Esophageal Disorders Flashcards
define dysphagia
difficult progression of food bolus from mouth to stomach
types/etiology of dysphagia
- oropharyngeal
- esophageal
- neuromuscular
describe oropharyngeal dypshagia
- transfer
- oropharynx to prox. esophagus
describe esophageal dysphagia
- transit
- prox. esophagus to stomach
dysphagia epidemiology
7%
dysphagia symptoms
- non-cardiac chest pain
- wt. loss
- globus (sensation of FB)
dysphagia risk factors
- hereditary
- Eagle Syndrome
dysphagia prevention
- denture check
- proper meal behavior
- no ETOH w/meal
- swallow eval w/ SLP
- observe pts
dysphagia S+S
- difficulty w/ both liquid and solid = motility
- progression of difficulty from solid to liquid = mechanical
- progression at all isa concern for CA/stricture
- vitals signs (?fever)
- anemia or scleroderma
- CN
dysphagia diagnostic studies
- CXR
- barium esophagography (BE)
- video esophagography
- upper endoscopy (EGD)
- esophageal manometry
- esophageal pH recording and impedance test
- capsular endoscopy
achalasia definition
failure of LES to relax which leads to obstruction and decr. peristalsis
achalasia etiology
- esophageal n. cell degeneration
- distal 2/3rds esophaguls decr. peristalsis
- idiopathic
achalasia epidemiology
20-60 y/o
achalasia symptoms
- gradual onset
- MC = substernal discomfort
- slow eater and uses manuver to clear food
- regugitation
- weight loss
achalasia diagnostic studies
- CXR = air fluid level in distal esophagus
- barium swallow = birds beak
- EGD = r/o lesions
- esophageal manometry
achalasia tx
- botox injx
- pneumatic dilation
- surgery = modified Heller cardiomyotomy
achalasia complications
less than 3% perforate in young and old
diffuse esophageal spasm definition
uncoordinated, simultatneous, or rapid progression of peristalsis
diffuse esophageal spasm epidemiology
- males more than females
- white more than other races
- under diagnosed
other types of diffuse esophageal spasm
- nutcracker
- jackhammer (presents w/ incr. pain)
diffuse esophageal spasm symptoms
- dysphagia
- regurgitation
- non-cardiac chest pain post prandial
diffuse esophageal spasm diagnostic studies
- high resolution manometry
diffuse esophageal spasm treatment
- CCB
- botox injx*
- nitrates*
- tricyclic antidepressants
- sildenafil w/ caution
- surgery (dilation, myotomy, esophagetcomy)
scleroderma definition
connective tissue d/o related to sm. muscle atrophy
scleroderma forms
- progressive systemic sclerosis
- CREST syndrome
describe progressive systemic sclerosis
diffuse scleroderma with fulminant involvement of internal organs
describe CREST syndrome
- Calcinosis
- Raynaud’s phenomenon
- Esophageal dysfunction
- Sclerodaetyly (sausage fingers)
- Telangectasia
scleroderma symptoms
- dysphagia in late dz
- choking d/t dysmotility
- GERD
- non-cardiac chest pain
scleroderma diagnostic studies
- manometry
- barium swallow
- EGD
scleroderma tx
- PPI
- prokinetic rx
- diet restrictions: multiple small meals, avoid fatty food, no ETOH, no peppermint, no chocolate
scleroderma complications
- strictures
- Barrett esophagus
- adenocarcinoma
esophagitis definition
inflammation or irritation of esophagus
esophagitis etiology
- infection
- medication or pill-induced
- caustic
- eosinophilia
- Barrett esophagus
esophagitis S+S
- odynophagia
- dysphagia
- non-cardiac chest pain
- cough
- GERD
- hoarseness
- morning paryngitis
esophagitis risk factors
- ETOH
- smoking anything
- surgery/radiation to chest
- poor po fluids w/ pills
- rx: bisphosphonates
- repeated vomiting
- immunocompromised, DM, steroids
esophagitis complications
- scarring
- strictures leading to swallowing difficulties
- Barrett esophagus
causes of infectious esophagitis
- candida albicans
- CMV
- HSV
tx of candida albicans infectious esophagitis
- fluconazole –> EGD w/ brushing and bx
tx of CMV infectious esophagitis
- HAART
- ganciclovir (can cause neutropenia)
- valganciclovir
- foscarnet
tx of HSV infectious esophagitis
- immunocompetent = standard antivirals
- immunosuppressed = acyclovir
risk factors for medication or pill-induced esophagitis
- not enough H20
- supine when taking po meds
- hospitalized or bed bound
diagnostic studies for medication or pill-induced esophagitis
- EGD
prevention of medication or pill-induced esophagitis
- po meds w/ more than 4oz H2O
- upright x at least 30 mins after po dosing
complications of medication or pill-induced esophagitis
- strictures
- hemorrhage
- perforation
caustic esophagitis S+S
- burning chest pain
- gagging
- dysphagia
- drooling
- aspiration
caustic esophagitis diagnostic studies
- CXR
- abdominal series XR
- free air
- pneumonitis
caustic esophagitis tx
- supportive
- psych referal
caustic esophagitis complications
- stricture
- deep ulcer
- necrosis
- medlastinitits
- peritonitis
- hemorrhage
- fistulas
- CA
define eosinophilic esophagitis & population
- white exudates or papules, red furrows, corrugated concentric rings, strictures
- MC in children
eosinophilic esophagitis S+S (adult)
- hx dysphagia w/ solids
- hx food impaction
- GERD
eosinophilic esophagitis S+S (children)
- chest pain/abdominal pain
- vomiting
- FTT
eosinophilic esophagitis diagnostic studies
- labs (CBC for eosinophilia, incr. IgE)
- Barium swallow
- EGD
- test for food allergies (steak + hotdogs)
eosinophilic esophagitis tx
- PPI
- food elimination diet
- steroids
eosinophilic esophagitis complications
- strictures
- narrow lumen
define mallory weiss tear
- non-penetrating tear at GEJ
mallory weiss tear etiology
MC = incr. trans abdominal pressure
mallory weiss tear risk factor
ETOHism
mallory weiss tear S+S
- hematemesis
- hx of retching, straining, vomiting
mallory weiss tear tx
- EGD
- fluid resuscitation
- blood transfusion
- endoscopic hemostasis
- epinephrine
- clipping or banding
- arterial embolization
define esophageal webs
- thin membranes of squamous mucosa that typically occur in the mid to prox
- may be multiple
esophageal web etiology
congenital
define Schatzki ring
- smooth, circumferential in distal esophagus at squamocolumnar junction
- seen w/ hiatial hernia
- dysphagia w/ less than 13mm diameter
esophageal web + ring
- dilation
- PPI
esophageal web + ring diagnostic studies
barium swallow better than EGD
define esophageal varicies
- dilated, submucosal veins in pts w/ portal HTN
esophageal varicies etiology
MC = cirrhosis
esophageal varicies S+S
- acute UGI bleed (rebleed is common)
- preceding retching, vomiting, dyspepsia
- hypovolemia
- shock
esophageal varicies tx
- resuscitation
- not too much transfusion/liquids
- correct coagulopathy
- abx
- vasoactive rxns
- Vit K w/ abx PTT
- endotracheal intubation
- balloon tamponade
- EGD
- endoscopy banding or sclerotherapy
- portal decompression procedures
- non-selective BB
- liver transplant
