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13 Cards in this Set
- Front
- Back
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What dz is characterized by:
- Incomplete relaxation of the LES - Lack of peristalsis in the esophageal body - often a Hypertensive LES - ganglionic drop out at LES --> classical presentation is increasing dysphagia to both liquids and solids w/ regurgitation; often w/ wt loss and/or chest pain |
achalasia
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What is the workup for achalasia?
- EGD? - Barium swallow? - Is there something else? |
- EGD to rule out mechanical obstruction
- barium swallow often shows dilated esophagus w/ debris - esophageal manometry is dx |
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Tx for achalasia:
- Are CCBs and Nitrates effective? - role of botulinum toxin injections? - surgery? |
- mildly
- can relax the LES temporarily - cut through LES |
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What dz is characterized by:
- Repetitive, simultaneous, abnormally long contractions of esophagus in response to swallows - Sometimes associated with LES dysfunction --> classic presentation is w/ chest pain, often + dysphagia |
Diffuse Esophageal Spasm (DES)
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DES workup:
- EGD? - Barium? - Anything else? |
- normal
- may be normal, or show "corkscrew" due to mult simultaneous contractions - E manometry show long, simultaneous waves |
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Tx for DES:
- CCB and nitrates? - Smooth muscle antagonists? - surgery? - progression of dz? |
- yes
- that's what CCB/nitrates are, dumbass - long myotomy occasionally - often improves w/ time, but may progress to achalasia. |
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If achalasia is “esophageal asystole,” and DES is “esophageal tachycardia,” this is “Esophageal CHF”.
what is this? |
Ineffective Esophageal Motility (IEM)
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What is Ineffective Esophageal Motility?
- often seen in association with? |
Characterized by:
greater than 30% of swallows being not having complete peristalsis Greater than 30% of swallows having a distal peristalsis of <30 mmHg - GERD |
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What is Scleroderma?
- GI sx? mech of these effects? |
dz of abnormal collagen deposition throughout the body
- GERD, Esophagitis... --> decreased motility in esophagus b/c collagen replaces muscle, and decreased LES resting pressure. |
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Pt presents with GERD, and decreased LES resting pressure. Upon further exam, they also have decreased esophageal motility. What jumps to the front of the list?
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Scleroderma, although Ineff. Eso. Motility should be on there as well.
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What are some colonic effects of scleroderma?
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constipation; diarrhea is less common
- basically, this is causing stasis. - the collagen is replacing smooth muscle... this is a systemic illness. |
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Decreased gastric tone to allow pooling of gastric contents
Simultaneous contraction of the duodenum Reverse peristalsis of the duodenum Diaphragm descends forcibly abdominus rectus is simultaneously contracted chest wall contracts to force the vomitus out of the esophagus ... this describes what? Is it physiological or pathological? |
Vomiting
Physiological |
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How does bowel obstruction usually present?
- what's on the DDx? |
Usually presents with abdominal pain, distension, nausea and vomiting
- if colonic, constipation is common - tumors, post-op adhesions, volvulus, diverticulitis, etc. |
