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Ch. 3 - Upper GI Surgery > Dysphagia and Oesophageal Motility disorders > Flashcards

Dysphagia and Oesophageal Motility disorders Flashcards

1
Q

Define odynophagia

A

Pain when swallowing

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2
Q

Define dysphagia

A

Difficulty swallowing

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3
Q

What is the most common congenital cause of Dysphagia?

A

Oesophageal atresia

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4
Q

What is a bolus bezoar?

A

Partially digested material

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5
Q

What is plummer vinson syndrome?

A

Triad of:
Iron deficiency anaemia
Oesophageal web
Dysphagia (post-cricoid)

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6
Q

Give 10 differentials for Dysphagia

A

Congenital -> Oesophageal atresia

Acquired:
1) Oesophageal:
Luminal - Bolus Bezoar, foreign body
Wall - Oesophageal web, carcinoma, Plummer Vinson Syndrome, stricture, GORD, oesophageal motility disorders
Extramural - Hilar lymphadenopathy, pharyngeal pouch, goitre, lung Ca

2)Neurological:
Stroke, Myasthenia Gravis, Motor neuron disease, MS

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7
Q

What are your top 3 differentials for Odynophagia

A

Pharyngitis, tonsillitis, oesophagitis, abscess

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8
Q

A patient has presented with odynophagia and later diagnosed with oesophagitis. Give 2 organisms that can cause that

A

HSV, CMV, Candida

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9
Q

What are your ddx for nocturnal cough?

A

pharyngeal pouch, achalasia, GORD

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10
Q

Quick! What would you ideally ask about in a hx of dysphagia

A

1) Degree of dysphagia (solids vs liquid vs both)
2) Timeline (progressive suggests malignancy, sudden onset = luminal)
3) Hx of dyspepsia (strictures from GORD/reflex)
4) Weight loss (malignancy or poor feeding)
5) Nocturnal cough (pharyngeal pouch, achalasia, severe GORD)
6) Nausea, vomiting, and Haematemesis (coffee ground vs frank, amount, timeline)
7) Anaemia (pallor, SOB, chest pain, pre-syncope)
8) Recurrent chest infection (pleuritic chest pain, fever)
9) Neurological symptoms (weakness, sensory loss)

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11
Q

What imaging is used for staging of oesophageal tumours?

A

Endoscopic US and CTTAP

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12
Q

What investigations will you perform for Dysphagia

A

Bedside: ABG - Check for hypochloraemic metabolic alkalosis with U&E
Bloods: FBC (anaemia). U&E (Dehydration => hypernatraemia + Hypochloraemic metabolic acidosis with ABG)

Imaging: CXR - Showing air-fluid level in mediastinum (achalasia & rolling hiatus hernia)
Endoscopic US & CTTAP for staging of oesophageal tumours

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13
Q

State the top 6 causes of Oesophageal motility disorder

A

Primary: Achalasia, Diffuse oesophageal spasm

Secondary: Chagas disease, scleroderma, DM, Amyloid, Myasthenia Gravis

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14
Q

What are your differentials for progressive difficulty to swallow both liquids and solids

A

Oesophageal Ca
All oesophageal motility disorders
Primary: Achalasia, Diffuse oesophageal spasm

Secondary: Chagas disease, scleroderma, DM, Amyloid, Myasthenia Gravis

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15
Q

What are the characteristic features of achalasia (4)

A

Loss of oesophageal paristalsis
Increased LOS tone
SM failure to relax. (increased tone)
Progreessive dysphagia of BOTH solids and liquids

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16
Q

What is the pathophysiology of achalasia

A

Neurological deficit in Auerbach’s plexux (part of myenteric plexus)

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17
Q

The myenteric plexus is composed of 2 subplexus. What are they and what does each control?

A

Auebach’s plexus - Controls motility => peristalsis
Meissner’s plexus - controls secretion and blood flow

18
Q

What are the 3 main diagnostic tests for achalasia?

