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GI 2 > Approach to GI Patient: Dysphagia > Flashcards

Approach to GI Patient: Dysphagia Flashcards

1
Q

What are the structural examples of oropharyngeal dysphagia?

A
  • Zenker’s diverticulum
  • neoplasm
  • Cervical web
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2
Q

What are examples of propulsive neurogenic oropharyngeal dysphagia?

A
  • Cerebral vascular accident
  • Parkinson’s
  • ALS
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3
Q

What is esophageal dysphagia?

A
  • Dysphagia localized to chest or neck, food impaction
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4
Q

What is oropharyngeal dysphagia?

A
  • Dyshpagia localized to neck
  • nasal regurgitation, aspiration, and assoc. ENT sx present
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5
Q

Examples of propulsive esophageal dyshpagia?

A

GERD with weak peristalsis

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6
Q

Examples of structural intermittent, progressive, and variable esophageal dysphagia

A

Intermittent:

  • Schatzki ring

Progressive:

  • Neoplasm

Variable:

  • Peptic stricture
  • EOE
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7
Q

What is the etiology behind Zenker’s diverticulum?

A
  • Structural abnormality
  • False diverticula involving herniation of mucosa and submucosa through muscular layer of esophagus
  • located in Killian’s triangle
    • _​_posterior esophagus- area of natural weakness proximal to cricopharyngeus muscle
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8
Q

What will the HPI look like with a Zenker’s diverticulum?

A
  • Progressive, intermittent and then contstant odynophagia with solids and liquids
  • Vague sx at first such as cough or throat discomfort
  • Diverticulum enlarges and as it does it holds food- feel for a mass
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9
Q

Who is Zenker’s Diverticulum common in?

A

Older men

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10
Q

How do you diagnose and treat Zenker’s diverticulum?

A
  • Diagnose with Barium swallow
    • do before EGD due to risk of perforation
  • Treat with surgery
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11
Q

Complication of Zenkers diverticulum?

A
  • Perforation (if EGD is done before Barium)
  • weight loss
  • Aspiration leading to pneumonia/lung abscess
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12
Q

What is the etiology behind an esophageal web?

A
  • It’s a structrual problem
    • Proximal or mid esophagus not the whole lumen
    • Thin diaphragm like membranes of the squamous mucosa
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13
Q

What does the HPI look like for esophageal webs?

A
  • Intermittent symptoms, NOT progressive
  • difficulty with solids
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14
Q

If esophageal webs are more proximal, what are they classified as?

A

Oropharyngeal esophageal webs

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15
Q

What do esophageal webs resemble?

A

Schatzki rings

  • differentiate by knowing that webs are proximal or mid esophagus and Schatzki rings are distal
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16
Q

How do you diagnose and treat esophageal webs?

A
  • Barium swallow (esophagram) gives best view
  • Dilation is tx
    • if patient needs multiple dilations, consider long term PPI
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17
Q

What is Plummer vinson syndrome?

A

Combination of:

  • Proximal esophageal webs
  • Koilonychia
  • Angular chelitis
  • Glossitis
  • Iron def. anemia
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18
Q

What is Sjogren syndrome?

A
  • Autoimmune/Rheumatologic cause of oropharyngeal dyshpagia
  • Motility propulsion problem
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19
Q

What does Sjogren syndrome HPI look like?

A
  • Female>male mid 50’s
  • Constant not progressive
  • Difficulty with solids
  • Sicca symptoms
    • ​Dry mouth
    • Parotid or other salivary gland enlargement
    • Dry eyes
20
Q

Diagnosis and treatment of Sjogren syndrome?

A
  • Minor salivary gland biopsy
  • Supportive treatment
21
Q

Complications of Sjogren syndrome

A
  • Increased oral infections
  • Dental caries
  • B cell NHL association
22
Q

Schatzki’s ring (esophageal ring) etiology?

A
  • Structural problem in the distal esophagus
  • assoc. with hiatal hernia
  • GERD possible etiology
23
Q

HPI of Schatzki’s ring

A
  • Intermittent not progressive
  • difficulty with solids
    • large poorly chewed food bolus is instigator
  • Reflux issues
24
Q

Diagnonsis and treatment of Schatzki’s ring?

