dysphagia - vanderbilt university medical center · barium swallow is first test in the work -up of...
TRANSCRIPT
![Page 1: Dysphagia - Vanderbilt University Medical Center · BARIUM SWALLOW is first test in the work -up of dysphagia in almost all cases . Achalasia Manometry findings? - Failure of LES](https://reader034.vdocuments.mx/reader034/viewer/2022042201/5ea1c8cd07f73a43675a6a34/html5/thumbnails/1.jpg)
Dysphagia
Rebeccah Baucom, PGY 3 August 3, 2011
![Page 2: Dysphagia - Vanderbilt University Medical Center · BARIUM SWALLOW is first test in the work -up of dysphagia in almost all cases . Achalasia Manometry findings? - Failure of LES](https://reader034.vdocuments.mx/reader034/viewer/2022042201/5ea1c8cd07f73a43675a6a34/html5/thumbnails/2.jpg)
Case Presentation
55-year-old female – Difficulty swallowing for 1 month
PMHx: HTN, HLD PSHx: lap chole, appendectomy Social: 1 PPD x 30 years, occ EtOH Meds: Lisinopril, HCTZ, Lipitor, Vitamin
![Page 3: Dysphagia - Vanderbilt University Medical Center · BARIUM SWALLOW is first test in the work -up of dysphagia in almost all cases . Achalasia Manometry findings? - Failure of LES](https://reader034.vdocuments.mx/reader034/viewer/2022042201/5ea1c8cd07f73a43675a6a34/html5/thumbnails/3.jpg)
Differential Diagnosis • OROPHARYNGEAL
– Stroke – Myasthenia gravis – Zenker diverticulum – Oropharyngeal cancer
• ESOPHAGEAL – Scleroderma – GERD – Achalasia – Esophageal spasm – Webs – Neoplasm – Extrinsic compression – Eosinophilic esophagitis – HMV/CMV/Candida – Caustic ingestion
![Page 4: Dysphagia - Vanderbilt University Medical Center · BARIUM SWALLOW is first test in the work -up of dysphagia in almost all cases . Achalasia Manometry findings? - Failure of LES](https://reader034.vdocuments.mx/reader034/viewer/2022042201/5ea1c8cd07f73a43675a6a34/html5/thumbnails/4.jpg)
Work-Up
Suspect caustic ingestion?
Yes No
Flexible endoscopy Barium swallow
BARIUM SWALLOW is first test in the work-up of dysphagia in almost all cases
![Page 5: Dysphagia - Vanderbilt University Medical Center · BARIUM SWALLOW is first test in the work -up of dysphagia in almost all cases . Achalasia Manometry findings? - Failure of LES](https://reader034.vdocuments.mx/reader034/viewer/2022042201/5ea1c8cd07f73a43675a6a34/html5/thumbnails/5.jpg)
Achalasia
Manometry findings?
- Failure of LES to relax
Treatment?
- Laparoscopic Heller esophagomyotomy with partial anterior fundoplication
![Page 6: Dysphagia - Vanderbilt University Medical Center · BARIUM SWALLOW is first test in the work -up of dysphagia in almost all cases . Achalasia Manometry findings? - Failure of LES](https://reader034.vdocuments.mx/reader034/viewer/2022042201/5ea1c8cd07f73a43675a6a34/html5/thumbnails/6.jpg)
Diffuse esophageal spasm
Manometry findings: - Periodic contractions - High-amplitude - Multipeaked - During wet swallow - Normal peristalsis during
intervening periods
Treatment: - CCB or nitrates
![Page 7: Dysphagia - Vanderbilt University Medical Center · BARIUM SWALLOW is first test in the work -up of dysphagia in almost all cases . Achalasia Manometry findings? - Failure of LES](https://reader034.vdocuments.mx/reader034/viewer/2022042201/5ea1c8cd07f73a43675a6a34/html5/thumbnails/7.jpg)
Zenker diverticulum
Risk of endoscopy as first step?
- PERFORATION
Treatment?
