{"type":"rich","version":"1.0","provider_name":"Transistor","provider_url":"https://transistor.fm","author_name":"Board Pearls","title":"Chapter 5, Ep 2 of 2: Infectious and Direct-Injury Esophagitis","html":"","width":"100%","height":180,"duration":846,"description":"Episode two of two on eosinophilic and infectious esophagitis, covering the infections and direct chemical injuries of the esophagus. One principle links them all: the lining got hurt by something that touched it, and immune status, ulcer shape, and biopsy site tell you the agent. Candida, herpes, CMV, pill esophagitis, and caustic ingestion, each read from contact time, anatomy, and host defenses.\n \nTopics covered\n\nCandida esophagitis\nHerpes esophagitis\nCMV esophagitis\nPill esophagitis\nCaustic and corrosive ingestion\nBiopsy targeting by organism\nZargar injury grading\nImmune status and organism prediction\n \n \nKey decisions\n\nCandida: non-washable plaques, fluconazole 200 to 400 mg daily for 14 to 21 days; echinocandin for azole failure, critically ill, or Candida glabrata; ART is the durable prevention in HIV.\nHerpes makes shallow volcano-edge ulcers, biopsy the edge for multinucleated giant cells with Cowdry inclusions, treat with acyclovir; CMV makes deep geographic ulcers low in the esophagus, biopsy the base for owl-eye inclusions, treat with ganciclovir then valganciclovir.\nPill esophagitis: discrete shallow kissing ulcers at the aortic arch with normal lining between; stop the drug, sucralfate, and prevent by taking pills upright with a full glass of water staying up 30 minutes.\nCaustic injury: alkali causes liquefactive necrosis and damages the esophagus, acid causes coagulative necrosis and biases toward the stomach; airway first, and never give emetics, neutralizing agents, or a blind early nasogastric tube.\nGrade caustic injury with the Zargar scale at endoscopy within a day or two; do not scope the unstable patient or one with perforation or airway necrosis, image with CT and consult surgery instead.\nA significant caustic ingestion is a lifelong premalignant condition: strictures heal with fibrosis and squamous cell carcinoma risk warrants surveillance endoscopy starting 15 to 20 years later.\n \n \nThis is an AI-generated podcast, and some pronunciations...","thumbnail_url":"https://img.transistorcdn.com/-FuAdDBcPDLhEoUmroZKtOBRvuBn_FHPpYlh41hOnU4/rs:fill:0:0:1/w:400/h:400/q:60/mb:500000/aHR0cHM6Ly9pbWct/dXBsb2FkLXByb2R1/Y3Rpb24udHJhbnNp/c3Rvci5mbS9iNzlh/ZTU4Y2MzNWExMjQ5/MjA5OWMwMmI3ZTk5/NGFiZS5wbmc.webp","thumbnail_width":300,"thumbnail_height":300}