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10 Cards in this Set
- Front
- Back
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Achalasia is due to degeneration of Auerbach's plexus causing aperistalsis and increased LES pressure; risk of cancer?
tx? |
yes, esophageal carcinoma
serial esophageal dilation; esophagomyotomy w fundoplication (Heller's); CCB & Nitrates (controversial) to relax LES. |
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How does scleroderma cause dysphagia?
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low LES pressure d/t esophageal dysmotility of lower 2/3 - small vessle vasculitis, collagen deposit, smooth muscle atrophy
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How does polymyositis cause dysphagia? Inc CPK, LFTs, LDH.
Gold standard for dx? |
Weakness of upper 1/3 of esophagus & pharyngeal (striated muscle) weakness
EMG, muscle bx Tx: antireflux, steroids, antimetabolites |
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Esophageal diverticuli (herniation of mucosa thru mucosal wall); where is Killian's triangle?
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region between the cricopharyngeal and inferior constrictor muscle [Picture A]
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Esophageal diverticuli (herniation of mucosa thru mucosal wall); where is Killian-Jamieson space?
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region between the oblique and transverse fibers of the cricopharyngeal muscle. [picture C]
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Esophageal diverticuli (herniation of mucosa thru mucosal wall); where is Laimer-Haeckermann space?
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region between the cricopharyngeal and most superior esophageal circular muscle [picture B]
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Zenker's (pharyngoesophageal) diverticulum; where does herniation typically occur?
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Killian's Triangle (superior to posterior cricopharyngeal muscle; below raphae of inferior constrictors)
[picture] |
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Treatment of Zenker's diverticuli: for minimal sxs? symptomatic & large >1.5cm diverticuli (3)?
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cricopharyngeal myotomy (minimal sxs);
1.transcervical diverticulectomy w cricopharyngeal myotomy (also esophageal dilator, gtube); 2.diverticulopexy (obliterate diverticulum by securing tip to nearby structure); 3.Endoscopic Staple Diverticulostomy (diverticulum opened into esophagus) |
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How does a Zenker's diverticulum form (what causes inc pressure)?
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incoordination of inferior constrictor muscles against closed cricopharyngeal muscle (UES); why CP muscle closed is up to debate, but that is why a CP myotomy is part of treatment
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Main complications of transcervical diverticulectomy (Zenkers)?
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fistulas 6.3%, recurrent laryngeal nerve palsy 3.6%, pneumomediastinum 0.8%, mediastinitis 3.1%, and mortality 2%
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