1.1 MTB Step 3 - Esophageal Disorders (Dysphagia) Flashcards
Cards Complete
INTRODUCTION
In general, what (2) Clinical Manifestations do Esophageal Disorders with ANY degree of Anatomic Damage leading to Narrowing result in?
- Dysphagia
- Weight Loss
ALL forms of Dysphagia can lead to Weight Loss
INTRODUCTION
- If Dysphagia is present and you do NOT know the diagnosis, what Test should you perform first?
- If Dysphagia is present and in the Stomach, what Test should you do first?
- Barium Study
- Endoscopy
INTRODUCTION
What are the ONLY (2) Esophageal Disorders for which Endoscopy is indispensable in the Diagnosis?
- Cancer
- Barrett Esophagus - precancerous histologic change.
Biopsy necessary to Diagnose both of these
INTRODUCTION
What is the Difference between Dysphagia and Odynophagia?
Dysphagia - Difficulty Swallowing
Odynophagia - Painful Swallowing (suggest Infectious process, such as HIV, HSV, Candida, CMV)
DYSPHAGIA
ACHALASIA
How does Achalasia typically present?
- Young
- Nonsmoker
- Progressive Dysphagia to both Solids & Liquids at the same time.
- Regurgitation & Aspiration of food.
DYSPHAGIA
ACHALASIA
- Which (2) Diagnostic Tests are equivalent as the Best INITIAL Tests for Achalasia?
- What is the Most ACCURATE Test for Achalasia?
- Barium Swallow or Chest X-Ray (CXR)
- Esophageal Manometry - shows Absence of normal Esophageal Peristalsis and abnormally High pressure at the Lower Esophageal Sphincter (LES) due to failure to relax (no mucosal abnormality).
DYSPHAGIA
ACHALASIA
Why would an Endoscopy be performed in a patient with Achalasia, and what would it show?
Endoscopy is done to Exclude Malignancy NOT to diagnose Achalasia.
DYSPHAGIA
ACHALASIA
- What is the Best INITIAL Therapy for Achalasia?
- What is the Next Best Therapy for Achalasia if the initial therapy is unsuccessful?
- What Therapy is used when the patient Refuses the first 2 therapies?
- Surgical Myotomy
- Pneumatic Dilation
-
Botulinum Toxin injection
- toxin Inhibits the release of Acetylcholine at the Neuromusclular Junction (NMJ)
DYSPHAGIA
ESOPHAGEAL CANCER
What are (4) Common Presenting Signs/Symptoms for Esophageal Cancer?
-
Dysphagia:
- to Solids first
- to Liquids later
- Heme-positive Stool or Anemia
- Age > 50
- Smokers and Alcohol drinkers
DYSPHAGIA
ESOPHAGEAL CANCER
- What is the Best INITIAL Diagnostic Test for Esophageal Cancer?
- Which Diagnostic Test should be used if the initial test is not one of the choices?
- Endoscopy
- Barium Swallow
Manometry will not be useful since cancer can only be diagnosed with a Biopsy.
DYSPHAGIA
ESOPHAGEAL CANCER
- What is the Best INITIAL Therapy for Esophageal Cancer?
- What Therapy should Follow the initial therapy?
- What Therapy should be added for Obstruction?
- Surgical Resection - if there are NO local or distant metastases.
- 5-Fluorouracil (5-FU) Chemotherapy
- Palliative Stenting
DYSPHAGIA
RINGS & WEBS
What are (2) Common Causes of Rings & Webs (a.k.a. peptic strictures)?
- Repetitive exposure of the Esophagus to Acid
- Sclerosing Agents for variceal bleeding (this is why variceal banding is a superior procedure)
DYSPHAGIA
RINGS & WEBS
What is the Best Diagnostic Test for Rings & Webs (a.k.a. peptic strictures)?
Barium Study
DYSPHAGIA
RINGS & WEBS
What are the (3) Types of Rings & Webs (a.k.a. peptic strictures)?
- Plummer-Vinson Syndrome
- Schatzki Ring
- Peptic Stricture
DYSPHAGIA
RINGS & WEBS
- What is Plummer-Vinson Syndrome?
- How is Plummer-Vinson Syndrome Treated?
- Plummer-Vinson Syndrome is a Proximal Stricture found in association with Iron Deficiency Anemia and is more common in Middle-aged Women.
- Iron Replacement
DYSPHAGIA
RINGS & WEBS
- What is a Schatzki Ring?
- What is the Best INITIAL Treatment for a Schatzki Ring?
- Schatzki Ring is a Distal Ring of the Esophagus that presents with Intermittent Symptoms of Dysphagia
- Pneumatic Dilation
DYSPHAGIA
RINGS & WEBS
- What is the cause of a Peptic Stricture?
- What is the Treatment for a Peptic Stricture?
- Peptic Stricture results from Acid Reflux
- Pneumatic Dilation
DYSPHAGIA
ZENKER DIVERTICULUM
What is a Typical Presentation for Zenker Diverticulum?
Dysphagia
with
Horribly Bad Breath
DYSPHAGIA
ZENKER DIVERTICULUM
What is the Cause of Zenker Diverticulum and its symptoms?
Rotting Food in the back of the Esophagus from Dilation of the Posterior Pharyngeal Constrictor Muscles
DYSPHAGIA
ZENKER DIVERTICULUM
- What is the Best Diagnostic Test for Zenker Diverticulum?
- What is the Best Therapy for Zenker Diverticulum?
- Barium Study
- Surgical Resection
DYSPHAGIA
SPASTIC DISORDERS
What are (2) Common Presenting Signs/Symptoms for Diffuse Esophageal Spasm (a.k.a. Nutcracker Esophagus)?
- Severe Chest Pain typically AFTER drinking a cold beverage.
- NO risk factors for ischemic heart disease
Always Pain but NOT always dysphagia
DYSPHAGIA
SPASTIC DISORDERS
What are the (2) Best Therapies for Spastic Disorders?
- Calcium Channel Blockers (CCBs)
- Nitrates
Same treatment as for Prinzmetal Angina/Coronary Vasospasm)
DYSPHAGIA
SCLERODERMA (PROGRESSIVE SYSTEMIC SCLEROSIS)
- How does Scleroderma present?
- What is the Treatment for Scleroderma?
- Scleroderma presents as Symptoms of Reflux
- Treat with Proton Pump Inhibitors (PPIs)
DYSPHAGIA
SPASTIC DISORDERS
Even though Esophageal Disorders can mimic Prinzmetal Variant Angina (sudden, severe pain not related to exercise) what difference should you look for on exam to distinguish the two?
- Prinzmetal Variant Angina will give you ST-segment Elevation and an Abnormality on Stimulation of the Coronary Arteries.
- Esophageal Spasm will not do the above.
