MTB Step 3- GI Flashcards
Esophageal Disorders manifestations
Dysphagia and weight loss
If patient presents with dysphagia and weight loss with unexplained etiology, what test do you order?
Barium study.
Only two esophageal disorders where initial diagnostic study of an Endoscopy confirms a diagnosis?
Esophageal cancer and Barrett esophagus
Both require Endoscopy with Biopsy
Dysphagia vs Odynophagia?
Dysphagia: difficulty swallowing
Odynophagia: painful swallowing
What causes Odynophagia?
Infectious reasons: HIV, CMV, HSV or Candida
Etiologies of Dysphagia?
- Achalasia,
- Esophageal Cancer,
- Esophageal rings and webs,
- Zenker Diverticulum,
- Spastic Disorders (DES, nutcracker esophagus),
- Scleroderma (Progressive Systemic Sclerosis)
What is Achalasia?
MOA?
- A rare disorder in which your esophagus is unable to move food and liquids down into your stomach
- MOA: a weakened LES leads to an inability for that sphincter to relax, thus preventing food from going into your stomach from the esophagus
Signs and Symptoms of Achalasia?
- Young non-smoker,
- Dysphagia to both solids and liquids
- Regurgitation of food
- Aspiration Regurgitation of previous food
Diagnostic testing of Achalasia?
Best initial: Barium Swallow or chest X-ray
Most Accurate: Esophageal manometry
Esophageal manometry in Achalasia?
- Absence of normal esophageal peristalsis
- Abnormally high pressure at the lower esophageal sphincter
- There is no mucosal abnormality.
Treatment for Achalasia?
- Best initial: Pneumatic dilation or surgical myotomy
- **Pneumatic dilation is done when surgical myotomy is unsuccessful
- **Botulinum toxin injection is used when patient refuses surgical myotomy or pneumatic dilation
MOA of Botulinum toxin?
-Botulinum toxin inhibits the release of acetylcholine at the neuromuscular junction. This inhibits nicotinic receptors and relaxes all skeletal muscle.
