Esophageal Disorders Flashcards
What are examples of mechanical obstructions causing dysphagia?
- Schatzki’s rings
- Peptic stricture
- Esophageal cancer
- Eosinophilic esophagitis
What are motility disorders that cause dysphagia?
- Achalasia
- Diffuse esophageal spasm
- Scleroderma
What is the main complaint of achalasia?
Substernal discomfort
What is the diagnostic test for achalasia?
Esophageal manometry (showing absent peristalsis or incomplete LES relaxation)
What does barium swallow show in achalasia?
Bird’s beak sign
Treatment for achalasia
- Botox (for pts w/comorbidities who can’t do other tx)
- Pneumatic dilation (can cause perforation)
- Modified Heller cardiomyotomy of LES
What is a complication of pneumatic dilation treatment of achalasia?
Perforation
What is a “nutcracker” or “jackhammer” esophagus associated with?
Hypertensive peristalsis
Esophageal spasm
Best diagnostic test for diffuse esophageal spasm?
Esophageal manometry
Treatments for diffuse esophageal spasm?
- CCBs, Botox, Nitrates, TCAs
- Surgery (dilation, myotomy)
What are the 2 forms of scleroderma?
- Progressive Systemic Sclerosis (PSS)
- CREST syndrome
Describe progressive systemic sclerosis
- Diffuse scleroderma
- More fulminant form w/early involvement of internal organs
Describe CREST sydnrome
- A variant of scleroderma
- Calcinosis, Raynauds, Esophageal dysfunction, Sclerodactyly, Telangiectasia
Treatment of scleroderma
- PPI
- Prokinetic drugs (Reglan, erythromycin)
- Multiple small meals
Complications a/w scleroderma
- Strictures
- Barrett esophagus
- Adenocarcinoma
Describe infectious esophagitis
- Candida (thrush)
- CMV (single deep ulcer)
- Herpes (multiple shallow ulcers)
Describe Mallory Weiss tear
- Non penetrating
- 0.5 to 4.0 cm linear at GEJ
- Increased trans-abdominal pressure
- ETOHism is a risk
- Stabilize patient!
Define esophageal webs
- Thin membranes of squamous mucosa
- Typically occur mid to proximal
- Congenital mainly
Define Schatzki rings
- Smooth, circumferential
- Distal esophagus at squamocolumnar junction
Most esophageal webs and rings are how big?
20+ mm diameter
What are esophageal varices?
“Varicose veins of esophagus”
- Dilated submucosal veins
- Portal HTN patients (pressures over 10 mmHg)
What is the MC cause of emergent UGI bleeding?
Esophageal varices
Acute treatment of esophageal varices
- Resuscitation
- Avoid over transfusion of fluids (increases venous pressures)
- Correct coagulopathy
- Vasoactive drugs to reduce portal pressure
Procedures to treat esophageal varices
- Balloon tamponade (initial control of bleeding)
- Acute endoscopic banding or sclerotherapy
- Portal decompression (TIPS)