A

Barium Swallow
Manometry
OGD/Endoscopy

19
Q

What is this image showing?
What is it consistent with?

A

Bird beak sign consistent with Achalasia

20
Q

What is the main cause of the bird beak sign in this image (not the name of the disease)

A

Increased tone of the LOS causing poor barium emptying

21
Q

What does manometry measure?

A

Muscle movement and intra-oesophageal pressure

22
Q

What findings on barium swallow and manometry would be consistent with achalasia?

A

Barium swallow: !!Bird beak apperance, narrow GOJ, aperistalsis, dilation of oesophagus, poor barium emptying

Manometry: High resting intra-oesophageal pressure >30 + aperistalsis

23
Q

What is the normal amount of intra-oesophageal pressure on manometry. What would be consistent with achalasia

A

Normal 0-30
Achalasia >30

24
Q

What are the complications of Achalasia?

A

Nocturnal aspiration (lying flat) causing bronchiectasis and lung abcess formation

SCC in mid oesophagus

25
Q

What is the definitive management of achalasia?

A

1) Balloon dilatation
2) Botulinium Toxin injection into LOS
3) Endoscopic myotomy
4) Heller’s Cardiomyotomy with anterior/Dor’s Fundoplication

26
Q

What is the main downfall of using Botulinum Toxin injection into LOS as a treatment for achalasia?

A

Not a long term option. Needs to be repeated

27
Q

Balloon dilatation is the best first line management for achalasia with a 70% success rate. What is the most important complication?

A

Perforation

28
Q

Where would you see a scar after Heller’s cardiomyotomy with anterior/Dor’s fundoplication?

A

Incision scar 5cm above to 3cm below the cardia

29
Q

A diffuse oesophageal spasm causes intermittent increases in tone and dysphagia. Is the dysphagia that of solids, liquids or both?

What is the characteristic feature of the disease?

A

Both solids and liquids just like achalasia.

Atypical angina-like chest pain

30
Q

What is being shown in this image

A

Manometer showing Nutcracker or corkscrew oesophagus consistent with Diffuse oesophageal spasm

31
Q

How is Diffuse oesophageal spasm diagnosed?
How is it managed?

A

dx: manometer showing nutcracker or corkscrew sign
Tx: Nifidipine + Reassurance

32
Q

What is Nifidipine

A

Dihydropyridine CCB

Do not confuse with Nimodipine which is used to prevent vasospasm in patients post-SAH

33
Q

What is Chagas Disease? (include pathophysiology)

A

Chronic infection with Trypanosoma Cruzi causing destruction of intramuscular ganglion cells

34
Q

Where is Chagas disease native to?

A

Brazil/south america

35
Q

How does Chagas disease present?

A

Dysphagia with a hx of south american travel

36
Q

Chagas disease typically presents with dysphagia. What is this disease also associated with

A

Mega everything
Cardiomyopathy
Megacolon
Megaduodenum
Megaureter

37
Q

Oesophageal involvement is present in 80% of patients with Scleorderma. How is it diagnosed?

Treatment of scleroderma requires a multidisciplinary approach. With regards to the oesophageal involvement, how is it specifically treated?

A

Manometry showing an adynamic oesophagus with hypotensive LOS (unlike the rest)

Tx: Partial fundoplication = Dor/Toupet

38
Q

Scleroderma manifestations are known by a pneumonic. What is it and expand it?

A

CREST Syndrome
Calcinosis - deposits on skin
Reynaud’s phenomenon
Esophageal dysfunction - Hypotensive
Sclerodactyly
Telangiectasia

39
Q

What is Reynaud’s phenomenon?

A

spasm of peripheral blood vessels in cold

40
Q

What is sclerodactyly

A

Thickening and tightening of skin

41
Q

What is telangiectasia
Describe the finding on exam

A

Capillary dilatation
Red spots on skin

Ch. 3 - Upper GI Surgery (7 decks)

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