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35 Cards in this Set
- Front
- Back
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Structural Causes of oropharyngeal dysphagia |
Cervical Osteophytes - high dysphagia Cricoid webs - HIgh dysphagia Zenker diverticulum - Aspiration, regurg foul smelling food Thyromegaly |
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Neurologic/Myogenic causes of oropharyngeal dysphagia |
ALS CNS tumor Stroke MD Myasthenia Gravis Parkinson disease Demntia Sjogren syndrome |
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Structural Causes of esophageal dysphagia |
Dysphagia lusoria Epiphrenic/Traction diverticulum Esophageal strictures Eosinophilic esophagitis Esophageal webs or rings Neoplams |
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Motility disorders associated with esophageal dysphagia |
Achalasia Diffuse esophageal spasm Scleroderma |
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Factors associated with reflux |
Cigarette smoking Large meals Eating late at night EtOH Chocolate Citrus furits Coffee Fatty and fried foods onions perppermint |
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Medications associated with reflux |
Anticholinergic agents ASA and other NSAIDs CCBs Nitrates Progesterone |
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Odynophagia |
Symptom of esophageal ulceration Usually caused by infectious esophagitis or pill-induced esophagitis Test with upper EGD |
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What causes achalasia |
Degeneration of the myenteric plexus resulting in loss of inhibitory neurons in the LES |
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Primary presenting symptom of alchalasia |
Chest pain secondary to simultaneous esophageal wall contractions |
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Findings of CXR of alchalasia |
dilated esophagus with air/fluid level |
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How to screen for alchalasia |
Barium swallow with birds beak appearance Confirm with manometry |
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What is pseudoachalasia |
Obstruction of the LES secondary to malignant lesion |
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When to perform EGD for suspected alchalasia |
To exclude mechanical obstruction |
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Treatment of choice for alchalasia |
Surgical myotomy is first line Nissen fundoplication (second line) Neumatic dilatationif not a surgical candidate Botox is last line Nitrates and CCB are not recommended |
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How to diagnose diffuse esophageal spasm |
Manometry with intermittent, high amplitude (>30 mmHg), simultaneous, nonperistaltic contractions in response to swallowing. |
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What is "corkscrew esophagus" |
Caused by multiple simultaneous contractions on barium swallow Characteristic of diffuse eso spasm |
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Treatment for diffuse eso spasm |
CCB is first line trazodone and imiptramine show improvement in small studies BoTox as last resort |
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hypomotility syndromes occur most frequently in what setting |
GERD |
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What is the treatment of hypotonic motility disorders |
controlling acid reflux |
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Can fundoplication be performed on patient's with hypotonic motility disorders |
No. would make dysphagia worse afterwards |
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What is scleroderma esophagus |
aperistalsis of the esophageal body and hypotensive lower esophageal sphincter |
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Common organisms that cause infectious esophagitis |
Candida albicans HSV CMV |
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What class of medications put immunocompetent patient's at risk for atypical eso infections |
swallowed aerosolized corticosteroids |
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What are some atypical infectious causes of esophagitis |
HPV Trypanosoma cruzi Myco tuverculosis Treponema pallidum |
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What infection causes isolated esophageal ulcers |
CMV |
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What infection causes multiple esophageal ulcers |
HSV |
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Treatment of CMV esophagitis |
ganciclovir |
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Treatment of HSV esophagitis |
Acyclovir |
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What medications commonly cause pill esophagitis |
Tetracycline Fe Bisphosphonates K-Dur NSAIDs Quinidine |
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If medications that commonly cause pill esophagitis have to be given how can esophagitis can be avoided |
Large bolus of water Avoid recumbent posture for 30-60 minutes after ingestion |
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How does Eosinophilic esophagitis present |
solid-food dysphagia food impaction |
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What risk factors are associated with eosinophilic esophagitis |
Asthma Systemic and seasonal allergies Males |
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How is eosinophilic esophagitis diagnosed? |
>15 eos/hpf AND exclusion of GERD |
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How and why must GERD be excluded before diagnosing eosinophilic esophagitis |
GERD can actually cause EE Failure to improve with 6 weeks of PPI or perform ambulatory pH monitoring |
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Treatment of Eosinophilic esophagitis |
swallowed aerosolized corticosteroids usually works well Refractory disease may need eso dilation, systemic corticosteroids or food elimination diet |
