Download Free Medical ESOPHAGEAL TOPICS PowerPoint Presentation

ESOPHAGEAL TOPICS PowerPoint Presentation

DOWNLOAD MEDICAL POWERPOINT PRESENTATION

About This Presentation

Description : Check out this medical presentation on Barretts Esophagus, which is titled "ESOPHAGEAL TOPICS", to know about various esophageal topics.

Tags : Digestive System, ESOPHAGEAL TOPICS, Barretts Esophagus

Published on : Jul 10, 2021 | Views : 1362 | Downloads : 3

Shareable Url :

Embed Code :

Comment

Transcript

Slide 1-

ESOPHAGEAL TOPICS Norman M. Simon, M.D., F.A.C.G.
Slide 2-

BARRETT’S ESOPHAGUS A change in the lining of the esophagus from the normal squamous lining to an intestinal type lining called intestinal metaplasia. Diagnosis suspected on endoscopy but requires confirmation by pathology examination of biopsies. Vast majority of cases caused by acid reflux and secondary injury to the normal lining. Incidence appears to have increased substantially.
Slide 3-

ppt slide no 3 content not found
Slide 4-

ppt slide no 4 content not found
Slide 5-

Increased incidence of Barrett’s seems responsible for increase in cases of esophageal adenocarcinoma. Controversy re. who to screen for Barrett’s. When Barrett’s suspected, biopsies taken to confirm diagnosis and to check for dysplasia. Monitoring generally being done at three to five year intervals unless dysplasia is found. Then depends on whether low or high grade changes.
Slide 6-

Candidates For Screening Caucasian Males Over 50 years of age Chronic symptoms of GERD Nocturnal reflux symptomatology Increased BMI with intra-abdominal fat distribution Tobacco use
Slide 7-

BARRETT’S WITHOUT DYSPLASIA
Slide 8-

BARRETT’S LOW-GRADE DYSPLASIA
Slide 9-

BARRETT’S HIGH-GRADE DYSPLASIA
Slide 10-

BARRETT’S HIGH GRADE DYSPLASIA
Slide 11-

Some evidence that anti-reflux treatment helps prevent the development of pre-cancerous dysplasia and cancer in patients with Barrett’s. Role of anti-reflux surgery controversial. Patients with low-grade dysplasia are monitored more frequently than those with no dysplasia. ? Eradicate the Barrett’s. If not, recheck every 6-12 months vs. every 3-5 yrs.
Slide 12-

Options for patients with high-grade dysplasia include doing nothing, surgical resection, intensive monitoring, photodynamic treatment, endoscopic mucosal resection, argon plasma coagulation, radio frequency ablation (HALO), and endoscopic spray cryotherapy
Slide 13-

Barrx 360 RFA Balloon Catheter
Slide 14-

26 y/o male with history of recurrent dysphagia for solids which seem to catch at midsubsternal level. Drinks fluids to clear the “obstruction.” Has been going on for about 6 months. Denies heartburn or other reflux symptoms. Past hx. negative aside from many year hx. of asthma. WHAT IS YOUR DIFFERENTIAL DIAGNOSIS?
Slide 15-

EOSINOPHILIC ESOPHAGITIS Also known as “allergic esophagitis”. Predominant symptom is dysphagia. Increasing incidence over past two decades. Occurs in both children and adults with majority being males. In adults, majority are in their 20’s and 30’s. High percentage have allergic issues including asthma, food allergies, hives, hay fever.
Slide 16-

EOSINOPHILIC ESPHAGITIS (CONT) Findings can include multiple rings, narrowed esophagus, whitish nodules, furrows, & strictures in upper esophagus. Some cases have involved several family members. Etiology may relate to food allergies, additives, pollen, reflux?
Slide 17-

ppt slide no 17 content not found
Slide 18-

ppt slide no 18 content not found
Slide 19-

ppt slide no 19 content not found
Slide 20-

FURROWS
Slide 21-

ppt slide no 21 content not found
Slide 22-

ppt slide no 22 content not found
Slide 23-

TREATMENT Trial of anti-reflux medication-PPI. Allergy testing and diet changes. Elemental diet Avoidance of six most frequent allergenic foods (eggs, soy, wheat, cow-milk protein, peanuts, and seafood). SFED Steroid inhaler- swallowing rather than inhaling the medication. Fluticasone propionate. Oral Prednisone- higher incidence of side effects. Dilitation- risks of perforation.
Slide 24-

ppt slide no 24 content not found
Slide 25-

SCHATZKI’S RING Occur at the distal end of esophagus at junction of esophagus and stomach. Often are assymptomatic. Probably are a consequence of reflux. Treatment is dilitation with bougie or balloon- may be best to go directly to large size ( 50 french or larger). Data shows decreased rate of recurrence with placing patients on anti-reflux medications.
Slide 26-

