 60. Prospective, Randomized, Controlled. Anderson K D, Rouse T M, Randolph J G. A controlled trial of corticosteroids in children with corrosive injury of the esophagus. N Engl J Med 1990; 323: 637.", "width": "800" } 34 CAUSTIC INGESTION EVIDENCE BASEDUse diluting agents Milk Water Use GERD therapy Use Antibiotics NONE!!! { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/6069660/18/images/34/CAUSTIC+INGESTION+EVIDENCE+BASED.jpg", "name": "CAUSTIC INGESTION EVIDENCE BASED", "description": "Use diluting agents. Milk. Water. Use GERD therapy. Use Antibiotics. NONE!!!", "width": "800" } 35 CAUSTIC INGESTION Esophageal carcinoma 1,000x increased risk13 to 71 years after injury Better prognosis than usual esophageal cancer { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/6069660/18/images/35/CAUSTIC+INGESTION+Esophageal+carcinoma+1%2C000x+increased+risk.jpg", "name": "CAUSTIC INGESTION Esophageal carcinoma 1,000x increased risk", "description": "13 to 71 years after injury. Better prognosis than usual esophageal cancer.", "width": "800" } Ppt on bond length chart Ppt on cross docking warehouse Ppt on symmetry of functions Ppt on brand building and management Ppt on historical places in india Download ppt on transportation in human beings Ppt on breast cancer Ppt on power grid system Ppt on layer 3 switching explained A ppt on business plan Caustic Ingestion and Foreign Bodies of the Aerodigestive TractForeign Bodies Foreign body ingestion Foreign body aspiration Toddlers Oral exploration Lack posterior dentition Easy distractibility Cognitive development.The Truth About Lye Pediatric Caustic Ingestions Amelia Simpson.Pediatric FB Ingestion & Aspiration Heather Patterson PGY4 August 14, 2008.Therapeutic Results of Early and Late Endoscopic Dilatation Therapeutic Results of Early and Late Endoscopic Dilatation IN ESOPHAGEAL STRICTURE CAUSED.MNA M osby ’ s Long Term Care Assistant Chapter 25 Nutritional Support and IV Therapy.Corrosive injury to upper gastrointestinal tract: Still a major surgical dilemma World J Gastroenterol Aug 28;12(32):A 50-year-old man with a history of symptomatic gastroesophageal reflux disease (GERD) has Barrett’s esophagus diagnosed on upper endoscopy. Which of.University of Tennessee College of Veterinary Medicine Department of Large Animal Clinical Sciences Esophageal Choke Horse Owners Seminar March 17, 2007.Adam Noyes PGY-3 Justin Goralnik PGY-2DYSPHAGIA Begashaw M (MD). Dysphagia Defn  Difficulty in swallowing Classification 1- Oropharyngeal dysphagia Causes– Local pain -trauma, oral candida,Complication Complication Procedure Primary DiagnosisDISORDER OF ESOPHAGUS GASTROESOPHGEAL REFLUX (GER) CORROSIVE STRICTURE.Management of Corrosive Ingestion A barium swallow is a test used to determine the cause of painful swallowing, difficulty with swallowing, abdominal pain, or unexplained weight loss.Esophageal Cancer. The principal histologic types of esophageal cancer are squamous cell carcinoma and adenocarcinomasquamous cell carcinoma.Understanding Your Gastroesophageal Reflux Disease (GERD)Feeding and Swallowing Disorders in ChildrenPediatric Respiratory Emergencies Part 2 Mohammed Al Faifi, MD. Pediatric Emergency Consultant Department of Emergency Medicine King Faisal Specialist.Auscultation: Listening to breath sounds with a stethoscope Similar presentations © 2017 SlidePlayer.com Inc. All rights reserved.



Download presentationWe think you have liked this presentation. If you wish to download it, please recommend it to your friends in any social system. Share buttons are a little bit lower. Thank you!Buttons: Presentation is loading. Please wait. To view this video please enable JavaScript, and consider upgrading to a web browser that supports HTML5 video Published byIris Lane Modified over 2 years ago 1 Disorders of the Upper Gastrointestinal TractDr. Aric Storck November 7, 2002 { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4555574/15/images/1/Disorders+of+the+Upper+Gastrointestinal+Tract.jpg", "name": "Disorders of the Upper Gastrointestinal Tract", "description": "Dr. Aric Storck. November 7, 2002.", "width": "800" } 2 objectives Review diagnosis and management of common disorders of the esophagus, stomach and duodenum Will not discuss disorders of bowel GI bleed – covered next week { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4555574/15/images/2/objectives+Review+diagnosis+and+management+of+common+disorders+of+the+esophagus%2C+stomach+and+duodenum..jpg", "name": "objectives Review diagnosis and management of common disorders of the esophagus, stomach and duodenum.", "description": "Will not discuss. disorders of bowel. GI bleed – covered next week.", "width": "800" } 3 Esophagus – anatomy 25-30 cm Relation to adjacent structuresPrevertebral fascia posteriorly Trachea / L mainstem bronchus/ heart anteriorly Fixed at origin Mobile throughout mediastinum Two layers Inner layer – circular Outer layer – longitudinal NB: No serosal layer { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4555574/15/images/3/Esophagus+%E2%80%93+anatomy+25-30+cm+Relation+to+adjacent+structures.jpg", "name": "Esophagus – anatomy 25-30 cm Relation to adjacent structures", "description": "Prevertebral fascia posteriorly. Trachea / L mainstem bronchus/ heart anteriorly. Fixed at origin. Mobile throughout mediastinum. Two layers. Inner layer – circular. Outer layer – longitudinal. NB: No serosal layer.", "width": "800" } 4 Proximal 1/3 Middle 1/3 Distal 1/3 Striated muscleAllows voluntary initiation of swallowing innvervated by spinal accessory nerve Middle 1/3 Striated and smooth muscle Dorsal motor nerve of vagus Distal 1/3 Smooth muscle { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4555574/15/images/4/Proximal+1%2F3+Middle+1%2F3+Distal+1%2F3+Striated+muscle.jpg", "name": "Proximal 1/3 Middle 1/3 Distal 1/3 Striated muscle", "description": "Allows voluntary initiation of swallowing. innvervated by spinal accessory nerve. Middle 1/3. Striated and smooth muscle. Dorsal motor nerve of vagus. Distal 