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Causes of dysphagia?
- Progressive dysphagia - AchalasiaQ • SclerodermaQ • Peptic strictureQ • CarcinomaQ
- Intermittent dysphagia - • Lower esophageal ring (Schatzki’s ring)Q • Diffuse esophageal spasmQ • Zenker’s diverticulumQ
Causes of odynophagia?
- − Candidial (monilial) esophagitisQ
- − Herpes esophagitisQ
- − Pill induced esophagitisQ
What is Dysphagia Lusoria?
- It is a disorder of swallowing caused due to vascular anomaliesQ (congenital abnormalities) Q
- [lusorium means anomalous]
Causes of Dysphagia Lusoria?
- • Abnormal right subclavian arteryQ (MC) - right subclavian artery arising from the descending aorta and travels behind the esophagus to complete its course to the right upper extremity
- • Right aortic archQ
- • Double aortic archQ
- • Abnormal innominate arteryQ
- • Vascular ring (constriction) formed by a PDA or a ligamentum arteriosum and the pulmonary artery or aortic archQ
What is Boerhaave’s Syndrome?
Spontaneous rupture usually occurs on the left posterolateral side of the distal esophagus into the left pleural cavity or just above the gastroesophageal junction
What is Mackler’s triadQ?
Thoracic pain, vomiting, and cervical subcutaneous emphysema - seen in spontaneous esophageal perforation
Contrast media used in esophagogram?
Gastrografin (water soluble) is preferredQ to prevent extravasation of barium into the mediastinum or pleura. If no leak is seen, a barium study should follow.
Treatment of esophageal perforation?
- Within 24 hours – Primary repair
- After 24 hours - Débridement of devitalized tissue + Esophageal diversion or resection + Creation of an esophagostomy + Wide drainage + feeding jejunostomyQ. Higher mortality
Types of esophageal perforation?
- Iatrogenic - Most common typeQ, Caused by endoscopyQ, MC site is cervical esophagus (cricopharyngeal area)Q
- Spontaneous - Esophageal rupture after vomiting, MC site: left posterolateral side of the distal esophagusQ
Most commonQ type of TEF?
Atresia with distal TEF (85%) – Type C
MC anomaly associated with TEF?
Treatment of Malignant Tracheoesophageal Fistula?
- It is a sign of incurable esophageal carcinomaQ
- Self expanding metallic stent is the best treatmentQ
What are Schatzki’s Rings?
- • Consists of a concentric symmetric narrowing representing an area of restricted distensibility of the lower esophagusQ.
- • Lying precisely at the squamocolumnar mucosal GEJ, involves mucosa and submucosaQ
- It consists of esophageal mucosa above and gastric mucosa below.
- It does not have a component of true esophageal muscle, nor is it associated with esophagitis
Extent of esophagus?
Length of esophagus?
What are primary, secondary and tertiary contractions of esophagus?
- Primary contraction - ProgressiveQ contractions and Triggered by voluntary swallowingQ
- Secondary contractions - • ProgressiveQ contractions • Triggered by distension or irritationQ of esophagus (but not by voluntary swallowing)
- Tertiary contractions - • Non progressive, non-peristaltic contractionsQ • Occur spontaneously and simultaneously between swallowsQ
Location of esophageal constriction?
- Pharyngoesophageal junction (At BeginningQ) – 15 cm – C6 level
- Aortic arch, Left bronchusQ – 25 cm
- Pierces Diaphragm – 40 cm – T10
- [@ BALD]
Features of upper esophageal sphincter?
- • Length: 4-5 cmQ
- • Pressure: 60 mm HgQ
- • Comprises three skeletal muscle groups: Distal portion of inferior pharyngeal constrictor, cricopharyngeus and circular muscle of proximal esophagusQ
Features of lower esophageal sphincter?
- • Length: 5 cmQ
- • Abdominal length: 2 cmQ
- • Pressure: 6-26 mm HgQ
Nerve plexus in Esophagus?
Only Auerbach plexus is present in esophagus (Meissner’s plexus is absent)Q.
Development of Diaphragm?
- • Septum transversum →Central tendonQ
- • Pleuroperitoneal membranes →Small intermediate muscular portionQ
- • Mesentery of esophagus →CruraQ
- • Body wall →Peripheral muscular diaphragmQ
- • Cervical myotomes (muscular input)Q
What is Hamman’s crunch?
- A crunching, rasping sound, synchronous with heartbeat, heard over the precordium and sometimes at a distance from the chest in spontaneous mediastinal emphysemaQ.
- Hamman’s sign may be present in acute Mediastinitis (as in esophageal perforation) Q.
Diameter of esophagus to be dilated for normal swallowing function?
Stricture should be dilated to at least 16 mm diameter or 50 French. Q
Length of Roux loop to avoid bile reflux esophagitisQ?
At least 50 cm long