3. Disorders Of The Esophagus II Flashcards
When are primary peristaltic contractions initiated?
During swallowing.
When do secondary peristaltic contractions begin?
Circular esophageal muscles begin to contract WITHOUT swallowing.
What causes secondary peristaltic contractions?
Distension
What are key symptoms that might suggest chest pain is gastric instead of cardiac?
Prolonged pain, nonexertional, meal-related, improved with antacids, accompanied by heartburn, dysphagia, and regurgitation (usually still requires cardiac work up)
Which patients might require an esophageal manometry?
Dysphagia, odynophagia, intractable heartburn (work up for Nissen), non cardiac chest pain.
ANY PROBLEMS WITH SWALLOWING
Primary esophageal motility disorders.
Achalasia
Diffuse Esophageal Spasm
Nutcracker Esophagus
Hypertensive LES
Disorder of hypomotility.
Achalasia
Disorders of Hypermotility
DES
Hypertensive LES
Nutcracker Esophagus
Achalasia is a degeneration of ____ in the ____________plexus.
Ganglion cells.
Esophageal myenteric
Achalasia is a degeneration in innervation which leads to ________ and _____________
decreased to absent peristalsis
Poor LES relaxation
What kind of deformity might you find in achalasia?
“Sigmoid deformity”
LES becomes hypertrophied (it’s not relaxing)
What kind of infection might cause achalasia?
Human herpes simplex virus. 1 +genetic susceptibility
Type of dysphagia with achalasia
Solid and liquid
S and S of achalasia
Dysphagia Regurgitation Chest pain Heartburn Weight loss-can’t maintain P.O. intake
Pt’s with achalasia are at a higher risk for_______,_______, and__________.
Bronchitis.
Pneumonia
Lung abscess
What kind of cancer is a complication of achalasia?
Esophageal squamous cell carcinoma-17x
Achalasia DDx
DES
Chagas
Pseudo achalasia
Achalasia Diagnosis
Barium swallow
+/1 Esophageal Manometry
What would you find in a barium swallow with a patient with achalasia?
Esophageal dilatation. Tapering at the gastroesophageal junction (beak.) Air-fluid level in the esophagus.
Sigmoid deformity (S curve) in advanced disease.
What would you find in manometry in pt’s with achalasia?
increased LES pressure and absent peristalsis
Can you reverse damage done by achalasia?
No
What are we trying to do when treating achalasia?
Reduce LES pressure and improvement movement of stuff out of esophagus
Pharm Tx. For achalasia
Nitrates or CCB before food
Botox into LES
Viagra
Major complication of pneumatic dilatation.
Perforation
Most common surgical tx. For achalasia
Heller myotonic-performed laparoscopically. (Cutting LES to allow food and secretions to easily pass into stomach)
Usually get a Nissen or Toupe wrap as well.
Nissan: full or partial?
full
A diagnosis of exclusion.
Diffuse Esophageal Spasm
A patient presents with abnormal esophageal contractions even during normal swallowing.
Diffuse Esophageal Spasm-“crazy” spasm all the time.
What is the diagnostic tool for DES?
Manometry
What would you find in a barium swallow in DES?
“Corkscrew esophagus”
The only controlled tx. for DES.
Anxiolytics-most effective
Found in infectious esophagitis no matter the infection.
Odynophagia
Most common types of causes of infectious esophagitis.
Candida albicans
Herpetic esophagitis-HSV1 or 2, varicella zoster, herpes zoster
Cytomegalovirus (CMV)
Herpetic esophagitis tx
Acyclovir
Candidiasis albicans infectious esophagitis tx
Antifungals( fluconazole)
CMV Tx
Ganciclovir and foscarnet
Endoscopic findings with EoE:
Edema
Esophageal rings
Longitudinally oriented furrows.
Punctuate exudate
A pt. has been on a PPI for a few weeks and continues to have heartburn..ddx?
EoE
Pediatric EoE Sx
Chest or abdominal pain
Nausea
Vomiting
Food aversion
EoE complications
Esophageal stricture
Food impaction
Esophageal perforation
Elimination diet for EoE
Milk, wheat, egg, soy, nuts, and seafood.
Swallowed glucocorticoids is a tx for______
EoE
