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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
Q

Esophageal stricture Etiology?

A
  • Most common cause is Peptic secondary to GERD but can calso occur bc of EOE, caustic esophagitis, or radiation
26
Q

HPI of esophageal stricture

A
  • 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
Q

Treatment and diagnosis of Esophageal Stricture

A
  • Barium swallow
  • EGD with biopsy, this is n_ecessary in all cases_
  • Pneumatic dilation at time of EGD
  • Long term PPI therapy
28
Q

With an esophageal stricture, why is EGD with biopsy mandatory in all cases?

A
  • necessary to differentiate peptic stricture from stricture by esophgeal carcinoma
29
Q

What can Barret’s esophagus progress to?

A

Esophageal adenocarcinoma

30
Q

Etiology of Barret Esophagus?

A
  • Columnar metaplasia replaces normal squamous mucosa of distal esophagus
31
Q

Risk for BE?

A
  • Complication of GERD
  • Truncal obesity
  • Greatest risk:
    • Obese white males >50 yo who smoke
32
Q

BE does not provoke specific symptoms, what does?

A

GERD

33
Q

Diagnosis and Tx of BE?

A
  • 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
Q

Squamous esophageal cancer etiology?

A
  • Structural
  • Most common type of esophageal cancer in the world
  • RF include smoking and alcohol
35
Q

HPI of squamous cell esophageal cancer

A
  • ·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
Q

How do you diagnose and treat squamous cell esophageal cancer?

A
  • EGD with biopsy, seen in middle 1/3
  • Surgery (esophagectomy)
    • poor survival due to abundant esophageal lymphatics leading to lymph node metastases
37
Q

Esophageal Adenocarcinoma etiology and RF’s?

A
  • 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
Q

Diagnosis and treatment of esophageal adenocarcinoma?

A
  • Distal 1/3 of esophagus see squamous to columnar repalcement with EGD biopsy
  • Endoscopic therapy (ablation)
39
Q

What is Achalasia?

A
  • 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
Q

What disease causes secondary Achalasia?

A

Chagas disease

41
Q

HPI of Achalasia?

A
  • 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
Q

Diagnosis of Achalasia?

A
  • 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
Q

Tx of Achalasia?

A
  • 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
Q

HPI and PE of scleroderma

A
45
Q

What will labs show in a Scleroderma diagnosis? Treatment?

A
  • 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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