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?

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

Tx:
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