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Diseases of the Esophagus 🐎, ⬆️ - Coggle Diagram
Diseases of the Esophagus 🐎
Diagnostic Tools
Physical Exam 🩺
Oral exam
Nasogastric Intubation
Palpation
Visual 👁️
Radiogrpahy
Survey Study
Obstructions
Barium Swallow
Integrity Changes
FB
⚠️ No sedation (inflates contractions) ⚠️
Contrast Studies
++ Study (liquid barium)
Masses 🐪
Strictures
Double study (L. barium + air)
Mucosal defects
Endoscopy
Obstruction
FB
Mucosal damage
Obstruction :
PE 🩺
Eliminate ddx
👄/🧠 exam
Palpate neck
Tracheal 🩺
:explode:
Pass NG tube
:explode:
🧪
Esophagoscopy
Bronchoscopy
Cervical Esophagography
Chest Rads
Lab Findings
Slight dehydration
Metabolic Acidosis
⬇️ of bicarb from saliva
Hyponatermia
Hypochloremia
CS 🤒
Ptyalism (too much spit)
Dysphagia (can't 🍆)
Coughing
Regurgitation (can't 🍆)
Extension of head
Causes 🕵️♀️
Impaction
Stricture
FB
Diverticulum 🐪
🏥
NG Tube
:explode: DO NOT PUSH :explode:
Sedation or GA
GENTLE lavage
Surgical mgmt
Saline & massage
Esophagotomy
Conservative mgmt
Off feed
IV fluids
NSAIDS
Xylazine (relaxes)
Abx
Prognosis = FAIR TO GOOD
Complications 🤡
Mucosal ulceration/Necrosis
Rupture
Aspiration pneumonia
Stricture
Rupture/Fistula 👊🏿
Complications 🤡
Mediastinitis
Carotid rupture
Pleuriitus
Jugular thrombosis
Septicemia
Laryngeal hemiplegia
Horners syndrome
*🧪
Endoscopy (for ID)
+/- NG (prolly won't pass)
Radiographs
SubQ emphysema
Contrast leaks into tissues
CS 🤒
Swelling
Cellulitis
Crepitus
Edema (brisket, legs, head)
*🏥
2nd intention healing
Abx, IV fluids, electrolytes
Drainage
Tube feeding
Distal esophagostomy
Feed through defect
Causes 🕵️♀️
Long standing obstruction
External trauma
FB perforation
Iatrogenic
Stricture
Causes 🕵️♀️
2nd to annular lesions
Recurrent obstructions
Types
1️⃣ Esophageal ring (M+SUB-M)
2️⃣ Mural lesion (adventitia & muscularis)
3️⃣ annular stenosis (all layers)
*🧪
Obstruction CS
Tube :red_cross:pass
pressure contrast study
*🏥
Chronic ⌛
Sx (>60d)
1️⃣ Esophagostomy @ stricture site (place feeding tube)
2️⃣ Convert sitrcture into traction diverticulum (2-3wk)
3️⃣ Remove tube, mucosal will heal closer to skin
Conservative mgmg (<60d)
Anatomy
Visualized on left neck
3 parts
Cervical (50%)
Thoracic
Abdomninal
Dorsal & Ventral vagal nerve
120-150cm long
⬆️