Adult Dysphagia

Question 1

Zenker’s diverticulum & its difference from meckel’s

Answer 1

Zenkerr’s div [Cricopharyngeal achalasia ]- post. pharyngeal pouch through killian dehiscence b/ w thyro pharyngeal & cricopharyngeal muscles (inferior constrictor muscle).
Unlike from meckel’s div Zenker ‘s is a false, acquired div. as it involves only mucosal & submucosal layers.

Question 2

1. clinical features.
2. complication of zenker div
3. IOC
4. Treatment

Answer 2

1. Dysphagia, Regurgitation & Halitosis (foul smell )
2. Aspiration & pulmonary abscess
3. IOC- barium swallow
4. < 2 Cm - p myotomy
   2-4 cm - Diverticulopexy
   > 4 cm - DohIman operation [ Diverticulo- esostomy linear stapler]

Question 3

I. Boyce & Bryce sign
II . Zen ker’s div stages

Answer 3

I. Boyce - gurgling sound heard on reducing swelling
Bryce - laryngocele
II. stage I - < 2 Cm length
Stage II - 2-4 cm
stage III - > 4 cm

Question 4

1. Achalasia Cardia
2. Pseudo Achalasia
3. causes

Answer 4

1. Failure of relaxation of LES due to - nce of ganglionic cells in Auerbach plexus + nt b/w the longitudinal & circular muscles of the sphincter. This also leads to failure in esophageal peristalsis. This plexus provides motor stimulus
2. it’s due to tumor around esophagus like mediastinal/ tumor of cardiac part of stomach. Causing constriction leading to compromising peristalsis.
3. Pri. is unknown. Secondarily can arise from chaga’s disease, DM, Scleroderma

Question 5

1 Cf for achalasia
2 Complication
3 location of esophagitis & Sq. cell carcinoma

Answer 5

1 Dysphagia [ initially for liquids then progresses to both solid & liquids]

2 Regurgitation, Aspiration, pulmonary complications

3 mid 1/3 of esophagus.

Question 6

I first & Standerd investigation of Achalasia
Il Intraw esophageal pressure in cases Normal, Achalasia, Nutcracker esophagus, Diffuse esophageal spasm

Answer 6

I first - Barium swallow. standard - Esophageal manometery
II Normal- 10-25 mm Hg
Achalasia - 25-100
Nutcracker eso - 180-200
DES- > 300-400

Question 7

I first & Standerd investigation of Achalasia
Il Intraw esophageal pressure in cases Normal, Achalasia, Nutcracker esophagus, Diffuse esophageal spasm

Answer 7

I first - Barium swallow. standard - Esophageal manometery
II Normal- 10-25 mm Hg
Achalasia - 25-100
Nutcracker eso - 180-200
DES- > 300-400

Question 8

signs on Barium swallow for Achalasia, DES, & cancer of eso

Answer 8

Achalasia - Bird beak/ pencil tip
DES - cork screw
cancer - Rat tail

Question 9

Rx for Achalasia

Answer 9

. Footnote

Drugs- CCB Nitrates
Pneumatic balloon dilatation - has risk of esophagus rupture So preffered is myotomy

Heller’s myotomy [open/ laparoscopic] - preferred - involves accessing LES from external aspect of esophagus followed by fundaplication

Per oral endoscopic myotomy - some muscles of LES, esophagus & stomach are cut removed

Fundoplication is done to prevent reflux.

Question 10

What characterizes Schatzki’s Ring?

Answer 10

Schatzki’s Ring is characterized by circumferential thickening at the squamo-columnar junction Causing esophageal narrowing resulting in intermittent dysphagia

Question 11

Schatzki ring Rx & Investigation

Answer 11

Rx - single endoscopic dilatation
Investigation - Barrium swallow

Common in GERD patients

Question 12

Compare sliding & paraesophageal Hiatal hernia

Answer 12

Although both show signs of chest pain & dyspnoea
Difference is
sliding - associated with GERD. Squamous -columnar junction is +nt in thorax
Para esophageal - is more prone to complication like ischemia & Strangulation. sq - columnar junct. is + nt in abdomen

Investigation _ CT w/ oral contrast OR Barium swallow