L14 Esophageal Dysphagia

Question 1

In the esophagus, sympathetic innervation controls __________ and parasympathetic innervation controls ________-

Answer 1

peristaltic contractions

digestion

Question 2

What are the 4 cardinal symptoms of pharyngeal dysphagia?

Answer 2

• problems initiating swallow
• postnasal regurgitation
• deglutitive cough
• repetitive swallows

Question 3

What is a hiatal hernia?

Answer 3

when the LES is loose and part of the stomach goes up through it

Question 4

Describe GER

Answer 4

• backflow of stomach contents into esophagus
• heartburn symptoms
• high incidence of esophagitis
• night supine reflux
• prolonged episodes
• greater incidence of obesity
• esophagus has natural protection against acid and pepsin

Question 5

Describe laryngopharyngeal reflux LPR

Answer 5

• backflow of stomach contents into laryngopharynx
• don’t experience heartburn
• low incidence of esophagitis
• daytime upright reflux
• brief episodes
• BMI varies
• larynx is vulnerable to acid and pepsin

Question 6

What is a Schatzki ring?

Answer 6

just above LES is an indentation in the esophagus - a mucosal shelf where food can stick

Question 7

What is an A ring

Answer 7

a muscular ring in the esophagus

Question 8

What is a a web?

Answer 8

a mucosal web higher up in the esophagus

Question 9

What is a stricture?

Answer 9

progressive tightening of the esophagus where liquids can get through but not solids, may need to be dilated

Question 10

If someone has esophageal problems that involve only solids, are progressive and rapid weight loss, what is the likely problem?

Answer 10

cancer

Question 11

What is achalasia?

Answer 11

-absence of peristalsis and failure of the LES to open leads to a dilated esophagus with a ‘birds beak’ appearance at the bottom

Question 12

Describe distal esophageal spasm

Answer 12

• high amplitude non-peristaltic contractions. Involve chest pain and dysphagia
• ‘corkscrew’ esophagus

Question 13

Describe hypertensive persitalsis

Answer 13

AKA nutcracker esophagus

• high intensity peristaltic contractions > 180mmHg
• chest pain and dysphagia

Question 14

T or F: imaging of the esophagus may be optionally included in a VFS study done by an SLP

Answer 14

True - but we aren’t qualified to interpret esophageal motility or anatomical findings, if these are suspected we must refer to physician for interpretation

Question 15

If someone has difficulty swallowing and alump in their throat between meals it is likely _____

Answer 15

globus

Question 16

If someone has difficulty swallowing and food sticks during meals in their sternum the problem is likely _________

Answer 16

esophageal

Question 17

If someone has difficulty swallowing and food sticks during meals in their neck the problem is likely _________

Answer 17

pharyngeal or esophageal (referred)

Question 18

If someone has difficulty swallowing and food sticks during meals in their neck and they have postnasal regurgitation and deglutitive cough, the problem is likely _________

Answer 18

pharyngeal

Question 19

In esophageal dysphagia, if the problem involves solids only it is likely _________ if it involves solids and liquids its is likely ________

Answer 19

structural

dysmotility

Question 20

If someone has esophageal dysphagia, affecting solids only and it is intermittent non progressive, what is it?

Answer 20

ring and/or web

Question 21

If someone has esophageal dysphagia, affecting solids only and it is progressive, with reflux what is it?

Answer 21

stricture

Question 22

If someone has esophageal dysphagia, affecting solids and liquids and it involves pain and a lot of regurgitation what is it?

Answer 22

achalasia

Question 23

If someone has esophageal dysphagia, affecting solids and liquids and it involves a lot of pain and possibly regurgitation what is it?

Answer 23

spasm