Esophageal Disease Year 4 Internal Medicine Notes OmpathStudy

Esophageal Disease Year 4 · Internal Medicine Collection: 4TH YEAR ALL NOTES / IMED / I MED BEAUTIFUL NOTES / GIT -- ● Objectives: ● Know the definition of dysphagia. ● Recognize the causes and types of dysphagia. ● Diagnose the important esophageal diseases like GERD, Achalasia & its major clinical\npresentations and complications. ● Understand the pathway of investigating patients with dysphagia. ● List the management outline for achalasia, GERD and Ca esophagus.\n[ Color index: ​Important​ ​Notes ​ ​Extra​ ] [​ ​Editing file​ ​ ​ ​Feedback​ ​ ​Share your notes​ ​ ​Shared notes​ ​ ​Twitter​ ] ● Resources: ● 435 slides\n\n● Done by:​ Mana Almuhaideb & Zaki Alwatban ● Team sub-leader:​ Jwaher Alharbi ● Team leaders:​ ​Khawla AlAmmari & Fahad AlAbdullatif ● Revised by: ​Ahmad Alyahya & Luluh Alzeghayer \n\n Know the definition of dysphagia\n\n - First, Swallowing occurs through three phases:\n1/Oral phase 2/Pharyngeal phase 3/Esophageal phase\n\n - The esophagus is a fibromuscular tube (upper third is composed of skeletal muscles,\nand the rest is composed of smooth muscles)\n- It has two sphincters ( UES: upper esophageal sphincter, LES: lower esophageal\nsphincter)\n- Esophagus has two main functions: 1- ​Transport of food by peristalsis 2- Prevention of gastric\nregurgitation by LES/UES\n- It is supplied by the vagus nerve & sympathetic trunk\n- Dysphagia​ is difficulty in swallowing and suggests an abnormality in the passage of\nliquids or solids from the oral cavity through the esophagus and into the stomach,\nhas mechanical and neuromuscular causes.\n- Odynophagia​ is painful swallowing.\n- Both dysphagia and odynophagia will result in weight loss,eventually.\n\n Recognize the causes and types of dysphagia.\nDysphagia can be either ​oropharyngeal​ or ​esophageal​: Oropharyngeal dysphagia Esophageal dysphagia \n- Also called​: transfer dysphagia - Arises from abnormalities in:\n- Arises from abnormalities of 1-The esophageal body\nmuscles, nerves or structures of the 2-Lower esophageal sphincter 1-Oral cavity 3-Cardia ​(part of the stomach where the esophagus enters) 2-Pharynx 3-Upper esophagus Classified into mechanical and motor: 4-Upper esophageal sphincter​.\n- Seen in cases of: Mechanical dysphagia, ​may be due to: Motor dysphagia: CVA (cerebrovascular accident), Motor 1-Large food bolus -Smooth muscle neuron disease, polymyositis, myasthenia 2-Intrinsic narrowing: disorders​: gravis, or striated muscle disease, A- Esophagitis B- Webs/rings 1- Scleroderma\nC- Tumor D- Strictures 2- Achlasia\n3-Extrinsic compression​: 3- Esophageal spasm\na- Enlarged thyroid b- Diverticulum c- Left\natrial enlargement \n\n - Clinically, dysphagia is considered an alarming symptom and the cause should be\nidentified.\n- If no cause can be identified, then it is considered functional dysphagia. \n● History of dysphagia: ​Always ask about the location of dysphagia! Make sure to ask the following 4 cardinal questions in history of dysphagia:\n1. Oropharyngeal ​(failure in initiating swallowing + food might leave through the\nnose + choking & coughing)​ or ​esophageal​ ​(initiate swallowing but food gets stuck\nlater)​?\n2. Solid ​(mechanical dysphagia)​ ​or solid and liquid​ ​(motor dysphagia)​?\n3. Intermittent or progressive?​ ​(progressive dysphagia indicates benign or\nmalignant esophageal stricture) (patients with rings have difficulty in swallowing\nsolids and intermittent dysphagia)\n4. Associated symptoms? ​(Heartburn indicates GERD, Loss of weight indicates tumor)\n5. Do you have medical problems? ​such as diabetes mellitus, scleroderma, Sjorgen\nsyndrome, overlap syndrome, AIDS, neuromuscular disorders (stroke, Parkinson’s,\nmyasthenia gravis, muscular dystrophy, multiple sclerosis), cancer, Chagas’ disease or\nothers?\n6. Previous surgery indicates strictures or Radiation therapy\n7. Some medications (Chloride, alendronate, ferrous sulfate, quinidine, ascorbic acid, tetracycline,\naspirin and NSAIDs) may cause pill esophagitis\n\n ● Physical Examination: Look for signs of:\n1. Bulbar palsy (1)\n2. Dysarthria\n3. Ptosis ​(Myasthenia gravis)\n4. Cerebrovascular accident\n5. Goitre ​(mechanical dysphagia)\n6. Changes in skin ​(connective tissue disease, eg, scleroderma) (1)which r​efers to a range of different signs and symptoms linked to impairment of function of the cranial nerves IX, X, XI and XII, which occurs due to a lower motor neuron lesion in the medulla oblongata or from lesions of the lower cranial nerves outside the brainstem. \n\n Diagnose the important esophageal diseases like GERD, Achalasia & its major clinical\npresentations and complications.\n\n1-Achalasia:\n\nCharacteristi It is characterized by a ​hypertonic LES ​(lower esophageal sphincter), which fails to relax during cs swallowing, and ​failure of peristalsis ​(main diagnostic feature, detected by manometry)​ which leads\nto progressive dilatation.\n- There is ​idiopathic​ loss of intramural neurons of LES and esophageal body\n- Most of c