1/3. Smooth muscle.", "width": "800" } 5 Normal Healthy Esophagus { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4555574/15/images/5/Normal+Healthy+Esophagus.jpg", "name": "Normal Healthy Esophagus", "description": "Normal Healthy Esophagus", "width": "800" } 6 Esophageal Obstruction4 areas of narrowing Cricopharyngeus (upper esophageal sphincter) Aortic arch Left mainstem bronchus Diaphragmatic hiatus Large foreign body in esophagus can obstruct airway { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4555574/15/images/6/Esophageal+Obstruction.jpg", "name": "Esophageal Obstruction", "description": "4 areas of narrowing. Cricopharyngeus (upper esophageal sphincter) Aortic arch. Left mainstem bronchus. Diaphragmatic hiatus. Large foreign body in esophagus can obstruct airway.", "width": "800" } 7 Esophageal obstruction clinical presentationComplete Unable to swallow Drooling Violent retching Pain from neck to epigastrium Proximal Sudden cyanosis Compression of trachea by food in upper esophagus or oropharynx { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4555574/15/images/7/Esophageal+obstruction+clinical+presentation.jpg", "name": "Esophageal obstruction clinical presentation", "description": "Complete. Unable to swallow. Drooling. Violent retching. Pain from neck to epigastrium. Proximal. Sudden cyanosis. Compression of trachea by food in upper esophagus or oropharynx.", "width": "800" } 8 Esophageal obstruction causesForeign bodies Coins, food, batteries Anatomic anomalies Carcinoma Schiatzki’s ring Peptic / chemical stricture Extrinsic compression Thyroid enlargement Zenker’s diverticulum Aortic arch Anomalous right subclavian artery Bronchogenic carcinoma { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4555574/15/images/8/Esophageal+obstruction+causes.jpg", "name": "Esophageal obstruction causes", "description": "Foreign bodies. Coins, food, batteries. Anatomic anomalies. Carcinoma. Schiatzki’s ring. Peptic / chemical stricture. Extrinsic compression. Thyroid enlargement. Zenker’s diverticulum. Aortic arch. Anomalous right subclavian artery. Bronchogenic carcinoma.", "width": "800" } 9 Esophageal obstruction diagnostic strategiesEndoscopy Gold standard for diagnosis and treatment Plain radiographs If foreign body suspected Not seeing it does not rule it out Contrast studies Gastrograffin vs barium NB:radigraphs + contrast studies False negatives <20% False positives <1% CT scan { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4555574/15/images/9/Esophageal+obstruction+diagnostic+strategies.jpg", "name": "Esophageal obstruction diagnostic strategies", "description": "Endoscopy. Gold standard for diagnosis and treatment. Plain radiographs. If foreign body suspected. Not seeing it does not rule it out. Contrast studies. Gastrograffin vs barium. NB:radigraphs + contrast studies. False negatives 10 Esophageal obstruction foreign body managementOropharyngeal Retrieve with Kelly / McGill forceps Esophageal Endoscopic removal Foley catheter (controversial) Lower esophagus Often food impaction Glucagon 1mg iv (maximum 2mg) Relax sphincter enough to allow passage of food in 50% of patients Affects only smooth muscle, thus not useful for proximal obstructions { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4555574/15/images/10/Esophageal+obstruction+foreign+body+management.jpg", "name": "Esophageal obstruction foreign body management", "description": "Oropharyngeal. Retrieve with Kelly / McGill forceps. Esophageal. Endoscopic removal. Foley catheter (controversial) Lower esophagus. Often food impaction. Glucagon 1mg iv (maximum 2mg) Relax sphincter enough to allow passage of food in 50% of patients. Affects only smooth muscle, thus not useful for proximal obstructions.", "width": "800" } 11 Reflux esophagitis stricturepizza Food impacted proximal to stricture Could attempt glucagon { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4555574/15/images/11/Reflux+esophagitis+stricture.jpg", "name": "Reflux esophagitis stricture", "description": "pizza. Food impacted proximal to stricture. Could attempt glucagon.", "width": "800" } 12 Esophageal StricturesCaustic stricture Narrowing of 2/3 of esophagus due to caustic ingestion years ago Accidental in children Suicide Radiation stricture Smooth midesophageal stricture { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4555574/15/images/12/Esophageal+Strictures.jpg", "name": "Esophageal Strictures", "description": "Caustic stricture. Narrowing of 2/3 of esophagus due to caustic ingestion years ago. Accidental in children. Suicide. Radiation stricture. Smooth midesophageal stricture.", "width": "800" } 13 Esophageal obstruction foreign body managementEffervescent agents (pop …) Sharp objects Urgent intervention Cause intestinal perforation in 15-35% Batteries “button” batteries – urgent removal Zn, Li, Hg – leakage causes toxicity Did you know …. There is a National Button Battery Ingestion Hotline (202) { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4555574/15/images/13/Esophageal+obstruction+foreign+body+management.jpg", "name": "Esophageal obstruction foreign body management", "description": "Effervescent agents (pop …) Sharp objects. Urgent intervention. Cause intestinal perforation in 15-35% Batteries. button batteries – urgent removal. Zn, Li, Hg – leakage causes toxicity. Did you know …. There is a National Button Battery Ingestion Hotline (202) 525-3333.", "width": "800" } 14 Bell in esophagus { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4555574/15/images/14/Bell+in+esophagus.jpg", "name": "Bell in esophagus", "description": "Bell in esophagus", "width": "800" } 15 Case A patient has been drinking heavily. He presents to the emergency room after several hours of severe vomiting and retching. He is complaining of severe epigastric pain radiating to the back. He has not had significant hematemesis. Diagnosis? { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4555574/15/images/15/Case.jpg", "name": "Case", "description": "A patient