Regurgitation and Dysphagia

Question 1

dysphagia

Answer 1

painful or difficult swallowing

Question 2

what can cause dysphagia?

Answer 2

seen in proximal esophageal disease, oral disease, pharyngeal disease, cricopharyngeal disease (achalasia), neuromuscular disease

Question 3

regurgitation

Answer 3

seen in disease of esophageal body (along with ptyalism)

can also be seen with distal esophagus disease

can be localized to specific part of esophagus or just generalized esophageal disease

Question 4

what are the 4 basic causes of regurgitation

Answer 4

inflammatory disease

extraluminal compression

intraluminal obstruction

neuromuscular disease

Question 5

what are some examples of inflammatory disease that cause regurgitation?

Answer 5

esophagitis (can lead to stricture)

myositis

granuloma

Question 6

what are some examples of extraluminal compression that cause regurgitation?

Answer 6

vascular ring anomaly

thymoma

other intrathoracic tumors

hilar lymphadenopathy

Question 7

what are some examples of intraluminal obstruction that cause regurgitation?

Answer 7

stricture

foreign body

tumor

diverticulum

intussusception

Question 8

what are some examples of neuromuscular disease that cause regurgitation?

Answer 8

dysmotility

megaesophagus (congenital or acquired)

Question 9

primary peristaltic waves

Answer 9

wave of relaxation in front of bolus and contraction behind it to propel it to the stomach, gets to lower esophageal sphincter which relaxes

Question 10

what are secondary peristaltic waves?

Answer 10

clear residual material in esophagus after bolus gets to stomach

Question 11

what are tertiary perstaltic waves?

Answer 11

seen in esophageal disease with disorganized contractile events in esophagus, associated with chest pain

Question 12

how is esophagitis/inflammatory disease diagnosed?

Answer 12

survey radiographs

contrast radiographs (stricture)

endoscopy (best way, don’t take biopsy unless neoplasia suspected)

Question 13

treatment for esophagitis/inflammatory disease

Answer 13

rest the esophagus (feeding tube in severe cases)

sucralfate liquid

increase LES tone (cisapride or metaclopramide)

reduce acid output (omeprazole)

pain meds

no abx unless there’s aspiration pneumonia

Question 14

how is extraluminal esophageal compression diagnosed?

Answer 14

radiographs (survey or contrast)

contrast CT (sometimes better)

endoscopy (sometimes)

Question 15

how is extraluminal esophageal compression managed?

Answer 15

surgical ligation of PRAA or mass removal (if present)

guarded prognosis in PRAA

Question 16

how is intraluminal or mural esophageal obstruction diagnosed?

Answer 16

contrast esophagram

endoscopy

radiographs (foreign body)

superficial biopsy on a per-esophageal tumor

Question 17

how is intraluminal or mural esophageal obstruction managed?

Answer 17

balloon dilation

bougienage

stenting

intralesional steroids

oral steroids NOT recommended

mitomycin C

antacids after dilation

maybe prokinetics post-stretching

Question 18

how is megaesophagus/neuromuscular dysfunction diagnosed?

Answer 18

survery radiographs, sometimes observation of aspiration pneumonia

contrast study

bloodwork

ACh receptor Ab test (MG dx)

maybe thyroid testing

certain breeds predisposed to congenital megaesophagus (poor to guarded px)

Question 19

how is megaesophagus/neuromuscular dysfunction managed?

Answer 19

symptomatic and supportive care

fluids

abx for pneumonia (possibly IV, culture if you can)

nutrition

prognosis is always guarded