dysphagia

Question 1

define globus pharyngeus

Answer 1

“lump” in throat, not affected by swallowing

Question 2

differentiate between the diagnostic methods used for oropharyngeal and esophageal dysphagia

Answer 2

oropharyngeal= video fluoroscope of swallowing

esophageal= barium swallow, EGD with biopsy

Question 3

list the conditions that fall under the category of oropharyngeal dysphagia

Answer 3

esophageal web
plummer vinson syndrome
zenker diverticulum
sjogrens

Question 4

what symptoms present with an oropharyngeal dysphagia

Answer 4

can’t START the swallow, food stuck at suprasternal notch, nasopharyngeal regurge/aspiration

mostly solids and liquids

Question 5

describe the clinical presentation, causes, diagnostic methods and treatment of .. esophageal web

Answer 5

1. clin present= intermittent, NOT progressive
2. cause = proximal webs are in the oropharynx: are a thin membrane of squamous mucosa, either congenital or secondary to eosinophilic esophagitis or plummer-vinson
3. dx= barrium swallow esophagogram
4. trx= bougie dilator, small endoscopic electrosurgical incision, PPI in the long term

Question 6

how can you differentiate between esophageal webs and schatzki’s rings?

Answer 6

location

esophageal webs are in the proximal esophagus

schatzki’s rings are in the distal esophagus

Question 7

describe the clinical presentation of

plummer-vinson syndrome

Answer 7

1. clin present= middle aged women with 
angular chelitis
glossitis
esophageal webs
koilonchia (spoon nails)
also anemia/fatigue

Question 8

is zenker’s diverticulum a true or false diverticulum

Answer 8

false = herniated mucosa + submucosa between the cricopharyngus M and inferior pharyngeal constrictor M

Question 9

describe the clinical presentation, causes, diagnostic methods and treatment of .. zenker’s diverticulum

Answer 9

1. clin present= old males, change in voice, weight loss, aspiration leading to abscess,
   halitosis, nocturnal choking, neck protrusion, regurge is worse with spaghetti
2. cause = decreased elasticity of the upper sphincter, with a diverticulun in Killian’s Triangle (a natural weak spot)
3. dx= esophagography or barium swallow before an EGD to decrease the risk of perforation
4. trx= surgery, upper myotomy or surgical diverticulectomy

Question 10

describe the clinical presentation, causes, diagnostic methods and treatment of .. sjogren’s

Answer 10

1. clin present= dry eyes+ mouth, increased oral candida, dental caries, parotid gland enlargment, kerathoconjunctivitis sicca (fb sensation)
   post-menopausal, mid-50s, females
2. cause = rheumatologic, associated with b cell non-hodgkins lymphoma
3. dx= lip biopsy, serology
4. trx= support

Question 11

what are the sx associated with esophageal dysphagia

Answer 11

food stick to the mid-lower sternal area–> regurge, aspiration, odynophagia

Question 12

list the entities categorized esophageal dysphagia

Answer 12

scleroderma
hiatal hernia
gerd
esphageal CA
schatzki ring 
achalasia
esophageal web
plummer vinson syndrome
esophageal dysmotility

Question 13

describe the clinical presentation, causes, diagnostic methods and treatment of ..
scleroderma

Answer 13

1. clin present= mainly solid, some liquids; propulsion problems, also have Raynaud’s, hearburn
   30-60 yo Female, AA
2. cause = PROGRESSIVE smooth M atrophy in esophagus, fibrosis of skin and organs, microangiography
3. dx= serology
4. trx= control sx to slow progression and prolong survivial

Question 14

differentiate between diffuse and limited scleroderma

Ab present
sx
dx
prognosis

Answer 14

diffuse= scl-70 topoisomerase Ab
-sx on trunk and proximal extremities
internal organs involved progressively
-dx with manometry, CORKSCREW ESOPHAGUS
-bad prognosis

limited= anti-centromere Ab
-sx on fingers, toes, face, distal extremities
CREST syndrome= calcinosis, esophageal dysmotility, raynauds, sclerodactyly, telangiectasia
-good prognosis

Question 15

what esophageal complications can occur with long term GERD

trx?

Answer 15

1. stricture–> most commonly a peptic stricture, gradually progress from solids only to solid+liquid

trx= EDD+dilation, PPI>H2 blocker, if refractory give steroid injection

2. Barrett’s esophagus–> metaplastic columnar epithelium with goblet cells leading to increased risk for adenocarcinoma
   * in OBESE, WHITE, MALES >50, smokers

trx= surveillance and monitor, PPI for sx

Question 16

describe the two types of esophageal CA

clinical presentation
risk factors
sx
dx
trx

Answer 16

MOST COMMON- SCC
-males, AA, >50
-risk= smoker, EtOH, hot drinks, injury
-sx: most in middle 1/3 of esophagus, show with progressive dysphagia, weight loss, anorexia, bleeding, hoarse voice+cough
dx= EGD w biopsy
trx= esophagectomy

adenocarcinoma
-males, white, 
risk= barrett's esophagus
sx- most in distal 1/3
dx= "
trx=ablation, endoscopic therapy

Question 17

describe the clinical presentation, causes, diagnostic methods and treatment of ..
schatzki ring

Answer 17

1. clin present= intermittent problem with solids, steakhouse syndrome (large, poorly chewed bolus)
2. cause = related to hiatal hernia, structural change in distal esophagus
3. dx= barium swallow or EGD
4. trx= sometimes will pass with increased fluids, bougie dilator or small electrosurgical incision
   PPI with long term heartburn

Question 18

describe the clinical presentation, causes, diagnostic methods and treatment of ..
achalasia

Answer 18

1. clin present= progressively worse, no solids or liquids, if secondary have initial eye swelling that goes away
   - nocturnal regurge, substernal fullness/discomfort, eating and position changes
   - weight loss, romona sign [swelling around eyes], arrhythmia
2. cause = loss of peristalsis and failure of LES relaxation with older age and denervated esophagus (x myenteric plexus)
   primary or secondary to trypanosoma cruzi (chagas)
3. dx= blood smear for parasite, esophogram, bird beak on x-ray, manometry to confirm dx
4. trx= decreased LESPw nitrates, CCB, botulin toxin injection
   pneumatic balloon dilation, surgery