has been drinking heavily. He presents to the emergency room after several hours of severe vomiting and retching. He is complaining of severe epigastric pain radiating to the back. He has not had significant hematemesis. Diagnosis", "width": "800" } 16 Esophageal perforationPotentially life-threatening Boerhaave’s syndrome Vomiting Valsalva maneuver Cough Childbirth Iatrogenic Endoscopy Foreign body ingestion Trauma { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4555574/15/images/16/Esophageal+perforation.jpg", "name": "Esophageal perforation", "description": "Potentially life-threatening. Boerhaave’s syndrome. Vomiting. Valsalva maneuver. Cough. Childbirth. Iatrogenic. Endoscopy. Foreign body ingestion. Trauma.", "width": "800" } 17 Esophageal perforation clinical presentationUpper esophagus Neck / chest pain Dysphagia Respiratory distress Fever Lower esophagus Abdo pain / pain radiating to back Pneumothorax Pneumomediastinum Subcutaneous emphysema (Hamman’s Sign) { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4555574/15/images/17/Esophageal+perforation+clinical+presentation.jpg", "name": "Esophageal perforation clinical presentation", "description": "Upper esophagus. Neck / chest pain. Dysphagia. Respiratory distress. Fever. Lower esophagus. Abdo pain / pain radiating to back. Pneumothorax. Pneumomediastinum. Subcutaneous emphysema (Hamman’s Sign)", "width": "800" } 18 Esophageal perforation DiagnosisCXR / upright AXR Subcutaneous emphysema Pneumomediastinum Mediastinal widening Pleural effusion Contrast studies Gastrograffin/barium CT Mediastinal air Extraluminal contrast Fluid collections { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4555574/15/images/18/Esophageal+perforation+Diagnosis.jpg", "name": "Esophageal perforation Diagnosis", "description": "CXR / upright AXR. Subcutaneous emphysema. Pneumomediastinum. Mediastinal widening. Pleural effusion. Contrast studies. Gastrograffin/barium. CT. Mediastinal air. Extraluminal contrast. Fluid collections.", "width": "800" } 19 Boerhaave’s Syndrome Esophageal ruptureContrast filling rounded area adjacent to distal esphagus Arrows = rupture { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4555574/15/images/19/Boerhaave%E2%80%99s+Syndrome+Esophageal+rupture.jpg", "name": "Boerhaave’s Syndrome Esophageal rupture", "description": "Contrast filling rounded area adjacent to distal esphagus. Arrows = rupture.", "width": "800" } 20 Esophageal Perforation TreatmentAggressive treatment Boerhaave’s Unstable Contamination of mediastinum/pleura Tx with broad spectrum ABX Conservative treatment Stable, afebrile Endoscopic injury Delayed presentation { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4555574/15/images/20/Esophageal+Perforation+Treatment.jpg", "name": "Esophageal Perforation Treatment", "description": "Aggressive treatment. Boerhaave’s. Unstable. Contamination of mediastinum/pleura. Tx with broad spectrum ABX. Conservative treatment. Stable, afebrile. Endoscopic injury. Delayed presentation.", "width": "800" } 21 Case A 42 year old woman comes to emergency complaining of trouble swallowing. The food seems to get stuck in her throat. This has been happening for several weeks. What has she got? { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4555574/15/images/21/Case.jpg", "name": "Case", "description": "A 42 year old woman comes to emergency complaining of trouble swallowing. The food seems to get stuck in her throat. This has been happening for several weeks. What has she got", "width": "800" } 22 Dysphagia From Greek “dys” difficult “phagia” eatingsensation of food getting “stuck” +/- pain indicates esophageal problem oropharyngeal esophageal 12% of patients in acute care hospital up to 50% of patients in chronic care { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4555574/15/images/22/Dysphagia+From+Greek+dys+difficult+phagia+eating.jpg", "name": "Dysphagia From Greek dys difficult phagia eating", "description": "sensation of food getting stuck +/- pain. indicates esophageal problem. oropharyngeal. esophageal. 12% of patients in acute care hospital. up to 50% of patients in chronic care.", "width": "800" } 23 Oropharyngeal dysphagiaInability to transfer food to esophagus food sticks immediately after swallowing neurological cortical - pseudobulbar palsy (UMN lesion) due to bilateral stroke bulbar - ischemia, tumour (LMN) peripheral - polio, ALS { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4555574/15/images/23/Oropharyngeal+dysphagia.jpg", "name": "Oropharyngeal dysphagia", "description": "Inability to transfer food to esophagus. food sticks immediately after swallowing. neurological. cortical - pseudobulbar palsy (UMN lesion) due to bilateral stroke. bulbar - ischemia, tumour (LMN) peripheral - polio, ALS.", "width": "800" } 24 Oropharyngeal dysphagiaMuscular muscular dystrophy cricopharyngeal incoordination failure of UES to relax with swallowing Zenker’s diverticulum { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4555574/15/images/24/Oropharyngeal+dysphagia.jpg", "name": "Oropharyngeal dysphagia", "description": "Muscular. muscular dystrophy. cricopharyngeal incoordination. failure of UES to relax with swallowing. Zenker’s diverticulum.", "width": "800" } 25 Esophageal Dysphagia Solid food only Solid or liquid foodMechanical obstruction Neuromuscular disorder intermittent progressive intermittent progressive Reflux Sx Respiratory symptoms Lower esophageal ring/web Age>50 heartburn DES scleroderma achalasia Peptic stricture carcinoma { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4555574/15/images/25/Esophageal+Dysphagia+Solid+food+only+Solid+or+liquid+food.jpg", "name": "Esophageal Dysphagia Solid food only Solid or liquid food", "description": "Mechanical obstruction. Neuromuscular disorder. intermittent. progressive. intermittent. progressive. Reflux Sx. Respiratory. symptoms. Lower esophageal. ring/web. Age>50. heartburn. DES. scleroderma. achalasia. Peptic stricture. carcinoma.", "width": "800" } 26 Achalasia