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Diseases of the esophagus.docx

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NURS 203
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Diseases of the esophagus Dysphagia and odynophgia = difficulty swallowing Most of the time, there will be 5-6 clues per question. A pt has problem swallowing foods, is it solids or liquids? If the pt can take down liquids and not solids (difficulty in swallowing solids), it is due to obstruction – can be due to esophageal web in Plummer Vinson syndrome, IDA with glossitis and cheilosis and an esophageal web, esophageal cancer If pt has problem swallowing solids AND liquids, it is a peristalsis problem, which is very bad. If it’s the upper 1/3 of the esophagus (which is all striated muscle), it is due to myasthenia gravis (b/c it affects striated muscle). If it’s the middle 1/3 (combo of smooth and striated muscle). And if it’s the lower 1/3 (smooth muscle) it’s due to Scleroderma (aka progressive systemic sclerosis and CREST syndrome) and achalasia. So, they will tell you immediately if they can swallow liquids and/or solids, or neither (which is a peristalsis problem). How can you distinguish PSS/CREST from achalasia? In achalasia, they vomit up the food they ate when they go to bed at night; or they will tell you pt has Raynaud’s, indicating that it is CREST. Odynophgia = PAINFUL swallowing; always abnormal In HIV pt = Candida esophagitis – is it AIDs defining? Yes. MC fungal infection in HIV = Candida When it gets into the esophagus, it is AIDs defining When it is a thrush, it is PRE AIDS lesion (not aids defining) Helpful hints with other diseases: Palpable purpura = immune HPY type III = Henoch Schonlein (MC) Epistaxis = platelet problem (don’t think hemophilia)…they give clues! Pansystolic murmur increases on inspiration = tricuspid regurg Pansystolic murmur increases on expiration = mitral regurg Tracheoesophageal fistula Blindly ending esophagus (prox esophagus ends blindly) – distal esophagus arrives from the trachea. What does the mom have? Polyhydramnios – amniotic fluid is baby urine, so have to recycle it, or mom will have big belly. So, the baby swallows it and it is reabsorbed in the small intestine. So, if you have obstruction in the esophagus, or proximal portions of the duodenum, mom will have polyhydramnios. So, there are 2 answers: 1) Tracheoesophageal fistula 2) duodenal atresia in Down’s syndrome – these 2 are associated with polyhydramnios. They block the ability to reabsorb amniotic fluid, leading to polyhydramnios. Also, when these kids eat, food gets caught and kids cough and sputter b/c the distal esophagus arises from the trachea and leads to distension of the stomach. This is very characteristic. Zenker’s diverticulum Area of weakness – cricopharyngeous muscle. It has a lil slit in between the fibers of it. Not the whole area is cut (which would be a true diverticulum – this is a false diverticulum). It goes out and gets a pouch. The pouch collects food and leads to halitosis. They have a tendency of regurgitating undigested food out of the nose. Achalasia Peristalsis prob – prob with relaxation of the LES, therefore it is in spasm all the time. Why? If you bx that area, this means that the ganglion cells are missing. What dz does this remind you of? Hirschsprung dz. What is in those ganglion cells? Vasointestina
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