Other Esophageal Disorders 1 P a g e OTHER ESOPHAGEAL DISORDERS 979 980 Esophageal Diverticula Saclike outpatchings of one or more layers of the esophagus Three main areas Above the supper esophageal sphincter o o Near esophageal midpoint o Above the LES Dysphagia Regurgitation Chronic cough Aspiration Typical Symptoms Weight loss Complications Malnutrition Aspiration Perforation Tasting sour food and smelling four odor Diagnostics Endoscopy or barium studies Treatment No specific treatment for diverticula Surgical via endoscopic or open approach Diverticulostomy most serious complication is perforation of the esophagus Esophageal Strictures Most common cause chronic GERD Other causes o o o o Strong acids or alkalis External beam radiation Surgical anastomosis Trauma such as throat lacerations and gunshot wounds Treat with dilation and surgical excision Temporary or permanent gastronomy Achalasia Peristalsis of the lower two thirds of the esophagus is absent Pressure in the LES increases along with incomplete relaxation Obstruction of the esophagus Food and fluid accumulate in lower esophagus Onset Insidious onset Common Symptoms Weight loss Dysphagia as the most common symptom Occurs with both liquids and solids Globus sensation and or substernal chest pain immediately after a meal Nocturnal regurgitation Halitosis Inability to eructate belch Diagnostic Studies Other Esophageal Disorders 2 P a g e Barium swallow Manometric and endoscopic evaluation Treatment Relieve dysphagia and regurgitation Improve esophageal emptying by disrupting LES Prevent development of megaesophagus Endoscopic pneumatic dilation repeats often required Heller myotomy done laparoscopically Returns 1 2 weeks following the procedure Semi soft diet and eat slowly Drink fluids with meals Sleep with the head elevated Medical Therapy Less effective than invasive procedures Smooth muscle relaxants o Side effects include Headache Drug tolerance Short duration of action o Nitrates Isordil o Calcium channel blockers Procardia taken sublinually 30 45 minutes before meals
View Full Document
Unlocking...