DYSPHAGIA
-
~
V v V
ESOPHAGEAL P D
UES dyslundion
. .
ORAL PHASE D .
PHARUNGEAL PD
. .
pain/chest
P
symptoms difficulties
miliating ↓
symptoms e epigastric
·
in
·
- ·
eliology-> #& N cancers
swallowing types d.
· nasal
regurgitation -
hypertensive
I
-
spasm neurological ·
hyposalivation
GERE
pulm Ab
ingestis weight loss
· .
symptoms
·
difficulties
miliating
·
- in
hypotensive esoph rogurgitia regurgitation
.
swallowing
-
·
neuromuscular diseases
·
etiology t nasal solid
regurgitation dysphagiz -> solid
·
·
#& N cancers achalasia +
incomplete relaxation - Cricoph pulm Ab
ingestis
-
- · .
infections lymphoma
pharyngeal CNs
muscular dystrophy
age -
Stroke oculoph .
inadequate opening cricoph bar
neurological
-
diseases
.
zenuers
dyscutonomic
delayed relaxes
primary mo
eviology NM disorder >
·
V >
-
->
Clinical picture secondary
symptoms
-
- > onset
· character
structural disorder > intr
·
associations -
·
irradiations
·
exacerbations
·
time + duration
#
·
severity
investigations - barium swallow
·
EUS
·
manometry
·
CT scan
-
dysphagitlochest,
to the neck +
dysphagia
nasal
reg - dspiration t ENT sympt
.
V
OROPHARUNGEAL
solid-liquid
, ACHALASIA SCERODERMA CAUS
DES NUTCRACKER E STRUCTURES
.
PKS MALIGNANCY INT
GERD
-hereditary unknown esophageal ringst 77040
eliology
Smooth atrophy
3
muscle
·
· dogenolivereducina
accidental
·
· ·
of neurons associations Rt therapy/caustic in
tury
possible iron deficiency ate
·
anemia + suicide
F)M occupational history : SCC
·
of
·
FoE
·
>
Dre
-
dysphagiz
·
a
↳
·
35-4040 GERD/BE : Ac ↓
Malignancies
·
CT disease ·
tabli
plexus MRGE Varices +C
immunological
·
·
·
·
esophagitis Iron
symploms
dysphagia vomiting
if
· dysphagiafollyif when dysphagiz
n s
wesm dysphagic
·
(solids Liquids) -only
dysphagia
+
·
: internitent ·
·
persistent ·
severe chest pain solids + Liquids ·
weight loss
·
aysphagiz
odyno phagi
stage
·
chronic · ulceration - chest pain-late
mucosal ery
·
·
·
bleeding odynophagia drooling
·
regurgitation (75 %)
·
heartburn
-
·
hematemesis
rongue edem
·
·
·
coughing/chocking chest pain stridor
chestpaise
· ·
*
chest hoarseness o
·
pain (40 % ) · heartburn ·
↓
·
tardive : -St
·
weight loss ·
dysphagia · S
· strictures
Eckardt score - hematemesis
↓
Alkali
ingeliqu
ing - coa
Acidic
one zone of stricture (instead of 3) core appearance
apple
·
Barium swallow ·
Bird's beak-initially ·
Corkscrew appearance ·
barium rellox · stenosis
latest
Signoid esophagus
-
·
lument dilatation not
indicated esophagiuis take biopsy ! diagnostic th
·
· narrow
·
mass-1 ·
Endoscopy
upstream
eid
pressure
-
·
poolig
· resistance to intubation
elevated LES pressures ·
Prolonged high-amplitude
,
·
esoph pressure
.
(180 mmHg hypotony of LES ·
lower 1/3 :
↑ see tone
swallowing
·
contractions when relaxation
(35 mmt ( non-peristaltic ·
good
Manometry
OR ·
normal peristal sis low amplitude ware
relaxation
·
·
incomplete Les
and repliea
· absent peristalsis
·
simultaneous
Chicago dassilication
deep
: esophagus
a
tears
complications ·
Candida esophagilis mucosal
· Bronco aspiration
carcinoma
· epidermoid
PPIs emeric sub
(rheumatological removal no
. Medical
1 therapy mechanical dilation endoscopic
-
· ·
·
Treatment of ster tspalliative CCS
1st
bougies placement no
= medical therapy dilation
· a
1st
·
·
line
. Endoscopy
2 of balloons ↳
· nitrates + CaC blockers
therapy
·
control of sumploms
bougies ·
surgery if n
low rates
· medical
↓ balloons
response 4. PPIs palliative
-
(only if
· ·
↳ nitrates + CacB +
not indicated
OTS
I I I
therapy amicholinergics + PPIs nitrates/CaCB .
2nd-surgical
·
iTS
↓ TCA lower pain sensation
↓ rate
· -
high success
↓
I I
. Pneumatic
1 dilation
I
↳
torwrsa
goodshort %
2nd line complications : perforation
endoscopy/surgery
boochine
I I
·
toxim
.
