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Esophagus (Dysphagia) (Dysphagia caused by (Motility (functional) (Paths…

- - - - Achalasia
        
        Path: absent myenteric (inhibitory) plexus, LES can't relax
        
        Pt: Dysphagia, a "ball of food" stuck at GE junction (midsternal)
        
        Dx: Barium + Mannometry + EGD biopsy
        
        Birds beak :bird: is pathognmonic
        
        Biopsy r/o Ca :crab:
        
        some cancers can look like birds beak: pseudoachalasia
        
        Tx:
        
        Botulinum: very quick, only in poor sx pts
        
        Dilation: risk of esophageal perforation, and only temporary (repeats nec)
        
        Myotomy
        
        1 more item...
      - Scleroderma
        
        Path: collagen deposition in SM of LES, can't contract
        
        Pt: Relentless GERD sx
        
        CREST
        
        Eso dysmotility (duh)
        
        Telangectasias
        
        Calcinosis
        
        Reynauds
        
        Sclerodactyly
        
        Systemic Scleroderma
        
        Pulm & Heart :<3: involvement
        
        DX: Barium, Mannometry, EGD biopsy
        
        Wide open LES and no contraction
        
        Tx: no good treatment, symptomatic
        
        PPI
        
        F/u: Serology
        
        SS: anti topoisomerase Ab
        
        CREST: Anticentromere Ab
        
        Diffuse esophageal Spasm
        
        Path; Random contractions of Eso (not LES)
        
        Pt: retrosternal CP that improves w/ NG and CCBs (just like MI)
        
        :pencil2:nitrates relax smooth muscle, pain is caused by this contraction
        
        Dx: r/o MI, then Barium, mammometry, EGD biopsy
        
        "Corkscrew Esophagus" esophagus looks like beads on a string.
        
        2 more items...
  - - - Esophageal webs :spider_web:
        
        Schatzki's Ring
        
        Path: Ring @ GE junction, narrows lumen so only large foods get stuck
        
        Pt: "Steakhouse Dysphagia" food :fork_and_knife: gets stuck only when taking massive bites of poorly masticated food
        
        Dx: Barium
        
        shows Narrowed lumen
        
        follow w/ Biopsy: Ca r/o; schatzki is benign though
        
        Tx: Lyse the ring to open lumen
        
        Path: Plummer Vinson
        
        Pt: Woman w/ Dysphagia, IDA, Webs, eventually Esophageal Ca
        
        Dx: Barium swallow only
        
        Tx: Fe supplement and screen w/ EGD biopsy for Ca screen
        
        :warning:Avoid Esophagectomy unless Ca :crab: already exists
        
        1 more item...
      - Zenker's diverticulum
        
        Path: Undigested food stuck in diverticulum
        
        Pt: Older man :older_man::skin-tone-3:w/ halitosis (bad breath), may cough or gag upon swallowing (don't confuse w/ CVA stroke), and regurgitates undigested food
        
        Dx: Barium will fill diverticulum, and EGD biopsy
        
        Tx: Sx repair
        
        Strictures :snake: vs Cancer :crab:
        
        Stricture :snake:
        
        Path: GERD in bottom 1/3 of Eso
        
        Pt: Longstanding GERD, progressive dysphagia, and weight loss
        
        Dx: Barium shows circumferential loss of lumen
        
        2 more items...
        
        Cancer :crab:
        
        Path: GERD in bottom 1/3 of Eso
        
        Pt: Longstanding GERD, progr dysphagia, and weight loss
        
        :pencil2:Generally GERD transforms to Barretts, but not reliable. Use diagnostic tests
        
        DX: Barium shows asymmetric lumen
        
        2 more items...
        
        :pencil2:not to be confused w/ SCC ( :smoking:) in upper 1/3 of Eso