Esophageal Disorders

Table Of Contents

	Right	Center	Left
Upper	Gallstones Biliary Colic Cholecystitis Stomach Ulcer Duodenal Ulcer Hepatitis Pancreatitis	Heartburn/GERD Indigestion Hiatal Hernia Epigastric Hernia Stomach Ulcer Duodenal Ulcer Hepatitis Pancreatitis Abdominal Aortic Aneurysm	Functional Dyspepsia Gastritis Stomach Ulcer Biliary Colic
Mid	Nephrolithiasis Pyelonephritis Inflammatory Bowel Disease Constipation Lumbar Hernia	Umbilical Hernia Early Appendicitis Stomach Ulcer Inflammatory Bowel Disease Pancreatitis Abdominal Aortic Aneurysm	Nephrolithiasis Pyelonephritis Inflammatory Bowel Disease Constipation
Lower	Appendicitis Inflammatory Bowel Disease Constipation Pelvic Pain (Gynecology) Ovarian Cyst Ovarian Torsion Ovarian Cyst Rupture Endometriosis Ectopic Pregnancy Mittelschmerz (Ovulation pain) Pelvic Inflammatory Disease	Bladder Infection Prostatitis Inflammatory Bowel Disease Inguinal Hernia (Groin pain) Pelvic Pain (Gynecology)	Diverticulosis Diverticulitis Constipation Irritable Bowel Syndrome Inflammatory Bowel Disease Pelvic Pain (Gynecology) Inguinal Hernia (Groin Pain) Ovarian Cyst Ovarian Torsion Ovarian Cyst Rupture Endometriosis Ectopic Pregnancy Mittelschmerz (Ovulation pain) Pelvic Inflammatory Disease

	Presentation	Treatment
Candida esophagitis	Odynophagia and white cottage cheese on the mouth that can be removed (Oral Thrush)	Fluconazole
CMV esophagitis		Valacyclovir or Acyclovir
HIV esophagitis	Opportunistic Infections	HAART
HSV esophagitis	Oral lesions, vesicles on erythematous base, and odynophagia in an AIDS pt	Valacyclovir or Acyclovir
Pill esophagitis

	Presentation	Diagnosis	Treatment
Achalasia	Motility	1. Esophagram (barium swallow) – Bird’s beak 2. EGD with bx to r/o pseudoachalasia (aka cancer 3. Biopsy: Absence of myenteric (Auerbach?) plexus	Myotomy
Diffuse Esophageal Spasm	Motility	Barium swallow – Corkscrew esophagus
Scleroderma	Motility		PPIs
Schatzki Ring	Mechanical Paroxysmal dysphagia to large caliber food
Esophageal webs	Mechanical
Zenker’s diverticulum	Mechanical Halitosis, old man, regurgitates undigested food	barium swallow
Esophageal spasm			CCB or Nitro spray
Plummer-Vinson Syndrome	Dysphagia, esophageal webs, iron deficiency anemia
GERD	Burning retrosternal pain better with sitting up and antacids Nocturnal asthma without daytime asthma	After 6 weeks of PPI – go to EGD for GERD without alarm symptoms	1. PPIs If N/V, Anemia and Weight loss – go straight to EGD for without tx
Barrett’s esophagus		Endoscopy – Salmon colored lesion Biopsy – Intestinal metaplasia (Duodenum)
Barrett’s metaplasia			High dose PPI
Esophageal dysplasia			Ablative therapy (you won’t have to choose which)
Esophageal adenocarcinoma			Resection
Esophageal cancer	lower esophagus with RF – GERD – Adenocarcinoma upper esophagus with RF – SCC – Smoking, EtOH
H. Pylori		EGD + bx (confirmatory)	Triple therapy – Amoxicillin – Clarithromycin – PPI ( – can use MTZ instead of amox)