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home - Oesophagus - Miscellaneous - Oesophageal Minutiae Written by Dr Sebastian Zeki
Nausea and Vomiting:
Understands the pathophysiology of vomiting.
Appreciates the gastrointestinal conditions that cause nausea and
vomiting as well as the range of extra-intestinal causes

Recognises the influence of neurological conditions and metabolic
derangements such as diabetes

Understands the physiology of gastric emptying and how this is
affected by disease, toxins and drugs

Abdominal Pain:
Knows the causes of acute and chronic abdominal pain that arise
from upper gastrointestinal, biliary and pancreatic diseases

Understands the clinical presentations of the various conditions
causing pain and the means by which they can be diagnosed and
treated

Weight Loss:
Knows the significance of weight loss as a consequence of upper
gastrointestinal disease, knows those conditions that present with
loss of weight and how they are managed

Skills
Makes a detailed clinical assessment of patients presenting with
symptoms indicating possible upper gastrointestinal disease,
construct a management plan and be aware of the various avenues
of treatment

Behaviours
Evaluates patients in a structured and timely manner, carries out
appropriate investigations and formulates management plan.

Oesophageal Minutiae

Written by Dr Sebastian Zeki Schatzki rings Asymptomatic schatzki rings are present in 6-14 % of routine barium studies.Rings become symptomatic when the internal ring diameter is < 13 mm (39 French). Cervical websThe pathogenesis of cervical webs is also unknown.They are distinct from oesophageal stenoses secondary to tracheobronchial remnants in oesophageal atresia.Webs are associated with iron-deficiency (Plummer-Vinson syndrome) although may be an old wives tale. Refractory rings options include:Balloon dilation.Intralesional steroid injection.Surgery.Endoscopic incision.Acid suppressive therapy.Consider eosinophilic (allergic) oesophagitis.Transendoscopic electrocautery incision-effective in case series. Treatment of websFor oesophagel webs- usually ruptured by endoscope- occasionally formal dilatation needed.If the web is refractory, laser and occasionally surgery needed.Oesophageal rings may need dilation with bougie (>50 French) or balloon dilator.Alternative management includes electrosurgical incision.Exercise caution with multiple rings and eosinophilic oesophagitis as these can perforate.Recurrence is likely. Associations of Cervical webs:Bullous dermatologic disorders such as epidermolysis bullosa (dystrophic, junctional and simplex), in which webs occur in up to 14 % of cases .Bullous pemphigoid, in which mucous membrane involvement occurs in one-third of patients.Pemphigus vulgaris, in which oral mucosal lesions are present in 90 to 100 % of young adults.Desquamative esophagitis in chronic graft-versus-host disease following bone marrow transplantation.Coeliac disease and iron deficiency-described in one report. Oesophageal webs and rings

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