GANGGUAN MOTILITAS TRAKTUS DIGESTIVUS ATAS

SOETAMTO WIBOWO BAG.I.BEDAH FK. UNAIR RS. DR. SOETOMO SURABAYA

MOTOR DISORDERS OF THE ESOPHAGUS

Primary Achalasia Spastic disorders Diffuse and segmental spasm Nutcracker esophagus Hypertensive LES Secondary Collagen vascular diseases Scleroderma, polymyosotis, dermatomyositis, systemic lupus erythematosus, mixed connective tissue disease Idiopathic intestinal dysmotility/pseudoobstruction Neuromuscular diseases Multiple sclerosis, huntingtons chorea, amyotrophic laretal sclerosis, nyotonis dystrophy, cerebrovascular accident Endocrine and metabolic Diabetes, hypothryoiidism, myasthenia gravis Other Trauma or operative nerve injury, radical neck surgery/radiation

Patient Symptoms and Likely Etiologies

Symptoms
Heartburn

Definition
Burning discomfort behind bone Bitter acidic fluid in mouth Sudden filling of mouth with clear/ salty fluid Sensation of food being hindered in passage from mouth to stomach

Likely etiology
Gastroesophageal reflux (GER)

Disphagia

Motor disorders Inflammatory process Diverticula Tumors Odynophagia Pain with swallowing Severe inflammatory process Globus sensation Lump in throat unrelated to swallowing Chest pain Mimics angina pectoris GER Motor disorders Tumors Respiratory Asthma/wheezing, bronchitis, GER Symptoms hemoptysis stridor Diverticula Tumors ENT symptoms Chronic sore throat, laryngitis, GER halitosis, chronic cough Diverticula Rimination Regurgitation of recently ingested Achalasia food into mouth Inflammatory process Diverticula Tumors

ASSESSMENT OF ESOPHAGEAL FUNCTION

CONDITION
Structural abnormalities

DIAGNOSTIC TEST
Barium swallow Endoscopy Chest X-ray CT scan Cine flouroscopy Endoscopic ultrasound

Functional abnormalities Esophageal exposure to gastric content

Manometry (stationary and 24 hours) Transit studies 24 hours pH monitoring

Provoke esophageal sympsoms

Others

Acid perfusion (Berstein) Edrophonium (tension) Ballon distension

Gastric analysis Gastric emptying study Gallbladder ultrasound

RADIOLOGIC STUDIES CONTRAST ESOPHAGOGRAM

Diverticle

RADIOLOGIC STUDIES CONTRAST ESOPHAGOGRAM

Hiatal Hernia

RADIOLOGIC STUDIES CONTRAST ESOPHAGOGRAM

Peptic stricture + Hiatal Hernia

RADIOLOGIC STUDIES CONTRAST ESOPHAGOGRAM

Esophageal Carcinoma

RADIOLOGIC STUDIES CONTRAST ESOPHAGOGRAM

Achalasia primer

ENDOSCOPIC ESOPHAGEAL SYMPTOM

Erosive esophagitis

ENDOSCOPIC ESOPHAGEAL SYMPTOM

Barretts esophagogram

ENDOSCOPIC ESOPHAGEAL SYMPTOM

Ca esophagus excophytic

ENDOSCOPIC ESOPHAGEAL SYMPTOM

Achalasia

ESOPHAGEAL MANOMETRY

Achalasia