10/5- Esophageal Diseases Flashcards
(31 cards)
How often does a normal adult swallow?
600 times/24 hrs (unconsciously)
What are the two parts of swallowing?
- Voluntary/involuntary?
- Muscles involved
Oropharyngeal
- Voluntary + involuntary
- Striated ??
Esophageal
- Involuntary
- Smooth muscle of the esophagus
Describe the oropharyngeal phase of swallowing
- Initiation of swallow
- Nasopharynx
- Protection of airway
- Clearing
Involves 26 muscles and 5 CN
What is dysphagia?
Sensation of ingested material being hindered in tits normal passage from the mouth to the stomach
Where can problems occur during the oropharyngeal phase of swallowing?
- Difficulty initiating swallowing
- Nasopharyngeal regurgitation
- Pulmonary aspiration
- Residual
What innervates the esophagus?
Medulla
- Nucleus ambiguus (NA) controls skeletal muscle
- Dorsal motor nucleus (DMV) controls the smooth muscle
NTs are: ACh, NO, VP
Dual innervation:
- Vagal pathway: through the nodose ganglia to the nucleus solitarius of the medulla
- Sympathetic
Some pathways may overlap with those of the heart and respiratory system (chest pain may be a symptom of varied esophageal conditions)
Describe the anatomy of the esophagus (the plexi)
Myenteric plexus (Auerbach’s plexus):
- Motor innervation to both layers of the muscular layer
- Secretomotor innervation
- Sensory component
Submucosal plexus (Meissner’s plexus)
- P-sympathetic
- Sensory neurons
What are the 2 broad categories of things causing dysphagia?
- Structural lesions
- Abnormal motility
The patient might not have dyshpagia; they might be describing __?
Globus (problem with the lungs)
What are comorbidities of dysphagia?
- Collagen vascular disease
- Immunosuppression
- h/o trauma, radiation, surgery
What can cause odynophagia?
(Pain on swallowing)
- Pill esophagitis
- Infection (immunosuppressed)
What should you think of if the esophageal dysphagia is solid only and intermittent?
- Esophageal ring
- Eosinophilic esophagitis
What should you think of if the esophageal dysphagia is solid only and progressive?
- Peptic stricture (chronic heartburn)
- Malignancy (pt > 50, weight loss)
What should you think of if the esophageal dysphagia is solid and/or liquid and intermittent?
- Diffuse esophageal spasm (with chest pain)
What should you think of if the esophageal dysphagia is solid and/or liquid and progressive?
- Scleroderma (chronic heartburn)
- Achalasia (regurgitation weight loss)
Pathogenesis of esophageal pain (stimuli/pathway)?
- Acid hyperosmolarity -> chemoreceps
- Distention/contraction -> mechanoreceps
- ?
What are the diagnostic modalities for esophageal diseases?
- Endoscopy
- Endoscopic ultrasound (especially useful in staging esophageal cancer)
- Barium esophagram
- Manometry/pressure topography
- pH monitoring (for reflux testing; lies 5 cm above LES)
-
What are some esophageal diseases?
- Structural disorders
- Mobility disorders
- Eosinophilic esophagitis
- GERD
- ?
What is Zenker diverticulum?
Regurgitation of undigested food
- Bad breath
- Pharyngoesophageal diverticulum
- Located superior to the cricopharyngeus muscle and inferior to the inferior constrictor muscles (Killian’s triangle)
When to you treat a Zenker diverticulum?
When diverticulum is very large or symptomatic, can do:
- Endoscopic myotomy
- Surgery
What is a hiatus hernia? Types?
Hiatal hernia = stomach herniates upward through the esophageal hiatus of the diaphragm
- Sliding HH: GEJ is displaced upward
- P-esophageal: GEJ is normal; fundus protrudes into the thorax
What is Barrett’s esophagus?
- What causes it?
- What is it associated with?
Intestinal metaplasia: replacement of squamous epithelium with intestinal epithelium (columnar with goblet cells) in the distal esophagus
- Due to chronic inflammatory due to gastroesophageal reflux disease (GERD)
- Associated w/ esophagitis, esophageal ulcers, increased risk of esophageal adenocarcinoma
T/F: Many patients with Barett’s esophagus do not have dysplasia?
True
- Handle with surveillance and GERD treatment
Case 1)
- 45 yo WF
- Intermittent esophageal dysphagia to solids only
- Otherwise healthy
- No weight loss
- Esophagram shows narrowing in esophagus
- Endoscopy shows concentric ring of mucosal tissue
What is the diagnosis?
A. Radiation-induced stricture
B. Schatzki’s ring
C. Esophageal adenocarcinoma
D. Achalasia Treatment?
What is the diagnosis?
A. Radiation-induced stricture
B. Schatzki’s ring
C. Esophageal adenocarcinoma
D. Achalasia Treatment?
- Classic presentation is intermittent
Treatment:
- Various dilators to stretch airways
- Balloon to break up ring
- Acid suppression
