Regurgitation and Dysphagia Flashcards
dysphagia
painful or difficult swallowing
what can cause dysphagia?
seen in proximal esophageal disease, oral disease, pharyngeal disease, cricopharyngeal disease (achalasia), neuromuscular disease
regurgitation
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
what are the 4 basic causes of regurgitation
inflammatory disease
extraluminal compression
intraluminal obstruction
neuromuscular disease
what are some examples of inflammatory disease that cause regurgitation?
esophagitis (can lead to stricture)
myositis
granuloma
what are some examples of extraluminal compression that cause regurgitation?
vascular ring anomaly
thymoma
other intrathoracic tumors
hilar lymphadenopathy
what are some examples of intraluminal obstruction that cause regurgitation?
stricture
foreign body
tumor
diverticulum
intussusception
what are some examples of neuromuscular disease that cause regurgitation?
dysmotility
megaesophagus (congenital or acquired)
primary peristaltic waves
wave of relaxation in front of bolus and contraction behind it to propel it to the stomach, gets to lower esophageal sphincter which relaxes
what are secondary peristaltic waves?
clear residual material in esophagus after bolus gets to stomach
what are tertiary perstaltic waves?
seen in esophageal disease with disorganized contractile events in esophagus, associated with chest pain
how is esophagitis/inflammatory disease diagnosed?
survey radiographs
contrast radiographs (stricture)
endoscopy (best way, don’t take biopsy unless neoplasia suspected)
treatment for esophagitis/inflammatory disease
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
how is extraluminal esophageal compression diagnosed?
radiographs (survey or contrast)
contrast CT (sometimes better)
endoscopy (sometimes)
how is extraluminal esophageal compression managed?
surgical ligation of PRAA or mass removal (if present)
guarded prognosis in PRAA
how is intraluminal or mural esophageal obstruction diagnosed?
contrast esophagram
endoscopy
radiographs (foreign body)
superficial biopsy on a per-esophageal tumor
how is intraluminal or mural esophageal obstruction managed?
balloon dilation
bougienage
stenting
intralesional steroids
oral steroids NOT recommended
mitomycin C
antacids after dilation
maybe prokinetics post-stretching
how is megaesophagus/neuromuscular dysfunction diagnosed?
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)
how is megaesophagus/neuromuscular dysfunction managed?
symptomatic and supportive care
fluids
abx for pneumonia (possibly IV, culture if you can)
nutrition
prognosis is always guarded
