Disorders of Esophagus Flashcards
Dysphagia
difficulty swallowing
most common symptom
Odynophagia
painful swallowing
Common Problem and Malfunction
Achalasia
absent or ineffective peristalsis of the distal esophagus
lower 2/3 of esophagus
- most often in 40 year olds
- incomplete relaxation of LES
Achalasia
Signs & Symptoms
- Dysphagia
- Sensation of food sticking in LES
- Noncardiac chest/epigastric pain or heartburn
- Secondary Pulmonary Complications
Achalasia
Assessment
- X-ray studies
- Barium swallow
- CT scan of chest and endoscopy
- Manometry
Manometry = confirmatory diagnostic examination
Achalasia
Management
- Small frequent feedings
- Ca channel blockers and nitrates
- Pneumatic dilation
- Esophagomyotomy
- Endoscopic myotomy
Achalasia (Management)
Ca channel blockers and nitrates
- ↓ esophageal pressure
- improve swallowing
- smooth muscle relaxants
Achalasia (Management)
Pneumatic dilation
stretch narrowed area
Achalasia (Management)
Esophagomyotomy
relax gastroesophageal junction
Achalasia (Management)
Endoscopic myotomy
pre-oral endoscopic myotomy (POEM)
Esophageal Spasm
abnormal muscle contractions in the esophagus
Esophageal Spasm
Types
- Diffuse Esophageal Spasm
- Hypertensive Peristalsis (Nutcracker Esophagus)
according to the book:
* DES
* Jackhammer esophagus
* Type III (spastic) achalasia
Type of Esophageal Spasm
Diffuse Esophageal Spasm
- uncoordinated spasms
- normal amplitude
- moves quickly and upwards
- only a portion is affected
regurgitate
Type of Esophageal Spasm
Jackhammer Esophagus (Hypercontractile Esophagus)
under Hypertensive Peristalsis
- extreme form
- coordinated movement
- entire is affected
Esophageal Spasm
Signs & Symptoms
- dysphagia
- odynophagia
- chest pain
Esophageal Spasm
Assessment
Esophageal Manometry
- measures motility and internal pressure
- LES
- standard test
- in side-lying position
Esophageal Spasm
Management
- Ca channel blockers
- nitrates
- smooth muscle relaxnts
- anti-cholinergics
- anti-anxiety
- PPIs
- soft diet
- Heller myotomy/POEM
Esophageal Spasm
Management
- Ca channel blockers
- nitrates
- smooth muscle relaxnts
- anti-cholinergics
- anti-anxiety
- PPIs
- soft diet
- Heller myotomy/POEM
Esophageal Spasm (Management)
Ca channel blockers
- first line of therapy
- nifedipine, verapamil
Esophageal Spasm (Management)
Ca channel blockers
- first line of therapy
- nifedipine, verapamil
Esophageal Spasm (Management)
Smooth Muscle Relaxants
- sildenafil/viagra
- after relaxing effect
Esophageal Spasm (Management)
Anticholinergics
Botulinum toxin
Esophageal Spasm (Management)
Anti-anxiety
tricyclic antidepressants
Esophageal Spasm (Management)
PPIs
omeprazole
Esophageal Spasm (Management)
soft diet
↓ esophageal pressure and irritation
small frequent feedings
Hiatal Hernia
opening in the diaphragm through which the esophagus passes becomes enlarged, and part of the upper stomach moves up into the lower portion of the thorax
outpouching
women > men
Hiatal Hernia
Types
- Sliding Hernia (Type I)
- Paraesophageal/Rolling Hernia (Type II)
Hiatal Hernia
Sliding Hernia
- stomach and gastroesophageal junction are displaced upward
- slides in and out
95% cases of hiatal hernia
