Esophagus. dyphagia. achalasia. scleroderma. DES Flashcards
Dysphagia. types?2
motility (funcitonal) and mechanical (structural)
Dysphagia. motility. how progress?
nonprogressive
Dysphagia. mechanical. how progress?
progressive. to foods then liquids
Dysphagia. motility. tests?
barium swallow is the first tests
manometry
endoscopy+biopsy
Dysphagia. mechanical. tests?
barium swallow is the first tests
endoscopy+biopsy
Dysphagia. schema. History of difficulty initiating swallowing with cough, choking, nasal regurgitation. —> YES –> ? –>?
Likely oropharyngeal dysphagia –> videofluoroscopic modified barium swallow.
Dysphagia. schema. History of difficulty initiating swallowing with cough, choking, nasal regurgitation. —> NO –>?
Likely esophageal dysphagia.
Dysphagia. schema. Likely esophageal dysphagia –> what if motility disorder?
esophageal dysphagia –> dysphagia with SOLIDS AND LIQUIDS at onset –>motility disorder –> barium swallow followed by possible manometry
Dysphagia. schema. Likely esophageal dysphagia –> what if mechanical disorder?
esophageal dysphagia –> dysphagia with solids PROGRESSIVE to liquids –> mechanical
Dysphagia. schema. dysphagia with solids PROGRESSIVE to liquids –> mechanical –> what to evaluate in history? what to do if yes/no?
history of prior radiation, caustic injury, complex stricture, surgery for esophageal cancer.
No –> upper endoscopy
Yes –> barium swallow followed by possible endoscopy
Achalasia. pathophysiology?
LES cannot relax due to absent myenteric plexus.
Inflammatory degeneration of inhibitory ganglions of the myenteric plexus
Achalasia. CP?
Ball of food stuck at GE junction.
Chronic dysphagia to solids and liquids, regurgitation
Heartburn, weight loss
Achalasia. Diagnosis. 3 methods?
Manometry - most accurate
EGD - the best test
barium esophagram
Achalasia. Diagnosis. what seen in manometry?
incr. LES resting pressure, incomplete LES relaxation, decr. peristalsis of distal esophagus.
Achalasia. Diagnosis. what seen in barium esophagram?
smooth ,,bird-beak” narrowing at gastro-eso junction
Achalasia. Diagnosis. why upper EGD good?
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.
Achalasia. management. drugs?
for non-surgical patients.
Botulin toxin injection, nitrates and CCB
Achalasia. management. dilation and miotomy? risks
laparoscopic myotomy or pneumatic balloon dilation.
Dilation – risk of perforation
Myotomy – might lead to GERD
Scleroderma. pathophysiology?
LES cannot contract.
Its collagen deposition disease
CREST (anti-centromere) or systemic sclerosis (anti-Scl70).
Scleroderma. CP? 1
C/P: Relentless GERD.
Scleroderma. diagnosis? 3
Barium, manometry, EGD
Scleroderma. treatment?
PPI
DES. pathophysiology?
Cp?
uncoordinated, simultaneous contractions of esophageal body
Intermitent chest pain
Dysphagia for solids and liquids.
DES. diagnosis?
Manometry - intermitent peristalsis, multiples SPONTANEOUS CONTRACTIONS
Esophagram: ,,Corkscrew” pattern
Important - rule out ACS
EGD
DES. treatment?
drugs.
CCB; alternates: nitrates or tricyclics
Oropharyngeal dysphagia. presentation?2
a. Difficulty initiating swallowing
b. Associated with coughing, choking, aspiration, or nasal regurgitation
Oropharyngeal dysphagia. etiologies? 4
a. Stroke
b. Advanced dementia
c. Oropharyngeal malignancy
d. Neuromuscular disorders (eg, myasthenia gravis)
Oropharyngeal dysphagia. complications?
a. Aspiration pneumonia
b. Weight loss
Oropharyngeal dysphagia. diagnosis?
Videoflouroscopic modified barium swallow study
This is used to evaluate swallowing mechanics, degree of dysfunction, and severity of aspiration
