Mary Ganley RN BSHA, CGRN
April 13, 2011
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List indications and contraindications for
manometry procedures involving esophagus,
stomach, small bowel, sphincter of oddi and
anal rectal.
Define what a normal swallow appears on the
manometry and how abnormal appears.
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ESOPHAGEAL MANOMETRY
Measures the pressure through out the
regions of the esophagus, which include the upper esophageal
sphincter (UES), the esophagus body, and the lower esophageal
sphincter (LES).
INDICATIONS
1. Evaluation of dysphasic
2. Evaluation of non cardiac chest pain
3. Pre operative evaluation for anti reflux surgery
4. Evaluation of gastric reflux disease
5.Location of LES for PH monitor
6. Exclude GI tract diseases scleroderma and pseudo-obstruction
7. To exclude esophageal etiology anorexia
Uncooperative patients
 Patient with Cardiac instability
 Recent gastric surgery
 Recent administration of sedatives or
narcotics
COMPLICATIONS
 Rare aspiration
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A probe configured with pressure sensors
 Transducer cables to transmit the electrical
signals to amplifiers
 Computer program to display waveforms
Types of Catheters
 Water profusion
 Disposable air-filled probes
 Solid state
 High Resolution manometry
 Impedance Manometry
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Equipment Set Up
Calibrate per manufactures instructions
Water to drink
Topical Anesthetic
60CC Syringe
Kleenex
Basin
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Purpose of test
Positioning that will be used
Effective relaxation methods
Techniques to be used
Approximate length of procedure
Sensation patients are likely to experience
Risk of procedure and the importance of patient
cooperating
Patient should be NPO at least 6 hours
Obtain history as to present symptoms
Medication withheld depends on the physicians
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Place the probe down the nasanpassage of
patients choice
Pass quickly pass the gag refex
Give small sips of water
Pass to the depth of 60-65cm
Verify the distal sensors are in the stomach
by having the patient take a deep breath.
Increased pressure will be seen if the sensor
is below the diaphragm.
Allow the patient to rest a few minutes after
intubation
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Smooth muscle 3 to 5 cm in length
LES relaxes in response to swallowing
LES pressure, length, location and relaxation
are evaluated.
The probe is pulled out 1cm at time
The LES pressure is usual10 to 45 mmHg
Six to 10 5cc of water given to patient and
recorded
He probe is then pulled 5 cm above the LES
Ten swallows are given to measure
esophageal muscle response
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Normal Swallow
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Abnormal findings
Swallows
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UES is striated muscle very high pressure and
requires a soldd state catheter
Bernstein Test
Used to asses esophageal sensitivity to acid.
Normal saline and 0.1G HCL are alternately
infused through the Bernstein port of the
manometry probe. The discomfort
experienced by the acid infusion must
duplicate the typical symptoms for it to be
considered positive
Achalasia
Difficulty swallowing
Nocturnal regurgitation
Pulmonary symptoms
Manometry Symptoms
Absent Peristalsis
Incomplete LES relaxation
Hypertensive LES
 Distal Esophageal Spasms
Simultaneous swallows
Repetitive contraction
Incomplete LES closure
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IEM – Ineffective Esophageal Motility
Low contraction amplitude
Nutcracker Esophagus
Nutcracker esophagus is a disorder of the movement of the esophagus,
and is one of many motility disorders of the esophagus, including
achalasia and diffuse esophageal spasm. It causes difficulty swallowing, or
dysphagia, to both solid and liquid foods, and can cause chest pain; it
may also be asymptomatic. Nutcracker esophagus can affect people of
any age, but is more common in the 6th and 7th decades of life. The
diagnosis is made by an esophageal motility study (esophageal
manometry), which evaluates the pressure of the esophagus at various
points along its length. The term "nutcracker esophagus" comes from the
finding of increased pressures during peristalsis, with a diagnosis made
when pressures exceed 180 mmHg; this has been likened to the pressure
of a mechanical nutcracker. The disorder does not progress, and is not
associated with any complications; as a result, treatment of nutcracker
esophagus targets control of symptoms only. Symptoms Nutcracker
esophagus is characterized as a motility disorder of the esophagus,
meaning that it is caused by abnormal movement, or peristalsis of the
esophagus. ...
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Hypertensive LES
Scleroderma
Small Bowel Manometry
Sphincter of Oddie Manometry
Anal Manometry
Questions