1 Feb 24 Flashcards
Mechanism of zenker diverticulum
Diminish relaxation of cricopharyngeal muscles during swallowing (cricopharyngeal motor dysfunction)
Increased intraluminal pressure abv cricopharyngeus eventually causes herniation of mucosa causing pulsion (push) pseudodiverticulum.
Zone of muscle weakness is between inferior pharyngeal constrictor fibers and cricopharyngeus muscle.
Zenker diverticulum CF
Age >60
Progressive dysphagia
Halitosis
Gurgling sound
Aspiration if regurgitated food leads to recurrent aspiration pneumonia.
Dx of zenkers.
Contrast swallow
Ttt of zenkers.
Cricopharyngeal myotomy
Followed by diverticulectomy (removal of diverticulum) or
Diverticulotomy (combining it with esophageal lumen)
True diverticulum
When mucosa with all its layers comes out (muscularis , serosa )
Formed due to traction (pull)
Eg. Meckel D , appendix.
Pseudodiverticulum
Only mucosa and submucosa come out
Eg. Diverticulosis , zenker
Peptic ulcer. CF
Postprandial nausea
Acute onset severe Upper abd pain
NSAID use
Positive stool guaiac
Signs of perforation ;
Marked abd tenderness with guarding
Systemic inf response(fever, tachy)
DX of perforated peptic ulcer and ttt
Upright Xray of chest and abd. :
Subdiaphragmatic free air
(CT scan with contrast if Xray unclear)
Ttt: Surgery.
🏀 endoscopy is contraindicated in perforation.
Esopageal perforation cause s
Instrumentation (endoscopy , TEE, trauma)
Effort rupture (boerhaave syndrome)
Esophagitis. (infectious /pills/caustic)
Esophageal perforation CF
Chest/back/epigastric pain
Systemic signs (fever)
Crepitus , hamman sign
U/L Pleural effusion with atypical (green) fluid
Dx of esophageal perforation
CXRay /CTscan :
Widemediastinum ,pneumomediastinum
Pneumothorax, pleural effusion
CTscan:
Esophageal wall thickening
Mediastinal fluid collection
Pleural fluid :
Low ph
High amylase >2500 IU/L
Food particles
Esophagography with watersoluble contrast:
Leak from perforation
Barium contrast (used when esophagography is inconclusive)
Barium is inflammatory
Ttt of esophageal perforation
NPO ,
IV antibiotics
PPIs
Emergent Surgery
(Can progress to mediastinitis and septic shock)
Pill esophagitis CF
Sudden onset odynophagia
Retrosternal pain
Difficulty swallowing
(Common location mid esophagus due to compression by aortic arch or enlarged Lt atrium)
DX of pill esophagitis
Mostly clinical
Confirmation on endoscopy;
Shows discrete ulcers with normal appearing surrounding mucosa.
Medications that cause pill esophagitis
Tetracyclines
Aspirin
NSAIDS
Alendronate
Risedronate
KCL
Iron