Incomplete relaxation of LES (resting pressure >30mm Hg)etiology idiopathic - most common Chagas disease - Latin America secondary to cancer (esophagus, stomach) { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4555574/15/images/26/Achalasia+Incomplete+relaxation+of+LES+%28resting+pressure+%3E30mm+Hg%29.jpg", "name": "Achalasia Incomplete relaxation of LES (resting pressure >30mm Hg)", "description": "etiology. idiopathic - most common. Chagas disease - Latin America. secondary to cancer (esophagus, stomach)", "width": "800" } 27 Achalasia - ComplicationsRespiratory aspiration bronchiectasis lung abscesses GI malnutrition increased risk of esophageal cancer { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4555574/15/images/27/Achalasia+-+Complications.jpg", "name": "Achalasia - Complications", "description": "Respiratory. aspiration. bronchiectasis. lung abscesses. GI. malnutrition. increased risk of esophageal cancer.", "width": "800" } 28 Achalasia - Diagnosis CXR barium esophagogramabsent air in stomach dilated fluid filled esophagus barium esophagogram prominent esophagus with “bird’s beak” esophageal motility study required for definitive diagnosis { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4555574/15/images/28/Achalasia+-+Diagnosis+CXR+barium+esophagogram.jpg", "name": "Achalasia - Diagnosis CXR barium esophagogram", "description": "absent air in stomach. dilated fluid filled esophagus. barium esophagogram. prominent esophagus with bird’s beak esophageal motility study. required for definitive diagnosis.", "width": "800" } 29 Achalasia - Treatment Nitrates, CCBs balloon dilatation of LES Surgery50% successful 5% perforation Surgery Heller myotomy { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4555574/15/images/29/Achalasia+-+Treatment+Nitrates%2C+CCBs+balloon+dilatation+of+LES+Surgery.jpg", "name": "Achalasia - Treatment Nitrates, CCBs balloon dilatation of LES Surgery", "description": "50% successful. 5% perforation. Surgery. Heller myotomy.", "width": "800" } 30 Achalasia Barium esophagogram. The dilated esophagus ends in a "bird's beak" that represents the nonrelaxing lower esophageal sphincter. Fluoroscopy during the swallow revealed no meaningful peristalsis in the esophageal body. { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4555574/15/images/30/Achalasia.jpg", "name": "Achalasia", "description": "Barium esophagogram. The dilated esophagus ends in a bird s beak that represents the nonrelaxing lower esophageal sphincter. Fluoroscopy during the swallow revealed no meaningful peristalsis in the esophageal body.", "width": "800" } 31 Achalasia Manometry Failure of LES relaxationFailure of peristaltic conduction to LES { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4555574/15/images/31/Achalasia+Manometry+Failure+of+LES+relaxation.jpg", "name": "Achalasia Manometry Failure of LES relaxation", "description": "Failure of peristaltic conduction to LES.", "width": "800" } 32 Diffuse Esophageal SpasmNormal peristalsis interspersed with abnormal high pressure waves unknown etiology diagnosis barium esophagogram - corkscrew pattern manometry treatment medical - nitrates, CCB, anticholinergics surgery - long myotomy { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4555574/15/images/32/Diffuse+Esophageal+Spasm.jpg", "name": "Diffuse Esophageal Spasm", "description": "Normal peristalsis interspersed with abnormal high pressure waves. unknown etiology. diagnosis. barium esophagogram - corkscrew pattern. manometry. treatment. medical - nitrates, CCB, anticholinergics. surgery - long myotomy.", "width": "800" } 33 DES Nutcracker esophagus note pseudodiverticula caused by spasm { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4555574/15/images/33/DES+Nutcracker+esophagus+note+pseudodiverticula+caused+by+spasm.jpg", "name": "DES Nutcracker esophagus note pseudodiverticula caused by spasm", "description": "DES Nutcracker esophagus note pseudodiverticula caused by spasm", "width": "800" } 34 CASE A 51 year old woman presents with trouble swallowing. You also note generally tight skin, particularly around the fingers. She says she has Reynaud’s phenomenon. What is the most likely diagnosis? { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4555574/15/images/34/CASE.jpg", "name": "CASE", "description": "A 51 year old woman presents with trouble swallowing. You also note generally tight skin, particularly around the fingers. She says she has Reynaud’s phenomenon. What is the most likely diagnosis", "width": "800" } 35 Scleroderma Microvascular disease and intramural neuronal dysfunctionaperistalsis & loss of LES tone … reflux … stricture … dysphagia { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4555574/15/images/35/Scleroderma+Microvascular+disease+and+intramural+neuronal+dysfunction.jpg", "name": "Scleroderma Microvascular disease and intramural neuronal dysfunction", "description": "aperistalsis & loss of LES tone. … reflux. … stricture. … dysphagia.", "width": "800" } 36 Scleroderma - TreatmentGERD prophylaxis anti-reflux surgery - last resort { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4555574/15/images/36/Scleroderma+-+Treatment.jpg", "name": "Scleroderma - Treatment", "description": "GERD prophylaxis. anti-reflux surgery - last resort.", "width": "800" } 37 Scleroderma Distal esophageal stricture { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4555574/15/images/37/Scleroderma+Distal+esophageal+stricture.jpg", "name": "Scleroderma Distal esophageal stricture", "description": "Scleroderma Distal esophageal stricture", "width": "800" } 38 CASE A teenager presents to the emergency department with a 2 day history of severe pain while swallowing. She has to spit out her saliva rather than swallow. She has acne and is taking tetracycline. Diagnosis? { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4555574/15/images/38/CASE.jpg", "name": "CASE", "description": "A teenager presents to the emergency department with a 2 day history of severe pain while swallowing. She has