Esophagus. dyphagia. achalasia. scleroderma. DES

Question 1

Dysphagia. types?2

Answer 1

motility (funcitonal) and mechanical (structural)

Question 2

Dysphagia. motility. how progress?

Answer 2

nonprogressive

Question 3

Dysphagia. mechanical. how progress?

Answer 3

progressive. to foods then liquids

Question 4

Dysphagia. motility. tests?

Answer 4

barium swallow is the first tests
manometry
endoscopy+biopsy

Question 5

Dysphagia. mechanical. tests?

Answer 5

barium swallow is the first tests
endoscopy+biopsy

Question 7

Dysphagia. schema. History of difficulty initiating swallowing with cough, choking, nasal regurgitation. —> YES –> ? –>?

Answer 7

Likely oropharyngeal dysphagia –> videofluoroscopic modified barium swallow.

Question 8

Dysphagia. schema. History of difficulty initiating swallowing with cough, choking, nasal regurgitation. —> NO –>?

Answer 8

Likely esophageal dysphagia.

Question 9

Dysphagia. schema. Likely esophageal dysphagia –> what if motility disorder?

Answer 9

esophageal dysphagia –> dysphagia with SOLIDS AND LIQUIDS at onset –>motility disorder –> barium swallow followed by possible manometry

Question 10

Dysphagia. schema. Likely esophageal dysphagia –> what if mechanical disorder?

Answer 10

esophageal dysphagia –> dysphagia with solids PROGRESSIVE to liquids –> mechanical

Question 11

Dysphagia. schema. dysphagia with solids PROGRESSIVE to liquids –> mechanical –> what to evaluate in history? what to do if yes/no?

Answer 11

history of prior radiation, caustic injury, complex stricture, surgery for esophageal cancer.
No –> upper endoscopy
Yes –> barium swallow followed by possible endoscopy

Question 12

Achalasia. pathophysiology?

Answer 12

LES cannot relax due to absent myenteric plexus.

Inflammatory degeneration of inhibitory ganglions of the myenteric plexus

Question 13

Achalasia. CP?

Answer 13

Ball of food stuck at GE junction.
Chronic dysphagia to solids and liquids, regurgitation
Heartburn, weight loss

Question 14

Achalasia. Diagnosis. 3 methods?

Answer 14

Manometry - most accurate
EGD - the best test
barium esophagram

Question 15

Achalasia. Diagnosis. what seen in manometry?

Answer 15

incr. LES resting pressure, incomplete LES relaxation, decr. peristalsis of distal esophagus.

Question 16

Achalasia. Diagnosis. what seen in barium esophagram?

Answer 16

smooth ,,bird-beak” narrowing at gastro-eso junction

Question 17

Achalasia. Diagnosis. why upper EGD good?

Answer 17

EGD – the best test. Also rules out cancer ,,pseudo-achalasia”.

In achalasia: normal appearing esophageal mucosa and a dilated esophagus with possible residual material. Ability to pass the endoscope through the lower esophageal sphincter.

Question 18

Achalasia. management. drugs?

Answer 18

for non-surgical patients.
Botulin toxin injection, nitrates and CCB

Question 19

Achalasia. management. dilation and miotomy? risks

Answer 19

laparoscopic myotomy or pneumatic balloon dilation.

Dilation – risk of perforation
Myotomy – might lead to GERD

Question 20

Scleroderma. pathophysiology?

Answer 20

LES cannot contract.

Its collagen deposition disease
CREST (anti-centromere) or systemic sclerosis (anti-Scl70).

Question 21

Scleroderma. CP? 1

Answer 21

C/P: Relentless GERD.

Question 22

Scleroderma. diagnosis? 3

Answer 22

Barium, manometry, EGD

Question 23

Scleroderma. treatment?

Answer 23

PPI

Question 24

DES. pathophysiology?

Cp?

Answer 24

uncoordinated, simultaneous contractions of esophageal body

Intermitent chest pain
Dysphagia for solids and liquids.

Question 25

DES. diagnosis?

Answer 25

Manometry - intermitent peristalsis, multiples SPONTANEOUS CONTRACTIONS

Esophagram: ,,Corkscrew” pattern

Important - rule out ACS

EGD

Question 26

DES. treatment?

Answer 26

drugs.

CCB; alternates: nitrates or tricyclics

Question 27

Oropharyngeal dysphagia. presentation?2

Answer 27

a. Difficulty initiating swallowing
b. Associated with coughing, choking, aspiration, or nasal regurgitation

Question 28

Oropharyngeal dysphagia. etiologies? 4

Answer 28

a. Stroke
b. Advanced dementia
c. Oropharyngeal malignancy
d. Neuromuscular disorders (eg, myasthenia gravis)

Question 29

Oropharyngeal dysphagia. complications?

Answer 29

a. Aspiration pneumonia
b. Weight loss

Question 30

Oropharyngeal dysphagia. diagnosis?

Answer 30

Videoflouroscopic modified barium swallow study

This is used to evaluate swallowing mechanics, degree of dysfunction, and severity of aspiration