2 Botulinum POEM ,
in 6
·
mo
↳ recurrence
lundodoplicatio
↳
great prognosis
. Heller's
3 mychomy +
in 90 % Pneumatic dilation
↳ excellent prognosis
·
4 POEM
· stent placement
.
BASED on Type
risk
how surgical
I-# Pneumatic dilation
Type >
= .
·
· mydomy
·
I
Type - Myoomy
· PoEM
risk
High surgical
bohlinum int
· All hypest
HIATAL HERNIA ESOPHAGITIS
V
clinical symptoms
GERD
·
dysphagia
·
odynophagia
chest pain
95%
·
typ
pair
type # ·
epigastric
I
type ·
laryng .
Symptoms
, MALIGNANT TURORS
V Clower
V (middle)
SQUAMOUS
CEL ADENOCARANOMA
CARCINOMA
EPIDEMONGY
V ~
· dincideae · incidea
white 6 : 1
·
Black : white = 1 :
4
-
Black : =
BE
dysplasia ·
precursor :
· precursor : Sq .
RISK FACTORS
~
~ · GERD/BE-10%
· tobacco use ·
Obesity
a
Alcoholab smoking
·
· ·
HP-protective
and fatty
Offer
·
High intake of processed
mistszis
↓
beverages
Picture
· hot
CLINICAL
·
HPV
vintake of fruits ,
·
veg
· PV syndrome
W
·
major e dysphagia
loss
weight
doia
dysphagiALARMO
· minor -
matory
·
regurgitation
tracheobronchialeishiz
· minor -
doia
regurgitation
tracheobronchialeishiz
~
V
1 Barium
.
esophagography .
1 Barium esophagography
2 .
Esophagograstro duodenoscopy . EGD
2
w/ biopsy
Mil
CT Pet
Bronchoscopy
,
,
.
3
,
Siewert classilication
4 .
.
3 Bronchoscopy ,
It of chest
PET M1l
4
. +
& /
STAGING
V
1 . Upper endoscopy
EUSPo. .
2 .
: 5 cm
3 wall thickness
- abnormal
CT
thickening
.
e
wall
· -Tzasum we thickening
·minalobstudio bronchial is ae
1 EUS
4 IN assessment
+ .
.
.
2 PET =
e
.
3 Normal t
(bones ( adiendes
via Ct +
1 .
Liver > lungs
. Distant
3 mets
assessment . RECIST criteria
Criteria
. Response
6 ·
FDG-PET/CT
· iREUST
TREATMENT
v
-
~
V v V
ESOPHAGEAL P D
UES dyslundion
. .
ORAL PHASE D .
PHARUNGEAL PD
. .
pain/chest
P
symptoms difficulties
miliating ↓
symptoms e epigastric
·
in
·
- ·
eliology-> #& N cancers
swallowing types d.
· nasal
regurgitation -
hypertensive
I
-
spasm neurological ·
hyposalivation
GERE
pulm Ab
ingestis weight loss
· .
symptoms
·
difficulties
miliating
·
- in
hypotensive esoph rogurgitia regurgitation
.
swallowing
-
·
neuromuscular diseases
·
etiology t nasal solid
regurgitation dysphagiz -> solid
·
·
#& N cancers achalasia +
incomplete relaxation - Cricoph pulm Ab
ingestis
-
- · .
infections lymphoma
pharyngeal CNs
muscular dystrophy
age -
Stroke oculoph .
inadequate opening cricoph bar
neurological
-
diseases
.
zenuers
dyscutonomic
delayed relaxes
primary mo
eviology NM disorder >
·
V >
-
->
Clinical picture secondary
symptoms
-
- > onset
· character
structural disorder > intr
·
associations -
·
irradiations
·
exacerbations
·
time + duration
#
·
severity
investigations - barium swallow
·
EUS
·
manometry
·
CT scan
-
dysphagitlochest,
to the neck +
dysphagia
nasal
reg - dspiration t ENT sympt
.
V
OROPHARUNGEAL
solid-liquid
, ACHALASIA SCERODERMA CAUS
DES NUTCRACKER E STRUCTURES
.