SCHATZKI’S RING
Slide 27-

ESOPHAGEAL STRICTURE
Slide 28-

ESOPHAGEAL STRICTURES Many causes including reflux, malignancy, radiation, toxic ingestions (e.g. lye), surgical anastomoses, sclerotherapy. Dilitation generally done gradually stepwise, often no more than three sizes on one day. Balloons (TTS) and standard dilators seem to produce similar results. Longterm anti-reflux therapy can reduce recurrence rate in many cases.
Slide 29-

ppt slide no 29 content not found
Slide 30-

ppt slide no 30 content not found
Slide 31-

69 y/o male with 1 ½ year of dysphagia primarily for solids which sometimes lodge in area of lower neck or upper chest region. Also has experience of coughing up small bits of food he ingested at a previous meal. WHAT DIAGNOSES WOULD YOU CONSIDER?
Slide 32-

ZENKER’S DIVERTICULUM Diverticulum occuring at junction of pharynx and upper esophagus. The “pocket” faces posteriorly. Dysphagia often occurs immediately with swallowing. Presents with dysphagia and/or spitting up of food eaten earlier. Also may complain of halitosis. Thought to be due to malfunctioning of the upper esophageal sphincter.
Slide 33-

ppt slide no 33 content not found
Slide 34-

ZENKER’S DIVERTICULUM
Slide 35-

Zenker’s Diverticulum (cont.) Treatment options include surgery through side of the neck with cutting the sphincter along with possible removal of the diverticulum or an endoscopic technique known as endoscopic staple-assisted esophagodiverticulostomy.
Slide 36-

NORMAL ESOPHAGEAL MANOMETRY
Slide 37-

ACHALASIA Achalasia is well recognized as a cause of swallowing difficulty. Distal esophageal sphincter does not relax with a swallow and the muscle of the lower esophagus does not propel the food or liquid downwards i.e. abnormal peristalsis. Result is dysphagia, occasionally chest pain and regurgitation, and weight loss X-rays can reveal a dilated esophagus.
Slide 38-

ACHALASIA (CONT.) On endoscopy often see retained food and secretions in esophagus even though patient has been NPO. Characteristic “yield” of LES to the scope being advanced. “Pseudo-achalasia”
Slide 39-

X-RAYS OF ACHALASIA
Slide 40-

ppt slide no 40 content not found
Slide 41-

ACHALASIA TREATMENT Three common treatment options Pneumatic forceful balloon dilitation with Rigiflex balloon. May not work; uncomfortable for patient; 3-5% risk of perforation. Botox injection. Not always successful. Tends to lose effect in 6-12 months requiring reinjection. Good option for poor surgical candidates. Surgery-laparoscopic myotomy. Cut the sphincter and add partial fundoplication. Rarely, Calcium Channel blockers or Nitrates.
Slide 42-

OTHER MOTILITY PROBLEMS Nutcracker esophagus, diffuse esophageal spasm, and hypertensive lower esophageal sphincter are three patterns often seen. Controversy as to whether these conditions can cause non-cardiac chest pain and/or dysphagia. In spite of these uncertainties treatment is often tried to see if clinical response. In some patients, may be related to reflux and therefore often give trial of anti-reflux medication first.
Slide 43-

DIFFUSE ESOPHAGEAL SPASM
Slide 44-

HYPERTENSIVE LES
Slide 45-

NUTCRACKER ESOPHAGUS
Slide 46-

Treatment In many patients improvement can be a consequence of learning they don’t have a serious cardiac issue. First line therapy often consists of a calcium channel blocker (diltiazem) or an antidepressant (imipramine). Can use nitrates or sildenafil on an as needed basis. Other options include trial of hot liquids with meals, botox injection, bougie.
Slide 47-

Esophageal Varices All patients with cirrhosis should have EGD screening for varices. No varices- rescope in couple years. Small varices- consider NSBB in these patients Large varices- low risk group probably use NSBB. High risk group (red wale signs, advanced liver disease) can choose between NSBB and EVL. Add PPI after EVL (ulceration) Sclerotherapy not warranted for primary prevention of bleeding.
Slide 48-

Esophageal Varices
Slide 49-

Esophageal Varices
Slide 50-

ppt slide no 50 content not found
Slide 51-

Case Presentation 18 y/o female in excellent general health awakens in the morning with rather severe substernal chest pain when she swallows anything even saliva. Has never had similar problems in the past. Her only medication is doxycycline which she has taken for acne for 2 years. WHAT IS YOUR DIFFERENTIAL DIAGNOSIS?
Slide 52-

Medication Ulcers First reported with KCl. Now known to be associated with multiple meds including quinidine, tetracyclines (doxycycline), iron products, alendronate, and anti-inflamatory medications most often ASA Onset is usual rapid and most often noticable on awakening in AM. Chest pain, odynophagia. Injury caused by direct contact of the caustic contents of the medication
Slide 53-

ppt slide no 53 content not found
Slide 54-

Treatment of Pill Ulcers No evidence that any medication speeds healing. Typically resolves in a few days. Pain meds. May need parenteral support in rare cases. Can try suspension of sucralfate (Carafate) or topical anesthetic (xylocaine).