Esophagus Flashcards
the essential feature of the majority of esophageal disorders
dysphagia
dysphagia vs odynophagia - dentition (both can lead to ….(another symptom))
dysphagia: difficulty swallowing
odynophagia: pain while swallowing
BOTH CAN LEAD TO WEIGHT LOSS
when severe, some forms of esophageal disroder will give
anemia and heme (+) stool
esophageal disorders - alarm symptoms
- weight loss
- Blood in stool
- Anemia
esophageal disorders with alarm symptoms - next step
indication for endoscopy
Achalasia - definition
it is the inability of the LES to relax due to a loss of nerve plexus (myenteric) within the esophagus. Also there is aperistalsis of the esophageal body
achalasia - age / associations with RFs
young patient (under 50) NO association with alcohol + tobacco use
achalasia - etiology
not clear
2ry to Chagas disease (T. cruzi) or extraesophageal malignancies (mass effect o paraneoplastic)
achalasia - characetiristic presentation
progressive dysphagia to BOTH solds and liquids at the SAME TIME
achalasia - diagnostic tests (only the names of the tests) - which is the most accurate
- Barium esophagram
- Manometry (the most accurate)
- Chest x-ray
- Upper endoscopy
achalasia - Barium esophagram
bird’s beak as the esophagus comes down to a point
achalasia - manometry
the most accurate
failure of the lower esophageal sphincter to relax
achalasia - chest x-ray
abnormal wideningof the esophagus,
NEITHER SENSITIVE NOR SPECIFIC
achalasia - upper endoscopy
normal mucosa in achalasa –> However useful to exclude malignancy
esophagus disorders - best first test
barium studies are acceptable to do first in most patients, ALTHOUGH RADIOLOGIC TESTS ALWAYS LACK THE SPECIFICITY OF ENDOSCOPIC procedures
esophagus - biopsy
in the esophagus, only CANCER and BARRET are diagnosed by biopsy
achalasia - treatment (explain - only names)
it cannot exactly be cured - nothing can resore the normal function of the missig neuroloical control. All the treatment is based on simple mechanical dilation of the esophagus:
- Pneumatic dilation
- Surgucal secioning or myotomy
- Botulinum toxin injection
achalasia treatment - pneumatic dilation - describe
place an endoscope with the ability to inflate a device that will enlarge the esophagus
achalasia treatment - pneumatic dilation - effective?
effective in more than 80-85% of patients
it can lead to perforation in less than 3% of patients
achalasia treatment - surgical sectioning or myotomy
to alleviate symptoms
achalasia treatment - pneumatic dilation vs surgeon
surgeon is more effective and more dangerous
HARD to choose between them
achalasia treatment - Botulinum injection - describe
relax tha LES
achalasia treatment - Botulinum injection - effective?
the effects will wear off in about 3-6 months, requiring reinjection
esophageal cancer - age / RF
- 50 or older
- more than 5-10 years of GERD symptoms
- association with prolonged alcohol and tobacco use
esophageal cancer - characteristic symptoms
dysphagia first for solids, followed (progressing) for dysphagia for liquids
esophageal cancer - most important clue id diagnosis
Progressive dysphagia