Esophageal Disorders Flashcards
Treatments for common esophageal issues
Webs/strictures =
- esophageal dilation, switch proton pump inhibtor, fundoplication
Cancer = excision and possible chemo
Goiter = iodine supplements and excision if needed
Zenker diverticulum = surgical
- often presents with history of recurrent pneumonia, bad breath and voice changes
What are the most common causes of SCC in the esophagus
Smoking
Achalasia
Barrett’s esophagus
Direct mechanical injury
Drinking irritants or acidic agents
What is cafe coronary?
A proximal mechanical obstruction that blocks the esophagus due to obstruction of the glottis
- causes a reflex inhibition of the heart due to chronic stimulation of the recurrent laryngeal nerve of the vagus nerve =- syncope
Treatment = hemlick maneuver
What is steakhouse syndrome?
A mechanical obstruction in the distal esophagus that is usually a piece of meat that causes an esophageal food bolus
- causes extreme sub sternal chest pain
Treatment = glucagon supplements, carbonated beverages sometimes, nifedipine
Boerhaave syndrome
A type of esophageal rupture that occurs posteriorly on the LEFT DISTAL esophagus
- is caused by a sudden abrupt session of vomiting or severe straining (numerous direct causes)
- typically in males
Symptoms:
- severe chest pain
- mediastinitis
- pyopneumothroax on left
- **will sound like crunching in the mediastinum on auscultation (hammon crunch)
Is life threatening
What is the most common cause of GI bleeding?
- Mallory-Weiss tears*
- caused by forceful vomiting (usually bulimic)
- tears in the esophagus/ proximal GI tract
- can also be caused by hiatal hernia and GERD or chronic alcoholism
NOT life threatening usually and is self-limiting
- treatment = watch them
Difference between a stricture/web and tumor masses via symptoms
Stricture/web = non-progressive dysphagia
Mass = progressive dysphagia
What are the therapies for food bolus impaction
Glucagon
- relaxes LES smooth muscle
Nifedipine
- reduces LES tone
Carbonated beverages
- increased luminal pressure above the food (force it down the esophagus)
Foley retrieval
- pushes food into the stomach
Endoscopy
- just to observe pathology
Causes of motility issues (dysphagia or pharyngeal weakness)
1) Neuromuscular:
- stroke, abscess, tumor
- *usually shows oropharyngeal weakness though
2) infectious
- botulism, diphtheria, rabies, tetanus, HIV
- *if rheumatic fever= Sydenham chorea
3) immunologic
- MG, MS, polymyositis
- MG = bulbar muscles go first
4) achalasia or Auerbach/vagus palsy
Perforated esophagus
Rupture of the esophagus due to endoscopy or dilation of the esophagus
Usually occur around the PE (pharyngo-esophagus) junction
Treatment
- surgery and early antibiotic administration
What is the perforation rate of the stomach when swallowing a sharp/pointed or large Foreign bodies?
35%, need to monitor with endoscopy
also must retrieve if in esophagus