to spit out her saliva rather than swallow. She has acne and is taking tetracycline. Diagnosis", "width": "800" } 39 Esophagitis GERD (#1 cause) Infectious esophagitis Pill esophagitisCaustic ingestion Radiation Sclerotherapy { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4555574/15/images/39/Esophagitis+GERD+%28%231+cause%29+Infectious+esophagitis+Pill+esophagitis.jpg", "name": "Esophagitis GERD (#1 cause) Infectious esophagitis Pill esophagitis", "description": "Caustic ingestion. Radiation. Sclerotherapy.", "width": "800" } 40 Infectious EsophagitisRare in immunocompetent hosts Risk factors DM, EtOH, GC’s, elderly Immunosuppressants, broad spectrum abx Candida albicans – most common Viral – HSV, CMV Bacterial – uncommon Trypanosoma cruzi, cryptosporidium { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4555574/15/images/40/Infectious+Esophagitis.jpg", "name": "Infectious Esophagitis", "description": "Rare in immunocompetent hosts. Risk factors. DM, EtOH, GC’s, elderly. Immunosuppressants, broad spectrum abx. Candida albicans – most common. Viral – HSV, CMV. Bacterial – uncommon. Trypanosoma cruzi, cryptosporidium.", "width": "800" } 41 Infectious esophagitis clinical manifestations+++ Odynophagia Dysphagia Solids & liquids Fever (uncommon) Bleeding (uncommon) { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4555574/15/images/41/Infectious+esophagitis+clinical+manifestations.jpg", "name": "Infectious esophagitis clinical manifestations", "description": "+++ Odynophagia. Dysphagia. Solids & liquids. Fever (uncommon) Bleeding (uncommon)", "width": "800" } 42 Esophagitis - diagnosisEndoscopy Infectious Candida – white plaques Herpes – vesicles Definitive dx via biopsy { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4555574/15/images/42/Esophagitis+-+diagnosis.jpg", "name": "Esophagitis - diagnosis", "description": "Endoscopy. Infectious. Candida – white plaques. Herpes – vesicles. Definitive dx via biopsy.", "width": "800" } 43 Candidal esophagitis Common in HIV Antibiotics Chemotherapy+++dysphagia Tx: fluconazole { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4555574/15/images/43/Candidal+esophagitis+Common+in+HIV+Antibiotics+Chemotherapy.jpg", "name": "Candidal esophagitis Common in HIV Antibiotics Chemotherapy", "description": "+++dysphagia. Tx: fluconazole.", "width": "800" } 44 HSV Esophagitis Common in: Chemotherapy HIV Tx: acyclovir { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4555574/15/images/44/HSV+Esophagitis+Common+in%3A+Chemotherapy+HIV+Tx%3A+acyclovir.jpg", "name": "HSV Esophagitis Common in: Chemotherapy HIV Tx: acyclovir", "description": "HSV Esophagitis Common in: Chemotherapy HIV Tx: acyclovir", "width": "800" } 45 Esophagitis Early Esophagitis Diffuse nodularity of mucosal surfaceMod. Esophagitis Thickened folds and nodularity in distal esophagus Severe Esophagitis Diffuse ulcerations and stricture { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4555574/15/images/45/Esophagitis+Early+Esophagitis+Diffuse+nodularity+of+mucosal+surface.jpg", "name": "Esophagitis Early Esophagitis Diffuse nodularity of mucosal surface", "description": "Mod. Esophagitis. Thickened folds and nodularity in distal esophagus. Severe Esophagitis. Diffuse ulcerations and stricture.", "width": "800" } 46 Infectious esophagitis treatmentCandida Fluconazole 200mg po od x 3-4 weeks HSV Acyclovir 400mg po 5x/day x 2 weeks CMV Gancyclovir Foscarnet Antacids, topical anesthetics, sucralfate { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4555574/15/images/46/Infectious+esophagitis+treatment.jpg", "name": "Infectious esophagitis treatment", "description": "Candida. Fluconazole 200mg po od x 3-4 weeks. HSV. Acyclovir 400mg po 5x/day x 2 weeks. CMV. Gancyclovir. Foscarnet. Antacids, topical anesthetics, sucralfate.", "width": "800" } 47 Pill esophagitis Pill fails to enter stomach and remains in esophagusRisk factors Age Decreased esophageal motility Compression Large pills { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4555574/15/images/47/Pill+esophagitis+Pill+fails+to+enter+stomach+and+remains+in+esophagus.jpg", "name": "Pill esophagitis Pill fails to enter stomach and remains in esophagus", "description": "Risk factors. Age. Decreased esophageal motility. Compression. Large pills.", "width": "800" } 48 Pill esophagitis clinical manifestationsSudden onset odynophagia +/- dysphagia Hx of pill ingestion Could be hours previously +/- sensation pill is “stuck” { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4555574/15/images/48/Pill+esophagitis+clinical+manifestations.jpg", "name": "Pill esophagitis clinical manifestations", "description": "Sudden onset odynophagia. +/- dysphagia. Hx of pill ingestion. Could be hours previously. +/- sensation pill is stuck", "width": "800" } 49 Pill esophagitis treatmentPrevention 4oz liquid with any pill Medications taken in upright position Avoid use of pills if possible { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4555574/15/images/49/Pill+esophagitis+treatment.jpg", "name": "Pill esophagitis treatment", "description": "Prevention. 4oz liquid with any pill. Medications taken in upright position. Avoid use of pills if possible.", "width": "800" } 50 GERD Asymptomatic reflux in most people GERD = reflux plus one ofHistopathologic changes of esophageal epithelial lining Symptoms of reflux Symptomatic reflux in 7% daily 14% weekly 40% monthly { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4555574/15/images/50/GERD+Asymptomatic+reflux+in+most+people+GERD+%3D+reflux+plus+one+of.jpg", "name": "GERD Asymptomatic reflux in most people GERD = reflux plus one of", "description": "Histopathologic changes of esophageal epithelial lining. Symptoms of reflux. Symptomatic reflux in. 7% daily. 14% weekly. 