- Surgery - Divide
cricopharyngeus muscle (myotomy)
- If >2cm should be excised
![Page 8: Dysphagia - Vanderbilt University Medical Center · BARIUM SWALLOW is first test in the work -up of dysphagia in almost all cases . Achalasia Manometry findings? - Failure of LES](https://reader034.vdocuments.mx/reader034/viewer/2022042201/5ea1c8cd07f73a43675a6a34/html5/thumbnails/8.jpg)
Schatzki ring
Treatment?
- dilation
![Page 9: Dysphagia - Vanderbilt University Medical Center · BARIUM SWALLOW is first test in the work -up of dysphagia in almost all cases . Achalasia Manometry findings? - Failure of LES](https://reader034.vdocuments.mx/reader034/viewer/2022042201/5ea1c8cd07f73a43675a6a34/html5/thumbnails/9.jpg)
Mid-esophageal SCC
![Page 10: Dysphagia - Vanderbilt University Medical Center · BARIUM SWALLOW is first test in the work -up of dysphagia in almost all cases . Achalasia Manometry findings? - Failure of LES](https://reader034.vdocuments.mx/reader034/viewer/2022042201/5ea1c8cd07f73a43675a6a34/html5/thumbnails/10.jpg)
Ulcerative esophagitis
![Page 11: Dysphagia - Vanderbilt University Medical Center · BARIUM SWALLOW is first test in the work -up of dysphagia in almost all cases . Achalasia Manometry findings? - Failure of LES](https://reader034.vdocuments.mx/reader034/viewer/2022042201/5ea1c8cd07f73a43675a6a34/html5/thumbnails/11.jpg)
Work-up after barium swallow
• Guided by history
Possible mass upper endoscopy
Staging EUS
Possible reflux pH monitoring
Motility disorder manometry
Extrinsic compression CT scan
![Page 12: Dysphagia - Vanderbilt University Medical Center · BARIUM SWALLOW is first test in the work -up of dysphagia in almost all cases . Achalasia Manometry findings? - Failure of LES](https://reader034.vdocuments.mx/reader034/viewer/2022042201/5ea1c8cd07f73a43675a6a34/html5/thumbnails/12.jpg)
Manometry
![Page 13: Dysphagia - Vanderbilt University Medical Center · BARIUM SWALLOW is first test in the work -up of dysphagia in almost all cases . Achalasia Manometry findings? - Failure of LES](https://reader034.vdocuments.mx/reader034/viewer/2022042201/5ea1c8cd07f73a43675a6a34/html5/thumbnails/13.jpg)
Normal LES
![Page 14: Dysphagia - Vanderbilt University Medical Center · BARIUM SWALLOW is first test in the work -up of dysphagia in almost all cases . Achalasia Manometry findings? - Failure of LES](https://reader034.vdocuments.mx/reader034/viewer/2022042201/5ea1c8cd07f73a43675a6a34/html5/thumbnails/14.jpg)
Normal Relaxation
![Page 15: Dysphagia - Vanderbilt University Medical Center · BARIUM SWALLOW is first test in the work -up of dysphagia in almost all cases . Achalasia Manometry findings? - Failure of LES](https://reader034.vdocuments.mx/reader034/viewer/2022042201/5ea1c8cd07f73a43675a6a34/html5/thumbnails/15.jpg)
Achalasia = “failure to relax”
![Page 16: Dysphagia - Vanderbilt University Medical Center · BARIUM SWALLOW is first test in the work -up of dysphagia in almost all cases . Achalasia Manometry findings? - Failure of LES](https://reader034.vdocuments.mx/reader034/viewer/2022042201/5ea1c8cd07f73a43675a6a34/html5/thumbnails/16.jpg)
Hiatal Hernia
![Page 17: Dysphagia - Vanderbilt University Medical Center · BARIUM SWALLOW is first test in the work -up of dysphagia in almost all cases . Achalasia Manometry findings? - Failure of LES](https://reader034.vdocuments.mx/reader034/viewer/2022042201/5ea1c8cd07f73a43675a6a34/html5/thumbnails/17.jpg)
Sources
• Villeneuve, James P. MDCM, PhD, FRCSC, and R. Sudhir Sundaresan, MD, FRCSC, FACS. “Dysphagia.” ACS Surgery. April 2010.
• Bremner, Cedric G. “Section I – Esophagus.” Ed. John L. Cameron. Current Surgical Therapy, 9th Ed. Mosby, Inc. 2008.