Dysphagia Flashcards
Achalasia
Pathogenesis
Oesophageal Motor Disorder
• Degeneration + loss of ganglion cells in auerbach plexus
− LOS not able to relax = raised resting pressure
− Loss of peristalsis in lower half of oesophagus = no waves of peristalstic waves = dilation
Achalasia
Diagnosis
• Barium swallow
− Stricture
− Smooth mucosa
− Progressive narrowing; achalasia (rat’s tail; birds beak)
• Mannometry
− Loss of peristalsis
Achalasia
Management
• Acutely
• Definitve
− Pharmacologically: CCB
− Endoscopically: botulin injections; dilation
− Surgery: oesophagomyotomy (Heller operation) = myotomy of LOS
Scleroderma
Pathogenesis
Oesophageal Motor Disorder
Blood vessel damage -> intramural neuronal dysfunction -> distal esophageal muscle -> weakening -> aperistalsis and loss of LES tone -> reflux -> stricture -> dysphagia
Scleroderma
Diagnosis
• Mannometry
− Decreased pressure in LES
− Decreased peristalsis in body of oesophagus
Scleroderma
Management
As for GORD
Diffuse Oesophageal Spasm
Pathogenesis
Oesophageal Motor Disorder
Normal peristalsis interspersed with frequent, repetitive, spontaneous, high pressure, non-peristaltic waves
Diffuse Oesophageal Spasm
Diagnosis
• Barium enema
− Cork screw pattern
• Mannometry
− >30% (but <100%) of esophageal contractions are aperistaltic
Oesophageal Cancer
SCC (70%) and Adenocarcinoma (29%)
(Others: Soft Tissue Carcinoma)
Clinical
Early
• Retrosternal discomfort
• Odynophagia
Late (late presentation: oesophagus = expansible musculature)
• Progressive dysphagia
• Weight loss
− Not eating -> will gain wait on parenteral nutrition
− Paraneoplastic syndrome -> won’t gain weight on parenteral nutrition
• Dehydration
Oesophageal Cancer
SCC
Epidemiology
- Black, rural: limpopo, trans-ski, Natal
- 2nd most common country secondary to east asia
- M>F
- 50-60 years
Oesophageal Cancer
SCC
Risk Factors
• Behavioural − Smoking (10x) − Alcohol (2x) − Chewing betel nuts − Vitamin and mineral deficiencies (selenium, vitamin E, beta-carotene)
• Chronic inflammation
− Stricture food bolus + fermentation
⎫ Achalasia
− Hot beverages
• Caustic injury: scar/strictures
• Genetics: Tylosis
⎫ Characterized by thickening of the skin on the palms of the hands and soles of the feet
Oesophageal Cancer
SCC
Diagnosis
• Barium swallow
− Can be in any third, most common in middle third (guideline: carina of bronchus divides upper oesophagus into upper 1/3 and lower 2/3; lower 2/3 divided in half from carina to oesophageal gastric junction)
− Pathopneumonic
1. Dilated proximal oesophagus; fluid level
2. Abrupt narrowing: shouldering
3. Stricture with irregular mucosa of stricture (rats tail)
4. Complications
♣ Sinus
♣ Fistula : into trachea
♣ Local infiltration -> axial deviation
• Gastroscopy + biopsy
− Fungating (60%), ulcerative (25%), infiltrative (15%)
Oesophageal Cancer
SCC
Complications: Local Invasion
• Respiratory
− Fistula trachea + bronchus (as they drink they cough)
⎫ Recurrent LRTI
⎫ Abscess
• Nerves
− Nerves: hoarseness
− Nerves: persistent pain
• Blood vessels
− Blood vessels (in oesophagus or aorta): haememesis anaemia
Oesophageal Cancer
Adenocarcinoma
Epidemiology
• White, male, suburban, well fed + obese
- M>F
- 50-60 years
Oesophageal Cancer
Adenocarcinoma
Risk Factors
• GORD Barrett’s oesophagus (fastest growing cancer: lifestyle disease)