GI Pathophysiology Flashcards
patients with esophageal motility disorders often present with
dysphagia, heartburn, and/or chest pain
Achalasia
neuromuscular disorder of the esophagus with esophageal outflow obstruction d/t inadequate relaxation of the LES and dilated hypomotile esophagus
symptoms of achalasia
dysphagia, heartburn, chest pain
diagnosis of achalasia
esophagram reveals “bird’s beak” appearance, EGD, esophageal manometry
type 1 achalasia
minimal esophageal pressurization, better outocmes
treatment is myotomy instead of botox or dilation
type 2 achalasia
pressurization of entire esophagus, best outcome regardless of treatment
type 3 achalasia
esophageal spasm with premature contractions, worst outcome
what can be used to relax the LES in achalasia?
calcium channel blockers
POEM procedure
Per Oral Endoscopic Myotomy
take out the circular layer of the LES but leave the longitudinal muscle intact
biggest risk is pneumothorax
distal esophageal spasm
diffuse esophageal spasm
autonomic nervous system dysfunction
esophagram shows corkscrew or rosary bead esophagus
pain mimics angina, responds favorably to nitroglycerin
GERD causes
mucosal injury in the esophagus/extraesophageal sites
most common symptoms of GERD are
heartburn, regurgitation, dysphagia, chest pain
patho of GERD
LES incompetence
transient LES relaxation from gastric distension
LES hypotension
anatomic distortion of GE junction such as hiatal hernia
reflux contents can be
HCl, pepsin, pancreatic enzymes, bile
complications of GERD
chronic peptic esophagitis, esophagitis, strictures, ulcers, barrett’s metaplasia
treatment of GERD
lifestyle modification: avoid fat, alcohol, peppermint, chocolate, acidic foods
pharmacologic treatment: PPI, H2 antagonists
surgery: Nissen fundoplication
periop considerations for GERD
sodium citrate given to pregnant/morbidly obese patients, large aspiration risk (volume 25 mL, pH less than 2.5), RSI, ETT
esophageal diverticula
outpouchings of the wall of the esophagus
pharyngoesophageal, midesophageal, and epiphrenic
what do you need to avoid in someone with esophageal diverticula
NG tube insertion (risk of perforation)
hiatal hernia
part of the stomach herniates into the thoracic cavity through the esophageal hiatus of the diaphragm
may be caused by weakening of the anchors at the GE junction to the diaphragm
esophageal tumors
presents with progressive dysphagia to solid food and weight loss
treatment of esophageal tumors
esophagectomy, mortality rate about 50%
complications: ARDS, RLN injury
