10/5- Esophageal Diseases Flashcards
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)
