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Barium swallow features of achalasia cardia?
- Dilated esophagus with a distal narrowing
- “Bird’s beak” ,“Pencil-tip” or “Rat’s tail” appearanceQ
- Note - “Rat-tail” filling defectQ in carcinoma esophagus
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Manometry test in achalasia?
- Manometry is gold standard test for diagnosis of achalasia.
- Abnormalities in LES - Incomplete or absent LES relaxationQ • Elevated LES pressureQ
- Abnormalities in esophageal body - Incomplete or absent LES relaxationQ • Elevated LES pressureQ• Elevated intraesophageal pressureQ (pressurization of the esophagus) from incomplete air evacuation • Simultaneous mirrored contractions with no evidence of progressive peristalsisQ• Low-amplitude waveformsQ indicating a lack of muscular tone
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Treatment of choice for achalasia?
Laparoscopic Heller myotomy is now the operation of choiceQ.
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Extent of Heller’s myotomy?
2 cm above GE junction to 1 cm belowQ, over stomach.
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Indications of Esophagectomy in achalasia?
- Megaesophagus, sigmoid esophagus
- Failure of more than one myotomy, or
- Undilatable reflux strictureQ
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Mecholyl test and CCK test positive in?
AchalasiaQ
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Chief complains of diffuse esophageal spasm?
Chest pain and dysphagia, that is heightened in emotional stress
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Barium swallow findings in Diffuse esophageal spasm?
- Corkscrew or rosary-bead esophagus, segmental spasm or pseudodiverticulosis appearanceQ
- Due to presence of tertiary contractionsQ
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Manometry in DES?
- Manometry is gold standard test for diagnosisQ.
- Classic manometry findings: Simultaneous, multipeaked contractions of high amplitude (>120 mm Hg) or long duration (>2.5 sec).
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Diagnosis of nutcracker esophagus?
Peristaltic esophageal contractions 2 standard deviations above the normalQ values on manometric tracings.
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What is Kilian’s triangle? Q
Between the upper oblique fibers (thyropharyngeus muscle) and lower horizontal fibers (cricopharyngeus muscle) of the inferior constrictor muscleQ
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Features of Zenkers diverticulum?
- • Increased intraluminal pressures (secondary to abnormal esophageal motility)Q pushes mucosa and submucosa through a muscular defect in the wall of the esophagus creating a pulsion diverticulumQ
- • It is a pseudodiverticulaQ
- • It arises posteriorly in the midline of the neck, mouth is in midline but sac projects laterallyQ (usually left laterally)
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Patholophysiology of Zenker Diverticulum?
- • Neuromuscular incordinationQ in this region
- • May be due to different nerve supply of the two parts of inferior constrictor muscleQ
- −−The thyropharyngeus (oblique fibers) supplied by the pharyngeal plexus
- −−Cricopharyngeus (horizontal fibers) by recurrent laryngeal nerve
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MC Complications of Zenker Diverticulum?
Pneumonia and lung abscess due to aspirationQ (MC)
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Surgical therapy for Zenker Diverticulum?
Cricopharyngeal myotomy + Diverticulopexy is treatment of choice
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What is Dohlman procedureQ?
Diverticulo-esophagostomy using a linear cutting staple gun - The septum between the esophagus and the diverticula is divided
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Why is Midesophageal diverticulum is also called as Traction Diverticula?
- Inflammation of the lymph nodes exerts traction on the wall of the esophagus leading to the formation of a true diverticulum in the midesophagus.
- Caused by inflamed mediastinal lymph nodes from tuberculosis, histoplasmosisQ and resultant fibrosing mediastinitis.
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Pathophysiology of scleroderma in GI tract?
Smooth muscle atrophy in lower two third of esophagus →Incompetent LES →GERD →StrictureQ
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Manometry finding in scleroderma?
Normal peristalsis in the proximal striated esophagus, with absent peristalsis in the distal smooth muscle portion
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Treatment of scleroderma?
Esophageal shortening may require a Collis gastroplasty in combination with a partial fundoplicationQ
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What is Plummer-vinson Syndrome?
- • Also known as Paterson-Brown Kelly syndrome
- • Occurs in middle aged edentulous (without teeth) womenQ.
- • Premalignant lesionQ (Approximately 10% of patients develop SCC of esophagus, oral cavity or the hypopharynx)
- • Iron-deficiency anemia is a common finding (known as sideropenic dysphagiaQ
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Cause of dysphagia in Plummer-vinson Syndrome?
- Cervical esophageal webQ (Post-cricoid web)
- Abnormal pharyngeal and esophageal motility may play a role.
- Schatzki’s ring - at the lower end of esophagusQ
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