PANCE REVIEW: Esophageal Dysmotility

 Esophageal Dysmotility in a nutshell.

6 types that you need to know about:

1- Neurogenic dysphagia
  • caused by brain stem injury
  • difficulty swallowing BOTH solids and liquids
2- Zenker's Diverticulum
  • Regurgitation of undigested solids/liquids several HRS after eating
3-Esophageal Stenosis
  • hard to swallow SOLIDS
  • slow progress = usually benign (rings)
  • fast progress = usually malignant
4- Achalasia
  • global motor dysfunc of esophagus
  • decrease peristalsis, increase sphincter tone
  •  SLOW, PROGRESSIVE dysphagia with episodic regurg and chest pain
  • **Parrot-beak** on barium swallow
 5- Esophageal spasms
  • intermit chest pain and dysphagia
  • may or may not be associated with eating
6- Scleroderma
  • often dz progression to esophagus
  • decrease in peristalsis, decrease in sphincter tone
  • s/sx of reflux

Question: What are the definitions of odynophagia and dysphagia?

A. Barium swallow: good for both structural and motility problems
B. Esophagoscopy: must be done to clarify strictures
C. Esophageal manometry: looks at peristalsis

Neurogenic? Treat underlying cause.
Stricture? BENIGN = dilation, MALIGNANT = resection

Answer: Odynophagia = painful swallowing, Dysphagia = difficulty swallowing

Pic: http://www.umm.edu/imagepages/19507.htm, http://www.bristolsurgery.com/page.aspx?id=184
Source: AAPA/PAEA Exam Review Book

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