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Esophagus Flashcards

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1
Q

Dysphagia

A

Difficulty swallowing

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2
Q

Causes of dysphagia

A
  1. Neuromuscular pathologies - MG, Scleroderma, Achalasia
  2. Obstruction - Tumors, webs
  3. Motility issues
  4. Odynophagia (painful swallowing)
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3
Q

How does Neuromuscular pathologies affects swallowing?

A

Difficulties swallowing SOLIDS + LIQUIDS

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4
Q

Tests to identify underlying causes of dysphagia

A
  1. Barium swallow
  2. EGD
  3. Manometry
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5
Q

General Tx of Dysphagia

A
  1. Diet modification
  2. Pharmacologic tx
  3. Training in swallowing techniques
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6
Q

Achalasia

A

Failure of LES to relax

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7
Q

Mechanism of Achalasia

A
  1. Dysfunction of Nitric Oxide Synthase producing neurons
  2. Denervation of esophageal muscle
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8
Q

What does pts. w/ Achalasia have inc. risk for?

A

Esophageal Squamous Cell Carcinoma

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9
Q

Causes of Secondary Achalasia

A
  1. Cancer
  2. Chagas disease
  3. Diabetic neuropathy
  4. Amyloidosis
  5. Sarcoidosis
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10
Q

CFs of Achalasia

A
  • Dysphagia to solids & liquids
  • Chest pain
  • Weight loss
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11
Q

Dx of Achalasia

A
  1. Esophageal manometry
  2. Barium swallow
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12
Q

Esophageal manometry results in Achalasia

A
  1. Inc. resting tone of LES
  2. Dec relaxation of LES after swallowing
  3. Impaired peristalsis
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13
Q

Barium swallow results in Achalasia

A
  1. “Bird’s beak” appearance @ LES
  2. Proximal esophageal dilation
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14
Q

Tx of Achalasia

A
  1. Esophagomyotomy - Preferred tx in pts. w/ low surgical risk
  2. Ballon/ Pneumatic dilation of LES
  3. Botulinum toxin injection in LES
  4. Nitrates
  5. Calcium channel blockers
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15
Q

Mechanism of pharmacologic tx of Achalasia

A

Dec LES tone

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16
Q

Why is ballon dilation less likely treatment choice of Achalasia?

A

-Esophageal rupture

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17
Q

Boerhaave Syndrome

A

Transmural esophageal perforation caused by sudden inc. in intra-esophageal pressure & dec in intrathoracic pressure.

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18
Q

Causes of Boerhaave Syndrome

A
  • Severe vomiting & straining (MCC)
  • Seizure
  • Childbirth
  • Weightlifting
  • Prolonged coughing or laughing
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19
Q

MC location of esophageal rupture in Boerhaave syndrome

A

Left Posterolateral aspect of distal esophagus

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20
Q

Mackler Triad CFs of Boerhaave Syndrome

A
  1. Forceful vomiting
  2. Retrosternal chest pain
  3. Spontaneous emphysema
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21
Q

Other CFs of Boerhaave Syndrome

A
  • Fever
  • Hypotension
  • Abdominal rigidity
  • Tachypnea <– Pleural effusion
  • Odynophagia + Neck pain (Cervical perforation - RARE)
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22
Q

How does Pleural Effusion occur in Boerhaave syndrome?

A

Perforation –> Leakage of esophageal contents into pleural cavity –> Contamination

