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Neuromuscular Oropharyngeal Dysphagia
- Stroke, Parkinson's disease
- Polymyositis, muscular dystrophy, myasthenia
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Structural oropharyngeal dysphagia
Zenker's diverticulum, thyromegaly, cervical spur, oral cancer
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Esophageal Dysphagia - Mechanical Obstruction (solids only)
- 1. Intermittent - Ring, web, eosinophilic esophagitisre
- 2. Prog sx, chronic GERD - peptic stricture
- 3. Prog sx - esophageal CA
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Esophageal dysphagia - Normal OGD - Motility disorder
- 1. intermittent sx/chest pain - diffuse esophageal spasm
- 2. Prog symptoms - reflux - scleroderma, amyloid, DM
- 3. Prog sx - achalasia (bird beak's narrowing) - idiopathic, pseudoachalasia (GE jxn tumor), chagas
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Achalasia
- Bird's beak narrowing
- -manometry - incomplete relaxation of LES
- -EGD to r/o pseudoachalasia
- -rx: pneumatic dilation or Heller myotomy
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Odynophagia
- Infxn esophagitis - immunosup. Candida, HSV, CMV
- Pill esophagitis - NSAIDs, KCl, bisphosp, doxy, tetracycline
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Eosinophilic esophagitis
- chronic, immune/antigen-medicated esophageal disease characterized by sym related to esophageal dysfunc and histo by eosinophil-predom inflmmation
- -more common in young men
- -dysphagia (s), food impaction, chest pain not responsive to antacids, GERD, epigastric pain
- -Rx: 3Ds - diet (no milk, soy, eggs, wheat, nuts, fish), drugs (swallow steroids), dilation
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Clinical Manifestations of GERD
- 1. esophageal - heartburn, atypical chest pain, regurgitation, water brash, dysphagia, globus sensation
- 2. extraesophageal - cough, asthma, laryngitis, dental erosions
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GERD alarm features
Dysphagia, vomiting, weight loss, blood loss
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GERD managemnt
- 1. PPI - bid
- 2. OGD if: 1. fails PPI, 2. alarm features, 3. male >50 yrs, symp >5 yrs + nocturnal sx, hiatal hernia, obesity , cigs
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UGIB DDx
- 1. PUD 50%
- 2. Varices 30% - esophageal
- 3. Gastropathy/gastritis/duodenitis - nsaids, asa, etoh, stress, portal hypertension
- 4. erosive esophagitis/ulcer 10%
- 5. mallory-weiss tear
- 6. Vascular lesions
- 7. neoplastic dz
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LGIB DDx
- 1. Diverticular 33% (60% in R colon)
- 2. Neoplastic 19%
- 3. Colitis 18% - infx, isch, rads, ibd
- 4. Angiodysplasia - ascending colon, cecum
- 5. Anorectal 4%
- 6. Postpolypectomy, vasculitis
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