GI - Dysphagia (Difficulty In Swallowing) Flashcards
Oesophageal anatomy: level at which it passes through diaphragm, 3 locations of narrowing, epithelium, Z line
- Runs in posterior mediastinum and passes through right crus of diaphragm at T10
- Locations of narrowing: level of cricoid, posterior to left main bronchus and aortic arch, LOS
- Epithelium: lined by non keratinising squamous epithelium
- Z line: transition from squamous to gastric columnar
Causes of dysphagia: inflammatory
- Tonsilitis, pharyngitis
- Oesophagitis
- Oral candidiasis
- Aphtous ulcers
Causes of dysphagia: Neurological/motility disorders - local
- Achalasia
- Diffuse oesophageal spasm
- Nutcracker oesophagus
- Bulbar/pseudubulbar palsy (CVA/MND)
Causes of dysphagia: Neurological/motility disorders - Systemic
- Systemic sclerosis/CREST
- MG
Causes of dysphagia: mechanical obstruction - luminal
- Food bolus
- Foreign body
Causes of dysphagia: mechanical obstruction - Mural
- Benign stricture: Web (eg Plummer-Vinson), Oseophagitis, trauma (eg OGD)
- Malignant stricture: pharynx, oesophagus, gastric
- Pharyngeal pouch
Causes of dysphagia: mechanical obstruction - extra mural
- Retrosternal goitre
- Rolling hiatus hernia
- Lung Ca
- Mediastinal lymph nodes (eg lymphoma)
- thoracic aortic aneurysms
Dysphagia: Ix
- Upper GI endoscopy
- Ba swallow
- esophageal motility study (manometry)
- Bloods: FBC, U+E, LFTs, CRP, CEA, CA 19-9, CA 125
Achalasia: definition and pathophysiology
- Definition: failure of smooth muscle fibres to relax, which can cause LOS to remain closed. It can occur anywhere in GI tract (eg rectum in Hirschsprung’s disease)
- Pathophysiology: degeneration of myenteric plexus (Auerbach’s), loss of peristalsis and LOS fails to relax
Achalasia: causes
- Primary: idiopathic - commonest
- Secondary: Chaga’s disease - Trypanosoma cruzi
Achalasia: presentation and complications
- Dysphagia: liquids then solids
- regurgitation: especially at night
- Substernal cramps
- weight loss
- Complcation: in chronic Achalasia, 3-5% of patients will develop SCC
Achalasia: Ix
- Ba swallow: will show dilated tapering of eosephagus/bird’s beak
- Manometry: failure of relaxation + loss of peristalsis
- CXR: widened mediastinum, double RH border
- OCD: done to exclude malignancy
Achalasia: Rx
- Medications: CCBs, nitrates
- Interventional: Botox injection, endoscopic balloon dilatation
- Surgical: Heller’s cardiomyotomy (open or lap)
What is a pharyngeal pouch? Definition, pathophysiology, presentation and rx
-Out-pouching between crico- and thyro-pharyngeal
components of the inf. pharyngeal constrictor.
-Area of weakness = Killian’s dehiscence.
-Defect usually occurs posteriorly but swelling usually
bulges to left side of neck.
-Food debris → pouch expansion → oesophageal
compression → dysphagia
-Presentation: Regurgitation, halitosis, gurgling sounds
-Rx: excision, endoscopic stapling
What is diffuse esophageal spasm? Symptoms? Ba imaging shows what?
- Uncoordinated contractions of the oesophagus, which cause difficulty swallowing or regurgitation
- Symptoms: intermittent disphagia +/- chest pain
- Ba swallow: shows corkscrew oesophagus
