Week 6 - Esophageal Disorders Flashcards
what are esophageal diverticula
- saclike outpouchings of one or more layers of the esophagus
what are symptoms of esophageal diverticula (6)
- dysphagia
- regurgitation
- chronic cough
- aspiration
- weight loss
- sour taste & bad breathe (r/t stagnant food & decomp of food in the diverticula)
how can esophageal diverticula be diagnosed
- barium studies
what is the treatment for esophageal diverticular (2)
- conversative
- surgery considered if pt has malnutrition
what is some conservative therapy/interventions for esophageal diverticula (3)
- empty pocket of food from diverticula by applying pressure to neck
- limited diet to food that pass easily (ex. blenderized)
- do not lay down after eating ( prevent food from sitting in pockets)
what surgical approach is used for esophageal diverticula (2)
- endoscopic
- external cervical approach
surgical therapy for esophageal diverticul should include
- cricopharyngeal myotomy
what is esophageal achalasia
- peristalsis of the lower 2 thirds (sm. muscle) of the esophagus is absent
what does achalasia cause
- increased P in LES
- incomplete relaxation of LES
= food and fluid accumulate in lower esophagus = obstruction of the esophagus at or near the diaphragm
what are symptoms of achalasia (8)
- dysphagia **
- globus sensation
- substernal chest pain w or immediately after meal
- bad breath
- inability to burp after eating
- regurgitation of sour tasting food & liquids
- symptoms of GERD (ex. heartburn)
- weight loss
what is the medical term for bad breath
- halitosis
how can achalasia be diagnosed (3)
- xrays
- manometric studies
- endoscopy
what do manometric tests test
- function of the LES and muscles of the esophagus
treatment of achalasia is focused on?
- symptoms mngmt
cause not exactly known
treatment of achalasia consists of (4)
- dilation
- surgery
- drugs
- symptomatic treatment
symptomatic treatment consists of (3)
- semisoft bland diet
- fluids w all meals
- sleep w head elevated
what is esophageal dilation known as
- bougienage
how is esophageal dilation done
- uses a balloon-tipped dilator passed orally
what effect does esophageal dilation have
- does not restore normal esophageal motility
- but provides better emptying of the esophagus into the stomach
what surgical interventions may be used to achalasia
- esophagomyotomy
- heller’s myotomy
what is an esophagomyotomy
- muscle fibres that enclose the narrowed area of the esophagus are divided = mucosa can pouch out thru the division in the muscle layer so food can be swallowed withoutobstruction
what is heller’s myotomy
- disrupts LES and reduces LES pressure
when is drug therapy used for achalasia
- short-term
- if pt is unfit to undergo dilation or surgery
what drug therapy can be used for achalasia (4)
- botox
- anticholinergics
- ca channel blockers
- long acting nitrates
what are the cons to using botox as treatment for achalasia (2)
- short term relief of symptoms : ~1 year
- repeated injections required
when might the use of botox for achalasia be preferred
- no risk of perforation
= older adults or those w multiple medical procedures