40% monthly.", "width": "800" } 51 GERD – mechanisms Decreased LES pressure Anticholinergics Benzoscaffeine, CCBs Ethanol Nicotine Nitrates progesterone { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4555574/15/images/51/GERD+%E2%80%93+mechanisms+Decreased+LES+pressure+Anticholinergics+Benzos.jpg", "name": "GERD – mechanisms Decreased LES pressure Anticholinergics Benzos", "description": "caffeine, CCBs. Ethanol. Nicotine. Nitrates. progesterone.", "width": "800" } 52 GERD - mechanisms Decreased Esophageal MotilityAchalasia DM Scleroderma Increased gastric emptying time Anticholinergics DM gastroparesis { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4555574/15/images/52/GERD+-+mechanisms+Decreased+Esophageal+Motility.jpg", "name": "GERD - mechanisms Decreased Esophageal Motility", "description": "Achalasia. DM. Scleroderma. Increased gastric emptying time. Anticholinergics. DM gastroparesis.", "width": "800" } 53 GERD - symptoms Heartburn Regurgitation Dysphagia Odynophagia AsthmaBeware - mimics ischemic heart pain Regurgitation Dysphagia Odynophagia Asthma Aspiration activation of vagal reflex arc Oropharyngeal Laryngitis, dental erosions, etc. { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4555574/15/images/53/GERD+-+symptoms+Heartburn+Regurgitation+Dysphagia+Odynophagia+Asthma.jpg", "name": "GERD - symptoms Heartburn Regurgitation Dysphagia Odynophagia Asthma", "description": "Beware - mimics ischemic heart pain. Regurgitation. Dysphagia. Odynophagia. Asthma. Aspiration. activation of vagal reflex arc. Oropharyngeal. Laryngitis, dental erosions, etc.", "width": "800" } 54 GERD – complications Erosion, ulceration, scarring EsophagitisStricture Columnar metaplasia Barrett’s esophagus Predisposes to adenocarcinoma { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4555574/15/images/54/GERD+%E2%80%93+complications+Erosion%2C+ulceration%2C+scarring+Esophagitis.jpg", "name": "GERD – complications Erosion, ulceration, scarring Esophagitis", "description": "Stricture. Columnar metaplasia. Barrett’s esophagus. Predisposes to adenocarcinoma.", "width": "800" } 55 GERD - diagnosis History and physical Relief with antacidspH monitoring Esophageal manometry endoscopy Must R/O ischemic heart disease!! { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4555574/15/images/55/GERD+-+diagnosis+History+and+physical+Relief+with+antacids.jpg", "name": "GERD - diagnosis History and physical Relief with antacids", "description": "pH monitoring. Esophageal manometry. endoscopy. Must R/O ischemic heart disease!!", "width": "800" } 56 GERD Erosions/ulcerations caused by acid reflux { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4555574/15/images/56/GERD+Erosions%2Fulcerations+caused+by+acid+reflux.jpg", "name": "GERD Erosions/ulcerations caused by acid reflux", "description": "GERD Erosions/ulcerations caused by acid reflux", "width": "800" } 57 Barrett’s Esophagus Barrett’s esophagus – ulceration of posterolateral wall Midesophageal stricture from healed Barrett’s ulcer Adenocarcinoma secondary to Barrett’s esophagus { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4555574/15/images/57/Barrett%E2%80%99s+Esophagus+Barrett%E2%80%99s+esophagus+%E2%80%93+ulceration+of+posterolateral+wall.+Midesophageal+stricture+from+healed+Barrett%E2%80%99s+ulcer..jpg", "name": "Barrett’s Esophagus Barrett’s esophagus – ulceration of posterolateral wall. Midesophageal stricture from healed Barrett’s ulcer.", "description": "Adenocarcinoma secondary to Barrett’s esophagus.", "width": "800" } 58 GERD - treatment Lifestyle Decrease acid production Sleep uprightAvoid eating before bed Avoid agents that decrease LES tone Nicotine, etoh, anticholinergics … Decrease acid production H2-blockers eg: ranitidine 150mg po bid Improvement in 70-90% of patients PPI { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4555574/15/images/58/GERD+-+treatment+Lifestyle+Decrease+acid+production+Sleep+upright.jpg", "name": "GERD - treatment Lifestyle Decrease acid production Sleep upright", "description": "Avoid eating before bed. Avoid agents that decrease LES tone. Nicotine, etoh, anticholinergics … Decrease acid production. H2-blockers. eg: ranitidine 150mg po bid. Improvement in 70-90% of patients. PPI.", "width": "800" } 59 GERD - treatment Acid neutralization Protect mucosa OTC antacidssucralfate { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4555574/15/images/59/GERD+-+treatment+Acid+neutralization+Protect+mucosa+OTC+antacids.jpg", "name": "GERD - treatment Acid neutralization Protect mucosa OTC antacids", "description": "sucralfate.", "width": "800" } 60 Gastritis Histologic diagnosis of inflammation of gastric mucosaetiology H.pylori (#1) NSAIDs (#2) Ethanol, potassium, iron often underlying cancer, ulcer, etc. other infectious organisms (viral, mycobacterial, etc.) Corrosive agents Bile Ingested acids/alkali { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4555574/15/images/60/Gastritis+Histologic+diagnosis+of+inflammation+of+gastric+mucosa.jpg", "name": "Gastritis Histologic diagnosis of inflammation of gastric mucosa", "description": "etiology. H.pylori (#1) NSAIDs (#2) Ethanol, potassium, iron. often underlying cancer, ulcer, etc. other infectious organisms (viral, mycobacterial, etc.) Corrosive agents. Bile. Ingested acids/alkali.", "width": "800" } 61 Gastritis - clinical presentationVariable & non-specific asymptomatic abdominal pain nausea and vomiting GI bleed (rare) shock (rare) { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4555574/15/images/61/Gastritis+-+clinical+presentation.jpg", "name": "Gastritis - clinical presentation", "description": "Variable & non-specific. asymptomatic. abdominal pain. nausea and vomiting. GI bleed (rare) shock (rare)", "width": "800" } 62 Gastritis Complications Diagnosis PerforationGastric outlet obstruction Diagnosis Usually clinical Must rule out other potential causes of pain Endoscopy +/- biopsy { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4555574/15/images/62/Gastritis+Complications+Diagnosis+Perforation.jpg", "name": "Gastritis Complications Diagnosis Perforation", "description": "Gastric outlet obstruction. Diagnosis. Usually clinical. Must rule out other potential causes of pain. Endoscopy +/- biopsy.", "width": "800" } 63 