A
  • Barium swallow
  • Dilation (Bougie dilator or Pneumatic dilation)
  • PPI longterm if persistent heart burn or multiple dilations
25
Esophageal stricture Etiology?
* Most common cause is **_Peptic_** secondary to GERD but can calso occur bc of EOE, caustic esophagitis, or radiation
26
HPI of esophageal stricture
* Progressive * heartburn * weight loss (potentially) * Problems with solids at first and then both solids and liquids * **As the stricture worsens** reflux and heart burn **_improves_** bc the stricture acts as a barrier to the reflux
27
Treatment and diagnosis of Esophageal Stricture
* Barium swallow * EGD with biopsy, this is n_ecessary in all cases_ * Pneumatic dilation at time of EGD * Long term PPI therapy
28
With an esophageal stricture, why is EGD with biopsy mandatory in all cases?
* necessary to differentiate peptic stricture from stricture by esophgeal carcinoma
29
What can Barret's esophagus progress to?
Esophageal adenocarcinoma
30
Etiology of Barret Esophagus?
* Columnar metaplasia replaces normal squamous mucosa of _distal_ esophagus
31
Risk for BE?
* Complication of GERD * Truncal obesity * Greatest risk: * _Obese white males \>50 yo who smoke_
32
BE does not provoke specific symptoms, what does?
GERD
33
Diagnosis and Tx of BE?
* EGD with biopsy * Endoscopic ablation for those with high grade dysplasia or adenocarcinoma * PPI * Surgical Resection is **NOT** recommended * Recurrent surveillance endoscopy every 3-5 yrs
34
Squamous esophageal cancer etiology?
* Structural * Most common type of esophageal cancer _in the world_ * RF include smoking and alcohol
35
HPI of squamous cell esophageal cancer
* **·Progressive dysphagia** * ·Solid food then solid and liquids both * ·Males \> Females; African Americans \> Caucasians; \> 50 years old * ·Weight loss and Anorexia * ·Pyrosis (heartburn) * ·Bleeding (occult/melena/hematemesis) * ·Hoarseness (left recurrent laryngeal nerve injury) * ·Cough * ·Odynophagia * ·Iron deficiency
36
How do you diagnose and treat squamous cell esophageal cancer?
* EGD with biopsy, seen in _middle_ 1/3 * Surgery (esophagectomy) * poor survival due to abundant esophageal lymphatics leading to lymph node metastases
37
Esophageal Adenocarcinoma etiology and RF's?
* Structural * Most common type of esophageal cancer in the _USA_ * GERD leading to BE leading to dysplasia leads to this * RF are obesity smoking and achalasia
38
Diagnosis and treatment of esophageal adenocarcinoma?
* _Distal 1/3_ of esophagus see squamous to _columnar_ repalcement with EGD biopsy * Endoscopic therapy (ablation)
39
What is Achalasia?
* Motility abnormality with the loss of peristalsis in the distal 2/3 esophagus and failure of LES to relax * **_Oxide producing inhiobitory neurons in myenteric plexus dysfunction_**
40
What disease causes secondary Achalasia?
Chagas disease
41
HPI of Achalasia?
* Progressive worsening over months to years * Difficulty with both solids and liquids * Regurgitation of undigested food seen (ddx: Zenkers) * Substernal chest discomfort PE: * weight loss * swelling * ROmana sign (periorbital swelling unilateral painless) * Arrhythmia * Fever
42
Diagnosis of Achalasia?
* Peripheral blood smear (if secondary to chagas) shows *Trypanosoma cruzi* parasite * Barium esophagram shows "Birds beak" tapering of esophagus * EGD is always performed to exclude distal stricture or infiltrating carcinomaw * Biopsy shows loss of ganglion cells w/n myenteric plexus * **Esophgeal manometry confirms the diagnosis**
43
Tx of Achalasia?
* Reduce pressure of LES with Nitrates and Ca channel blockers or Botulinum toxin injection during endoscopy * Pneumatic balloon dilation (risk bleeding/perf) * Surgery * Antiparasitic tx if chagas
44
HPI and PE of scleroderma
45
What will labs show in a Scleroderma diagnosis? Treatment?
* Topoisomerase I antibodies (Scl-70) diffuse * Anti centromere antibodies limited * No approved disease modifying therapy * PPI slows progressive to improve quality of life and lengthen survival

GI 2 (19 decks)

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