GI-Esophageal Disorders Flashcards
(9 cards)
Motility v Mechanical
Motility
- NOT progressive,
- Foods and liquids
Dx: Barium, Manometry, EGD
Mechanical
- Progressive, Foods THEN liquids
Dx: Barium, EGD
Achalasia
Path: Motility
- Absent myenteric plexus
- LES cannot relax
Pt: Knot/Ball of food
Stuck @ GE junction
Dx: Barium = Birds Peak
Manometry - LES high tone
EGD w biopsy r/o Cancer (pseudoachalasia)
Tx: Botulinuim (poor surgical candidate)
Dilation (perforates)
Myotomy (Best)
F/u: GERD (if you take too much)
Scleroderma
Path: motility
- Collagen deposition
- LES cannot contract
Pt: CREST Anti-centromere
SS - Anti-Scl-70
Relentless GERD
Dx: Barium = Normal
Manometry = LES low tone
EGD w Bx = Collagen
Tx: PPI
F/u: Serology
Diffuse Esophageal Spasm
Path: Motility
- Random sustained contractions
Pt: “Heart Attack” /// better w nitro
Exacerbated by cold liquids
Dx: r/o ACS first (trops, ekg)
Barium = corkscrew esophagus
Manometry = Random contractions
NO EGD
Tx: CCB, Nitro
Schatzki Ring
Path: mechanical
- Ring @ GE Junction
Pt: “Steak House Dysphagia” = infrequent, large caliber foods get stuck
Dx: Barium = narrowed lumen / ring
EGD w Bx = Ring
Tx: Lysis during EGD
Esophageal Webs
Path: Mechanical
- Plummer-Vinson Syndrome
Pt: Woman w dysphagia
- Iron deficiency anemia, webs, and eventually….esophageal cancer
Dx: Barium = Webs
Tx: EGD to Screen for cancer only
- Iron for iron deficiency anemia
F/u: DO NOT DO esophagectomy
Zenkers Diverticulum
Path: Mechanical Diverticulum
Pt: Old guy w Halitosis….chokes while eating and regurgitates undigested food
Dx: Barium = Pouch
EGD w Bx = Visualization
Tx: Surgical Resection (endoscopic or open)
Stricture
Path: GERD Grade IV
Pt: GERD, Dysphagia, Weight Loss
Dx: Barium = Symmetric
EGD Bx = no cancer
Tx: PPI, dilation
Cancer
Path: Adeno = lower 1/3 Esoph = GERD
SCC = upper 1/3 esop = smoking, alcohol
Pt: GERD, dysphagia, weight loss
Dx: Barium = asymmetric
EGD Bx = cancer
Tx: Chemo/Radiation, Surgery