Mediastinitis-induced effusion

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23
Q

Dx of Boerhaave syndrome

Study These Flashcards
A

CT chest
Water-soluble contrast Esophagram

24
Q

Findings on CT characteristic of Boerhaave syndrome

Study These Flashcards
A
  1. Esophageal wall edema
  2. Esophageal wall thickening
25
Why is Water-soluble contrast preferred to Barium contrast in Esophagography?
Barium induces mediastinal inflammation
26
Findings on Chest x-ray (not diagnostic) in Boerhaave syndrome
1. U/L pleural effusion (usually left) 2. Widened mediastinum (air & fluid) 3. Pneumomediastinum Can be -ve in early cases
27
Characteristics of Pleural Effusion analysis in Boerhaave syndrome
1. Inc salivary amylase 2. pH <6 3. Undigested food *Exudative fluid*
28
Management of Boerhaave symdrome
1. IVF (pt is NPO) 2. IV PPI 3. IV broad-spectrum Ab (Ticarcillin-clavulanate) 4. Surgery
29
PE findings in Boerhaave syndrome
1. Crepitus on chest wall palpation 2. Mediastinal crunching w/ each heartbeat on auscultation (Hamman's sign - best heard in left lateral decubitus position) Air accumulation --> Subcutaneous & Mediastinal emphysema (Pneumomediastinum)
30
Complications of Alcoholism
1. Mallory-Weiss syndrome 2. Boerhaave syndrome 3. Wernicke-Korsakoff syndrome 4. Esophageal varices 5. Liver disease 6. Pancreatitis (acute & chronic) Withdrawal 1. Delirium tremens 2. Alcoholic hallucinosis
31
Cause of Wernicke-Korsakoff syndrome
Thiamine (B1) Deficiency<-- Alcoholism
32
Triad of Wernicke Encephalopathy
1. Confusion 2. Ophthalmoplegia 3. Ataxia
33
Triad of Korsakoff Syndrome
1. Anterograde amnesia 2. Retrograde amnesia 2. Confabulation Untreated Wernicke's --> Korsakoff
34
MRI findings specific to Wernicke encephalopathy & Korsakoff syndrome
Mamillary body atrophy
35
Tx of Wernicke encephalopathy
IV Thiamine --> Glucose Thiamine is always given first bc glucose can precipitate Wernicke encephalopathy
36
Mallory-Weiss Sydrome
Longitudinal mucosal laceration @ GEJ caused by excessive vomiting
37
CFs of Mallory-Weiss Syndrome
Painful hematemesis
38
Cause & Complication of Esophageal Varices
Caused by Portal HTN and can result in bleeding
39
Delirium tremens
-Life threatening - 2-5 days after withdrawal - Delirium + Hyperthermia + Tachycardia + Seizures
40
Alcoholic Hallucinosis
- 12-48 hours after abstinence - resolves w/i 1-2 days - Usually visual & tactile hallucinations - Stable vital signs
41
Zenker Diverticulum
Outpouching of upper, posterior esophagus in Killian's triangle d/t increased intrabolus pressure during swallowing
42
CFs of Zenker Diverticulum
1. Vomiting of food eaten days before 2. Bad breath 3. Problems swallowing 4. Inc in neck mass w/ eating or drinking 5. Feelings of aspiration 6. Dysphagia
43
Dx of Zenker Diverticulum
Barium swallow - Outpouching of esophagus
44
Tx of Zenker Diverticulum
1. Diverticulectomy 2. Cricopharyngeal myotomy
45
Complications of Zenker Diverticulum
1. Esophageal rupture (during EGD)
46
Complication of Zenker Diverticulum treatment
1. Vocal cord paralysis 2. Mediastinitis
47
Hiatal hernia
Protrusion of upper stomach through the esophageal hiatus in the diaphragm
48
Types of Hiatal hernia
1. Sliding (type 1) 2. Paraoesophageal (type 2)
49
Sliding hiatal hernia
GEJ + Proximal stomach --> Herniation
50
Paraoesophageal hiatal hernia
Proximal stomach herniation
51
CFs of Hiatal hernia
1. Asymptomatic 2. Acid reflux 3. Chest pain 4. Nausea 5. Early satiety
52
Dx of Hiatal hernia
1. Upper endoscopy (best) 2. Barium swallow 3. Chest x-ray
53
Complications of hiatal hernia
1. Acid reflux 2. Esophagitis 3. Esophageal strictures 4. Perforation 5. Volvulus (MC Type 2) 6. Strangulation (MC Type 2)
54
Tx of hiatal hernia
1. PPI 2. Diet modification - smaller portions, Inc fiber Refractory to meds/ Volvulus 1. Nissen fundoplication - 360-degree wrap of fundus around GEJ to prevent herniation
55
RFs for hiatal hernia
Inc age >50 years

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