PKS MALIGNANCY INT
GERD
-hereditary unknown esophageal ringst 77040
eliology
Smooth atrophy
3
muscle
·
· dogenolivereducina
accidental
·
· ·
of neurons associations Rt therapy/caustic in
tury
possible iron deficiency ate
·
anemia + suicide
F)M occupational history : SCC
·
of
·
FoE
·
>
Dre
-
dysphagiz
·
a
↳
·
35-4040 GERD/BE : Ac ↓
Malignancies
·
CT disease ·
tabli
plexus MRGE Varices +C
immunological
·
·
·
·
esophagitis Iron
symploms
dysphagia vomiting
if
· dysphagiafollyif when dysphagiz
n s
wesm dysphagic
·
(solids Liquids) -only
dysphagia
+
·
: internitent ·
·
persistent ·
severe chest pain solids + Liquids ·
weight loss
·
aysphagiz
odyno phagi
stage
·
chronic · ulceration - chest pain-late
mucosal ery
·
·
·
bleeding odynophagia drooling
·
regurgitation (75 %)
·
heartburn
-
·
hematemesis
rongue edem
·
·
·
coughing/chocking chest pain stridor
chestpaise
· ·
*
chest hoarseness o
·
pain (40 % ) · heartburn ·
↓
·
tardive : -St
·
weight loss ·
dysphagia · S
· strictures
Eckardt score - hematemesis
↓
Alkali
ingeliqu
ing - coa
Acidic
one zone of stricture (instead of 3) core appearance
apple
·
Barium swallow ·
Bird's beak-initially ·
Corkscrew appearance ·
barium rellox · stenosis
latest
Signoid esophagus
-
·
lument dilatation not
indicated esophagiuis take biopsy ! diagnostic th
·
· narrow
·
mass-1 ·
Endoscopy
upstream
eid
pressure
-
·
poolig
· resistance to intubation
elevated LES pressures ·
Prolonged high-amplitude
,
·
esoph pressure
.
(180 mmHg hypotony of LES ·
lower 1/3 :
↑ see tone
swallowing
·
contractions when relaxation
(35 mmt ( non-peristaltic ·
good
Manometry
OR ·
normal peristal sis low amplitude ware
relaxation
·
·
incomplete Les
and repliea
· absent peristalsis
·
simultaneous
Chicago dassilication
deep
: esophagus
a
tears
complications ·
Candida esophagilis mucosal
· Bronco aspiration
carcinoma
· epidermoid
PPIs emeric sub
(rheumatological removal no
. Medical
1 therapy mechanical dilation endoscopic
-
· ·
·
Treatment of ster tspalliative CCS
1st
bougies placement no
= medical therapy dilation
· a
1st
·
·
line
. Endoscopy
2 of balloons ↳
· nitrates + CaC blockers
therapy
·
control of sumploms
bougies ·
surgery if n
low rates
· medical
↓ balloons
response 4. PPIs palliative
-
(only if
· ·
↳ nitrates + CacB +
not indicated
OTS
I I I
therapy amicholinergics + PPIs nitrates/CaCB .
2nd-surgical
·
iTS
↓ TCA lower pain sensation
↓ rate
· -
high success
↓
I I
. Pneumatic
1 dilation
I
↳
torwrsa
goodshort %
2nd line complications : perforation
endoscopy/surgery
boochine
I I
·
toxim
.
2 Botulinum POEM ,
in 6
·
mo
↳ recurrence
lundodoplicatio
↳
great prognosis
. Heller's
3 mychomy +
in 90 % Pneumatic dilation
↳ excellent prognosis
·
4 POEM
· stent placement
.
BASED on Type
risk
how surgical
I-# Pneumatic dilation
Type >
= .
·
· mydomy
·
I
Type - Myoomy
· PoEM
risk
High surgical
bohlinum int
· All hypest
HIATAL HERNIA ESOPHAGITIS
V
clinical symptoms
GERD
·
dysphagia
·
odynophagia
chest pain
95%
·
typ
pair
type # ·
epigastric
I
type ·
laryng .
Symptoms
, MALIGNANT TURORS
V Clower
V (middle)
SQUAMOUS
CEL ADENOCARANOMA
CARCINOMA
EPIDEMONGY
V ~
· dincideae · incidea
white 6 : 1
·
Black : white = 1 :
4
-
Black : =
BE
dysplasia ·
precursor :
· precursor : Sq .
RISK FACTORS
~
~ · GERD/BE-10%
· tobacco use ·
Obesity
a
Alcoholab smoking
·
· ·
HP-protective
and fatty
Offer
·
High intake of processed
mistszis
↓
beverages
Picture
· hot
CLINICAL
·
HPV
vintake of fruits ,
·
veg
· PV syndrome
W
·
major e dysphagia
loss
weight
doia
dysphagiALARMO
· minor -
matory
·
regurgitation
tracheobronchialeishiz
· minor -
doia
regurgitation
tracheobronchialeishiz
~
V
1 Barium
.
esophagography .
1 Barium esophagography
2 .
Esophagograstro duodenoscopy . EGD
2
w/ biopsy
Mil
CT Pet
Bronchoscopy
,
,
.
3
,
Siewert classilication
4 .
.
3 Bronchoscopy ,
It of chest
PET M1l
4
. +
& /
STAGING
V
1 . Upper endoscopy
EUSPo. .
2 .
: 5 cm
3 wall thickness
- abnormal
CT
thickening
.
e
wall
· -Tzasum we thickening
·minalobstudio bronchial is ae
1 EUS
4 IN assessment
+ .
.
.
2 PET =
e
.
3 Normal t
(bones ( adiendes
via Ct +
1 .
Liver > lungs
. Distant
3 mets
assessment . RECIST criteria
Criteria
. Response
6 ·
FDG-PET/CT
· iREUST
TREATMENT
v
