Disorders of Esophagus

Question 1

Dysphagia

Answer 1

difficulty swallowing

most common symptom

Question 2

Odynophagia

Answer 2

painful swallowing

Question 3

Common Problem and Malfunction

Achalasia

Answer 3

absent or ineffective peristalsis of the distal esophagus

lower 2/3 of esophagus

• most often in 40 year olds
• incomplete relaxation of LES

Question 4

Achalasia

Signs & Symptoms

Answer 4

• Dysphagia
• Sensation of food sticking in LES
• Noncardiac chest/epigastric pain or heartburn
• Secondary Pulmonary Complications

Question 5

Achalasia

Assessment

Answer 5

• X-ray studies
• Barium swallow
• CT scan of chest and endoscopy
• Manometry

Manometry = confirmatory diagnostic examination

Question 6

Achalasia

Management

Answer 6

• Small frequent feedings
• Ca channel blockers and nitrates
• Pneumatic dilation
• Esophagomyotomy
• Endoscopic myotomy

Question 7

Achalasia (Management)

Ca channel blockers and nitrates

Answer 7

• ↓ esophageal pressure
• improve swallowing
• smooth muscle relaxants

Question 8

Achalasia (Management)

Pneumatic dilation

Answer 8

stretch narrowed area

Question 9

Achalasia (Management)

Esophagomyotomy

Answer 9

relax gastroesophageal junction

Question 10

Achalasia (Management)

Endoscopic myotomy

Answer 10

pre-oral endoscopic myotomy (POEM)

Question 11

Esophageal Spasm

Answer 11

abnormal muscle contractions in the esophagus

Question 12

Esophageal Spasm

Types

Answer 12

• Diffuse Esophageal Spasm
• Hypertensive Peristalsis (Nutcracker Esophagus)

according to the book:
* DES
* Jackhammer esophagus
* Type III (spastic) achalasia

Question 13

Type of Esophageal Spasm

Diffuse Esophageal Spasm

Answer 13

• uncoordinated spasms
• normal amplitude
• moves quickly and upwards
• only a portion is affected

regurgitate

Question 14

Type of Esophageal Spasm

Jackhammer Esophagus (Hypercontractile Esophagus)

under Hypertensive Peristalsis

Answer 14

• extreme form
• coordinated movement
• entire is affected

Question 15

Esophageal Spasm

Signs & Symptoms

Answer 15

• dysphagia
• odynophagia
• chest pain

Question 16

Esophageal Spasm

Assessment

Answer 16

Esophageal Manometry

• measures motility and internal pressure
• LES
• standard test
• in side-lying position

Question 17

Esophageal Spasm

Management

Answer 17

• Ca channel blockers
• nitrates
• smooth muscle relaxnts
• anti-cholinergics
• anti-anxiety
• PPIs
• soft diet
• Heller myotomy/POEM

Question 18

Esophageal Spasm

Management

Answer 18

• Ca channel blockers
• nitrates
• smooth muscle relaxnts
• anti-cholinergics
• anti-anxiety
• PPIs
• soft diet
• Heller myotomy/POEM

Question 19

Esophageal Spasm (Management)

Ca channel blockers

Answer 19

• first line of therapy
• nifedipine, verapamil

Question 20

Esophageal Spasm (Management)

Ca channel blockers

Answer 20

• first line of therapy
• nifedipine, verapamil

Question 21

Esophageal Spasm (Management)

Smooth Muscle Relaxants

Answer 21

• sildenafil/viagra
• after relaxing effect

Question 22

Esophageal Spasm (Management)

Anticholinergics

Answer 22

Botulinum toxin

Question 23

Esophageal Spasm (Management)

Anti-anxiety

Answer 23

tricyclic antidepressants

Question 24

Esophageal Spasm (Management)

PPIs

Answer 24

omeprazole

Question 25

Esophageal Spasm (Management)

soft diet

Answer 25

↓ esophageal pressure and irritation

small frequent feedings

Question 26

Hiatal Hernia

Answer 26

opening in the diaphragm through which the esophagus passes becomes enlarged, and part of the upper stomach moves up into the lower portion of the thorax

outpouching

women > men

Question 27

Hiatal Hernia

Types

Answer 27

• Sliding Hernia (Type I)
• Paraesophageal/Rolling Hernia (Type II)

Question 28

Hiatal Hernia

Sliding Hernia

Answer 28

• stomach and gastroesophageal junction are displaced upward
• slides in and out

95% cases of hiatal hernia