Bulbar vs pseudobulbar palsy
Bulbar palsy (lower motor neuron lesion) causes dysphagia due to
muscles weakness, whereas pseudobulbar palsy (upper motor neuron lesion) causes
dysphagia due to disordered contractions
Alkali burns cause liquefaction necrosis (much more serious), whereas
acidic burns cause coagulation necrosis.
GE Reflux due to lower esophageal sphincter (LES) can be caused by
the effect of recently ingested fat in the duodenum or because of over
distension of the stomach
Suspect GE reflux in patients with persistent nonproductive cough
especially if there is hoarseness
Foods/Substances that Aggravate GERD Symptoms:
• EtOH
• Caffeine
• Tobacco
• Fatty/fried foods
• Chocolate
• Peppermint
• Spicy foods
• Citrus fruit juices
Both acute coronary
syndrome and GERD or esophageal spasm may be relieved by nitroglycerin.
70% of non-cardiac chest pain caused by GE reflux disease and not
necessarily associated with heart burn
No need for endoscopy in patient with classic symptoms of GERD,
the diagnostic workup starts with therapeutic trail
Drugs that may delay gastric emptying and promote reflux are:
calcium channel blockers, antihistamines, tricyclic anti depressing, and
anticholinergics
About 25% of patients with Barrett’s esophagus do not report
symptoms of GERD.
24hr
esophageal pH monitoring is gold standard investigation in GERD
Plummer Vinson
Syndrome Triad:
- Iron Deficiency anemia
- Dysphagia
- Esophageal webs
Plummer-Vinson syndrome
Cervical esophageal web, it is more commonly found in females and often
associated with iron deficiency anemia.
Schatzki ring
Mucosal ring narrowing of the lower esophagus
Causes intermittent dysphagia with solids
Treatment: endoscopic ring disruption
Infectious esophagitis
Candida is the most common cause; herpes is the second most common
If the patient has dysphagia affecting both solids and liquids
from the beginning, think of achalasia as a cause
Odynophagia
(Pain on swallowing) is a typical of esophageal candidiasis, it is a common
complication of inhaled steroid therapy
Alarming
signs and symptoms of dyspepsia (Raise suspicion of gastric malignancy):
• Unintended weight loss
• Persistent vomiting
• Progressive dysphagia
• Odynophagia
• Unexplained anemia or iron deficiency
• Hematemesis
• Jaundice
• Palpable abdominal mass or lymphadenopathy
• Family history of upper GI cancer
• Previous gastric surgery
Helicobacter pylori may be protective against esophageal cancer
Risk factors for esophageal Squamous Cell Carcinoma:
Smoking
Alcohol
Achalasia
Plummer-vinson syndrome
Rare: coeliac disease, scleroderma
Sensitive to radiotherapy
Risk factors for esophageal Adenocarcinoma:
GERD
Barrett's esophagus
Esophageal adenocarcinoma
Esophageal adenocarcinoma is not sensitive to radiation, so the
treatment is only surgery or chemotherapy
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