Gastritis - treatment H2 – antagonists Consider H.pylori eradicationrefer to GI as outpatient if persistent { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4555574/15/images/63/Gastritis+-+treatment+H2+%E2%80%93+antagonists+Consider+H.pylori+eradication.jpg", "name": "Gastritis - treatment H2 – antagonists Consider H.pylori eradication", "description": "refer to GI as outpatient if persistent.", "width": "800" } 64 Gastric Volvulus Rare (400 cases in literature)Caused by >180 degree rotation of stomach upon itself Usually aged y.o. 20% in children <1 Often have paraesophageal hernia Complications Gastric ischemia & perforation Death (15-20%) { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4555574/15/images/64/Gastric+Volvulus+Rare+%28400+cases+in+literature%29.jpg", "name": "Gastric Volvulus Rare (400 cases in literature)", "description": "Caused by >180 degree rotation of stomach upon itself. Usually aged 40-50 y.o. 20% in children 180 degree rotation of stomach upon itself. Usually aged 40-50 y.o. 20% in children 65 Gastric volvulus Clinical presentation Diagnosis TreatmentSudden, severe abdo pain May radiate to chest or back Vomiting Borchardt’s triad Epigastric pain & distension, vomiting, inability to pass NG tube Diagnosis AXR – large gas-filled loop of bowel Treatment Insertion of NG tube Decompresses and may reduce volvulus Surgery { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4555574/15/images/65/Gastric+volvulus+Clinical+presentation+Diagnosis+Treatment.jpg", "name": "Gastric volvulus Clinical presentation Diagnosis Treatment", "description": "Sudden, severe abdo pain. May radiate to chest or back. Vomiting. Borchardt’s triad. Epigastric pain & distension, vomiting, inability to pass NG tube. Diagnosis. AXR – large gas-filled loop of bowel. Treatment. Insertion of NG tube. Decompresses and may reduce volvulus. Surgery.", "width": "800" } 66 Peptic Ulcer Disease Erosion Ulcer superficial to muscularis mucosano scarring Ulcer penetrates muscularis mucosa scarring { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4555574/15/images/66/Peptic+Ulcer+Disease+Erosion+Ulcer+superficial+to+muscularis+mucosa.jpg", "name": "Peptic Ulcer Disease Erosion Ulcer superficial to muscularis mucosa", "description": "no scarring. Ulcer. penetrates muscularis mucosa. scarring.", "width": "800" } 67 PUD - epidemiology 4 million in US $15 billion in US { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4555574/15/images/67/PUD+-+epidemiology+4+million+in+US+%2415+billion+in+US.jpg", "name": "PUD - epidemiology 4 million in US $15 billion in US", "description": "PUD - epidemiology 4 million in US $15 billion in US", "width": "800" } 68 PUD - etiology { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4555574/15/images/68/PUD+-+etiology.jpg", "name": "PUD - etiology", "description": "PUD - etiology", "width": "800" } 69 PUD & H. pylori Gram negative rodLives in upper GI tract between epithelial surface and mucus fecal-oral transmission Increases risk of gastric cancer Almost all non-NSAID ulcers are due to H.pylori (95% duodenal, 84% gastric as per Rosen) Dx: serology, biopsy, C14 breath test Not practical for emergency medicine { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4555574/15/images/69/PUD+%26+H.+pylori+Gram+negative+rod.jpg", "name": "PUD & H. pylori Gram negative rod", "description": "Lives in upper GI tract between epithelial surface and mucus. fecal-oral transmission. Increases risk of gastric cancer. Almost all non-NSAID ulcers are due to H.pylori (95% duodenal, 84% gastric as per Rosen) Dx: serology, biopsy, C14 breath test. Not practical for emergency medicine.", "width": "800" } 70 PUD & NSAIDs Direct effect Indirect effect Diffuse into mucosal cellsBecome trapped and directly damage cell Inhibition of prostaglandin secretion Reduced mucus production Reduced cell turnover Indirect effect Systemic inhibition of COX decreases production of protective prostaglandins { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4555574/15/images/70/PUD+%26+NSAIDs+Direct+effect+Indirect+effect+Diffuse+into+mucosal+cells.jpg", "name": "PUD & NSAIDs Direct effect Indirect effect Diffuse into mucosal cells", "description": "Become trapped and directly damage cell. Inhibition of prostaglandin secretion. Reduced mucus production. Reduced cell turnover. Indirect effect. Systemic inhibition of COX decreases production of protective prostaglandins.", "width": "800" } 71 PUD – Hx and Px Abdominal pain (94%) Duodenal ulcerGenerally epigastric Usually worst 2-4 hours after meal Often between 2-3AM (HCl secretion highest) Relieved with antacids Duodenal ulcer Pain worst before meal Relieved by meal { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4555574/15/images/71/PUD+%E2%80%93+Hx+and+Px+Abdominal+pain+%2894%25%29+Duodenal+ulcer.jpg", "name": "PUD – Hx and Px Abdominal pain (94%) Duodenal ulcer", "description": "Generally epigastric. Usually worst 2-4 hours after meal. Often between 2-3AM (HCl secretion highest) Relieved with antacids. Duodenal ulcer. Pain worst before meal. Relieved by meal.", "width": "800" } 72 PUD – Diagnosis & WorkupHistory and clinical exam Endoscopy Upper GI series Labs: CBC, lytes, LFT, lipase Imaging: CXR / AXR if suspected perforation Cardiac workup if suspect MI/ACS { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4555574/15/images/72/PUD+%E2%80%93+Diagnosis+%26+Workup.jpg", "name": "PUD – Diagnosis & Workup", "description": "History and clinical exam. Endoscopy. Upper GI series. Labs: CBC, lytes, LFT, lipase. Imaging: CXR / AXR if suspected perforation. Cardiac workup if suspect MI/ACS.", "width": "800" } 73 Duodenal Ulcer (Huge!) Note fresh bleeding at edge >90% H.pyloriNSAIDS { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4555574/15/images/73/Duodenal+Ulcer+%28Huge%21%29+Note+fresh+bleeding+at+edge+%3E90%25+H.pylori.jpg", "name": "Duodenal Ulcer (Huge!) Note fresh bleeding at edge >90% H.pylori", "description": "NSAIDS.", "width": "800" } 74 Clean, well demarcated, benign