Esophageal Disease Lecture Powerpoint Flashcards
Oropharyngeal vs esophageal dysphagia
Difficulty with initiating swallow vs difficulty after initiating swallow with food stuck in the esophagus
Acute dysphagia
Typically foreign body impactation in the esophagus such as a food bolus, causes sensation of something stuck and inability to swallow saliva
Acute dysphagia treatment options (3)
- removal during endoscopy
- glucagon mg IV lower esophagus
- referral to gastro
Esophageal stricture/peptic stricture, how are they diagnosed (1)
Gradual progressive dysphagia for solids often due to chronic acid reflux or tumor,
-barium swallow
Most common esophageal cancer globally vs in the US
Globally is squamous cell, adenocarcinoma in the US
Clinical presentation of esophageal cancer (2)
- dysphagia often progressive
- unintentional weight loss
Esophageal cancer diagnostic studies (2)
- endoscopy and biopsy
- PET for mets
Esophageal cancer treatment options (3) and prognosis
- endoscopic mucosal resection (stage T1a)
- esophagectomy with lymphadenectomy (stage T1b)
- most of time palliative chemo, stents, brachytherapy, etc.
5 year survival rate only about 50% even without metastasis
Eosinophilic esophagitis and presentation
Chronic inflammation due to allergic process resulting in increased eosinophils in esophageal tissue, presents with reflux symptoms, solid food dysphagia, and impactation of food bolus, symptoms do NOT improve with acid suppression**
Eosinophilic esophagitis diagnosis (3)
- EGD with esophageal biopsy with pathology report showing >15 eosinophils per hpf not otherwise explained
- eosinophilia persists after trial of PPI
- characteristic tears on endoscopy
Eosinophilic esophagitis treatment options (3)
- first line inhaled corticosteroid (complication is candida, fluconazole might help)
- allergy testing
- esophageal dilation
Esophageal webs
-tissue membrane protruding into lumen most common in cervical esophagus, can be associated with iron deficiency anemia - plumme vinson syndrome
Triad of plummer vinson syndrome
Anemia
Cervical esophageal webs
dysphagia
Esohpageal rings
Concentric ring protruding into lumen that is typically in the distal esophagus and asymptmatic mostly but sometimes causees intermittent dysphagia for solids esp when the tube become <13 mm in diameter***
Esophageal web and rings diagnostic study (1)
-EGD
Esophageal webs and rings treatment options (3)
- rupture during EGD
- bougie dilation
- PPI daily x6 weeks
Zenker diverticulum and gold standard diagnosis (1) and treatment (1)
- Herniation of esophageal mucosa, rare typically in elderly populations who regurgitate undigested food stuffs
- barium swallow
- surgical technique if necessary
Nutcracker esophagus or hypertensive LES
Hypercontractility of the esophagus
Ineffective esophageal motility or hypotensive LES
Hypocontractility of the esophagus
Diffuse esophageal spasm (DES)
Discoordinated motility of the esophagus, can cause chest pain
Esoophageal motility disorders diagnostic studies (3)
- barium swallow
- EGD to rule out structural cause
- esophageal manometry
Up to __% of scleroderma patients with have esophageal involvement, resulting in…
90%, resulting in atrophy, sclerosis, absent peristalsis
Achalasia
Inadequate peristalsis in the lower esophagus due to a tight lower esophageal sphincter that leads to progressive dysphagia for solids and liquids***
Achalasia diagnostic studies (2)
- bird beak sign on barium esophogram
- EGD
