Week 6 - Esophageal Disorders

Question 1

what are esophageal diverticula

Answer 1

• saclike outpouchings of one or more layers of the esophagus

Question 2

what are symptoms of esophageal diverticula (6)

Answer 2

• dysphagia
• regurgitation
• chronic cough
• aspiration
• weight loss
• sour taste & bad breathe (r/t stagnant food & decomp of food in the diverticula)

Question 3

how can esophageal diverticula be diagnosed

Answer 3

• barium studies

Question 4

what is the treatment for esophageal diverticular (2)

Answer 4

• conversative

- surgery considered if pt has malnutrition

Question 5

what is some conservative therapy/interventions for esophageal diverticula (3)

Answer 5

• 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)

Question 6

what surgical approach is used for esophageal diverticula (2)

Answer 6

• endoscopic

- external cervical approach

Question 7

surgical therapy for esophageal diverticul should include

Answer 7

• cricopharyngeal myotomy

Question 8

what is esophageal achalasia

Answer 8

• peristalsis of the lower 2 thirds (sm. muscle) of the esophagus is absent

Question 9

what does achalasia cause

Answer 9

• increased P in LES
• incomplete relaxation of LES
  = food and fluid accumulate in lower esophagus = obstruction of the esophagus at or near the diaphragm

Question 10

what are symptoms of achalasia (8)

Answer 10

• 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

Question 11

what is the medical term for bad breath

Answer 11

• halitosis

Question 12

how can achalasia be diagnosed (3)

Answer 12

• xrays
• manometric studies
• endoscopy

Question 13

what do manometric tests test

Answer 13

• function of the LES and muscles of the esophagus

Question 14

treatment of achalasia is focused on?

Answer 14

• symptoms mngmt

cause not exactly known

Question 15

treatment of achalasia consists of (4)

Answer 15

• dilation
• surgery
• drugs
• symptomatic treatment

Question 16

symptomatic treatment consists of (3)

Answer 16

• semisoft bland diet
• fluids w all meals
• sleep w head elevated

Question 17

what is esophageal dilation known as

Answer 17

• bougienage

Question 18

how is esophageal dilation done

Answer 18

• uses a balloon-tipped dilator passed orally

Question 19

what effect does esophageal dilation have

Answer 19

• does not restore normal esophageal motility

- but provides better emptying of the esophagus into the stomach

Question 20

what surgical interventions may be used to achalasia

Answer 20

• esophagomyotomy

- heller’s myotomy

Question 21

what is an esophagomyotomy

Answer 21

• 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

Question 22

what is heller’s myotomy

Answer 22

• disrupts LES and reduces LES pressure

Question 23

when is drug therapy used for achalasia

Answer 23

• short-term

- if pt is unfit to undergo dilation or surgery

Question 24

what drug therapy can be used for achalasia (4)

Answer 24

• botox
• anticholinergics
• ca channel blockers
• long acting nitrates

Question 25

what are the cons to using botox as treatment for achalasia (2)

Answer 25

• short term relief of symptoms : ~1 year

- repeated injections required

Question 26

when might the use of botox for achalasia be preferred

Answer 26

• no risk of perforation

= older adults or those w multiple medical procedures