lookingGastric Ulcer Clean, well demarcated, benign looking All should be biopsied as high risk of cancer { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4555574/15/images/74/Clean%2C+well+demarcated%2C+benign+looking.jpg", "name": "Clean, well demarcated, benign looking", "description": "Gastric Ulcer. Clean, well demarcated, benign looking. All should be biopsied as high risk of cancer.", "width": "800" } 75 Stomach Ulcer Upper GI with barium contrast Arrow = ulceration { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4555574/15/images/75/Stomach+Ulcer+Upper+GI+with+barium+contrast+Arrow+%3D+ulceration.jpg", "name": "Stomach Ulcer Upper GI with barium contrast Arrow = ulceration", "description": "Stomach Ulcer Upper GI with barium contrast Arrow = ulceration", "width": "800" } 76 PUD - complications Upper GI bleed (15%) Perforation (7%)Posterior surface (gastroduodenal art.) Tx: resuscitation, endoscopy, PPI, surgery Perforation (7%) Usually anterior duodenal ulcers Sudden generalized peritonitis Dx: free air on CXR Tx: surgery – oversew ulcer and Graham patch, antrectomy & vagotomy { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4555574/15/images/76/PUD+-+complications+Upper+GI+bleed+%2815%25%29+Perforation+%287%25%29.jpg", "name": "PUD - complications Upper GI bleed (15%) Perforation (7%)", "description": "Posterior surface (gastroduodenal art.) Tx: resuscitation, endoscopy, PPI, surgery. Perforation (7%) Usually anterior duodenal ulcers. Sudden generalized peritonitis. Dx: free air on CXR. Tx: surgery – oversew ulcer and Graham patch, antrectomy & vagotomy.", "width": "800" } 77 PUD - complications Gastric outlet obstruction (2%) PenetrationNausea / Vomiting Caused by edema and scarring Tx: surgery Penetration Posterior duodenal ulcers erode into pancreas Hx of epigastric pain that worsens and radiates to back. Becomes refractory to tx Lab: elevated amylase { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4555574/15/images/77/PUD+-+complications+Gastric+outlet+obstruction+%282%25%29+Penetration.jpg", "name": "PUD - complications Gastric outlet obstruction (2%) Penetration", "description": "Nausea / Vomiting. Caused by edema and scarring. Tx: surgery. Penetration. Posterior duodenal ulcers erode into pancreas. Hx of epigastric pain that worsens and radiates to back. Becomes refractory to tx. Lab: elevated amylase.", "width": "800" } 78 PUD - treatment Lifestyle modifications NSAID induced ulcerReduce caffeine, EtOH, spicy foods Smoking cessation Stop NSAIDs NSAID induced ulcer Stop NSAID PPI H2-blocker (less effective than PPI) { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4555574/15/images/78/PUD+-+treatment+Lifestyle+modifications+NSAID+induced+ulcer.jpg", "name": "PUD - treatment Lifestyle modifications NSAID induced ulcer", "description": "Reduce caffeine, EtOH, spicy foods. Smoking cessation. Stop NSAIDs. NSAID induced ulcer. Stop NSAID. PPI. H2-blocker (less effective than PPI)", "width": "800" } 79 PUD - treatment PUD in patient not taking NSAIDs Treat for H.pyloriPPI H2-blocker { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4555574/15/images/79/PUD+-+treatment+PUD+in+patient+not+taking+NSAIDs+Treat+for+H.pylori.jpg", "name": "PUD - treatment PUD in patient not taking NSAIDs Treat for H.pylori", "description": "PPI. H2-blocker.", "width": "800" } 80 H.pylori eradication Multiple regimes and commercially packaged products eg: PrevPac x 14 days Lansoprazole 500 po bid, clarithromycin 500 po bid, amoxicillin 1g po bid x 14 days Many other acceptable cocktails { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://slideplayer.com/4555574/15/images/80/H.pylori+eradication+Multiple+regimes+and+commercially+packaged+products.+eg%3A+PrevPac+x+14+days..jpg", "name": "H.pylori eradication Multiple regimes and commercially packaged products. eg: PrevPac x 14 days.", "description": "Lansoprazole 500 po bid, clarithromycin 500 po bid, amoxicillin 1g po bid x 14 days. Many other acceptable cocktails.", "width": "800" } Ppt on id ego superego sigmund Strategic management ppt on nestle Introduction to liquid crystal display ppt online Ppt on leverages Mba project ppt on imf Ppt on reliance life insurance Ppt on global warming for class 7 Doc convert to ppt online shopping Ppt on trade fairs Ppt on mauryan empire ESOPHAGEAL DISEASES Prof. Saleh M. Al-Amri Consultant, Gastroenterology Unit College of Medicine & K.K.U.H. King Saud University.Upper Gastrointestinal Diseases. Upper GI Diseases Esophagus Stomach Duodenum.Approach to dysphagia. Definition of Dysphagia The word dysphagia is derived from the Greek phagia (to eat) and dys (with difficulty). It specifically.This lecture was conducted during the Nephrology Unit Grand Ground by a Sub-intern under Nephrology Division, Department of Medicine in King Saud University.APPROACH TO DYSPHAGIA Dr Nahla Azzam Assistant ProfDYSPHAGIA Aswad H. Al.Obeidy FICMS, FICMS GE&Hep Kirkuk General Hospital.Gastro-Esophageal Reflux DiseaseGERD Robert Erickson MD.Esophagus Anatomy, Physiology, and DiseasesGROUP D.  narrowing of the esophagus(distal) near the junction with the stomach (squamocolumnar jxn).  sequelae of gastroesophageal reflux– induced.Gastrointestinal Diseases Dr. Maha Arafah Pathology, 2012.به نام خدا.Peptic Ulcer Disease Biol E /11/06. From: Current Diagnosis & Treatment in Gastroenterology - 2nd Ed. (2003)Dysphagia Dr. Raid Jastania.Peptic ulcer disease.Peptic Ulcer Disease. Peptic ulcer  refers to erosion of the mucosa lining any portion of the G.I. tract.  It is defined as : A circumscribed ulceration.Esophageal Motility DisordersDISEASES OF THE OESOPHAGUS BY Dr. ARWA M FUZI Lecture 1.Gastric and Duodenal Ulcer. 2 What is a Peptic Ulcer? It is a hole that forms in the mucosal wall of the stomach, in the pylorus (opening between stomach.Benign Esophageal Diseases Dr.Sami Alnassar MD, FRCSC.FCCP Dr.Sami Alnassar MD, FRCSC.FCCP. Similar presentations © 2017 SlidePlayer.com Inc. All rights reserved.





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