Disease of Upper GI/Stomach [7] Flashcards
Possible etiologies of obstructive disorders in the oropharyngeal area
Head + neck cancers
Zenker’s diverticulum
Radiation therapy (thyromegaly, fibrosis)
Possible etiologies of propulsive motility disorders in the oropharyngeal area
Neurologic conditions - stroke* - ALS - MS - Parkinsons Myasthenia gravis Muscular dystrophy
Possible etiologies of obstructive disorders in the esophageal area
Esophageal strictures esophageal rings/schatzki's rings EoE Extrinsic compression Esophageal cancer*
Possible etiologies of propulsive motility disorders in the esophageal area
Achalasia*
Scleroderma*
Esophageal spasm “corkscrew eso”
What test can you run for obstructive disorders in the oropharyngeal area
barium swallow
*can do this test for propulsive/motility disorders of the oropharyngeal area too
What test can you run for obstructive disorders in the esophageal area
EGD (Esophagogastroduodenoscopy)
Esophagram
Possible etiologies of propulsive motility disorders in the esophageal area
Esophagram
EGD (to exclude)
Esophageal manometry
Possible etiologies of propulsive motility disorders in the oropharyngeal area
Barium swallow
*can do this test for obstructive disorders of the oropharyngeal area too
Oropharyngeal dysfxn symptoms
- oropharyngeal (transfer) dysphagia
- nasal regurg
- aspiration (solids/liquids)
Esophageal dysfxn with propulsive/motility symptoms
dysphagia to BOTH solids and liquids
Chest pain
Achalasia
"No relaxation" "A-chalasia" Impaired relaxation of esophagus (LES) - majority is IDIOPATHIC - dmg to myenteric plexus - Type I: Swallowing → no significant change in esophageal pressurization
dysphagia to both solids/liq, weight loss, regurg
Esophageal dysfxn with obstructive symptoms
Dysphagia to solids (first) then liquid (much later)
Weight loss (ominous)
Heart burn
Tx for achalasia
Endoscopic therapy
- GE junction botulinum toxin injxn → inhib of ACh release from nerve endings
- Pneumatic balloon dilation → tear LES muscle fibers
- POEM
- Surgical (hellar) myotomy
meds suck
(nitrates, CCB, sildenafil)
Eosinophilic esophagitis EoE (- obstructive disorders in the esophageal area) What is it? How is it dx? Population affected?
chronic immune/antigen mediated esophageal disease
dx: dysphagia
eosinophilic infiltrate in esophagus
absence of other pot causes of esophageal eosinophilia
White male + assoc. with other allergic diseases
sx: dysphagia, acute food impaction, heartburn, food avoidance, non spec. in kids
Tx for EoE
3 D’s
Drugs - steroids
Diet - 6 food elim
Dilation
Causes of GERD
Inappropriate LES relaxation Hiatal hernia gastric/esophageal surgery dysmotility or obstruction ZE Sjogern's Scleroderma
Barretts esophagus
- what is it
- tx?
Consequence of GERD with those at risk (White, male, fat, old)
- Metaplasia of esophageal squamous cells into columnar intestinal cells
- risk of dysplasia → adenocarcinoma
Tx: endoscopic treatment for high grade dysplasia and early esophageal adenocarcinomas
(ablation of Barretts tissue and resection of visible lesions )
Esophageal cancer. which is more prevalent in US? World wide?
US: adenocarcinoma
World wide: Squamous
*note: adenocarcinoma is almost always in distal esophagus or gastric cardia
Risk factors for esophageal SCC and Adenocarcinoma
SCC:
Old age, Alcohol/tobacco, caustic injuries
4M:1F
8AA:1 Cauc
Aden:
Old age, SMOKING, obesity, GERD, BARRETTS
8M:1F
