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Flashcards in Esophageal Disorders Deck (74)
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1

What is the esophagus?

Muscular tube that conveys food from pharynx to stomach

2

Muscle layers of the esophagus? 2

What is it missing?

Food passes through quickly because of what?

1. Inner circular muscle

2. Outer longitudinal muscle

 

No serosa

 

peristalsis

3

Which part of the muscle is contracting during swallowing and which is relaxaing?

1. Circular muscle contraction after the bolus

2. Circular muscle relaxation before the bolus

4

What are the two types of movement in the esophagus and describe them?

5

Dysphagia common etiologies

1. Originating in the lumen? 1

2. Originating in the wall? 3 main ones, 3 more rare

3. Originating outside the wall? 1 main, 3 more rare

4. Neuromuscular disorders? 1 main, 1 more rare

1. ^ In the lumen

-Tumor

2. ^ In the wall

-Achalasia*

-Tumor of the esophagus*

-GERD*

-Plummer Vinson syndrome- iron deficiency anemia

-Scleroderma- replaced with collagen tissue that has no contractibility

-Chagas’ disease- infectious.

3. ^ Outside the wall

-Pressure of enlarged lymph nodes*

-Thoracic aortic aneurysm

-Bronchial carcinoma

-Retrosternal Goiter

 

4. ^ Neuromuscular disorders

-Myesthenia gravis

-Stroke*

 

6

1. UES moves how?

2. LES moves how?

3. Longitudinal and circular muscle moves how?

1. UES….closes and relaxes

2. LES….base line tone. Mostly stays shut

3. Longitudinal and circular muscle…peristalsis

7

Normal phases of swallowing

1. The voluntary part of swallowing consists of what?

2. Involuntary swallowing consists of what? 3

Voluntary

1. Oropharyngeal phase – bolus is voluntarily moved into the pharynx

Involuntary

1. UES relaxation

2. peristalsis (aboral movement)

3. LES relaxation

8

Between swallows:

1. UES prevents what? 2

2. LES prevents what? 1

 

 

1. 

-prevents air entering the esophagus during inspiration and

-prevents esophagopharyngeal reflux

2. gastroesophageal reflux

 

9

Esophageal disorders

6

1. Motility

2. Anatomic & Structural

3. Reflux

4. Infectious

5. Neoplastic

6. Miscellaneous (Perforation, Burns, Bleeding)

10

What kind of epithethium makes up the esophagus?

squamous

11

Oropharyngeal dysphagia (transfer dysphagia)

1. Patients complain of what?

2. What may cause symtpoms?

1. patients complain of difficulty swallowing

2. tracheal aspiration may cause symptoms

12

What are some pharyngoesophageal neuromusclar disorders?

8

1. stroke

2. Parkinson’s

3. poliomyelitis

4. ALS

5. multiple sclerosis

6. diabetes

7. myasthenia gravis

8. dermatomyositis and polymyositis

13

Upper esophageal sphincter dysfunction/HTN aka?

cricopharyngeal

14

What is a achalasia?

Incomplete relaxation of lower sphincter during swallowing leading to functional obstruction and proximal dilatation 

 

(failure to relax)

15

Achalasia:

1. PP: 3 contributing factors?

2. What structures are usually dimished or absent?

3. Histology findings?

4. Hypotheses for etiologies? 2

5. 5% develop what?

1.

-Aperistalsis,

-incomplete relaxation,

-increased resting tone

2. Ganglion cells of the myenteric plexus are diminished or absent

3. Histology: Inflammation in the area of M. plexus

4. Hypotheses: autoimmune, viral infections

5. 5% develop squamous cell carcinoma

16

Clincial picture of Achalasia:

History? 5

 

1. Dysphagia (most common)

2. Regurgitation

3. Chest pain

4. Heartburn

5. Weight loss

 

17

Achalasia:

 

1. 25-50% report episodes of what?

2. 80-90% experience spontaneous what?

3. some patients may present with signs or symptoms of what?

 

1. retrosternal chest pain

2. regurgitation.

3. pneumonia

18

Lab studies for Achalasia? 1

Imaging studies? 3 (and what will the findings be?)

The radiologic examination of choice in the diagnosis of achalasia is what?

Lab Studies

1. Laboratory studies are noncontributory.

 

Imaging Studies

1. UGI: Bird’s Beak.

2. EGD: Normal or dilated esophagus.

3. Manometry

 

Test of Choice: a barium swallow study performed under fluoroscopic guidance.

19

Normal esophageal mucosa appears what color?

white to tan

20

What is esophageal manometry used to assess? 2

Used to assess LES pressure & peristalsis

21

1. The goal of therapy for achalasia is to do what?

2. What are our two types of treatment?

1. relieve symptoms by eliminating the outflow resistance caused by the hypertensive and nonrelaxing LES.

2. 

-Medical Management

-Surgical Management

22

Diffuse Esophageal Spasm (DES) Characteristics

5

1. Chest pain

2. Intermittent dysphagia

3. Segmental non-peristaltic contractions

4. Corkscrew esophagus

5. Muscular hypertrophy

23

What is a nutcracker esophagus characterized by?

High pressure peristaltic contractions

(Nutcracker esophagus, or Hypertensive peristalsis, is a disorder of the movement of the esophagus characterized by contractions in the smooth muscle of the esophagus in a normal sequence but at an excessive amplitude or duration.)

24

What is esophageal atresia?

congenital abnormality in which the mid-portion of the esophagus is absent

25

What is a TE fistula?

What are the etiologies depending on age? 2

A tracheoesophageal fistula is an abnormal connection (fistula) between the esophagus and the trachea.

TEF is a common congenital abnormality, but when occurring late in life is usually the sequela of surgical procedures such as a laryngectomy.

26

What will show that the tube has not reached the abdomen suggesting either atresia or a fistula?

A plain radiograph will confirm the tube has not reached the stomach

27

Absence of gas in the abdomen suggests that the patient has either what or what?

1. atresia without a fistula or

2. atresia with a proximal fistula only

28

Gastroesophageal reflux (GERD) is defined as what?

Mucosal damage produced by the abnormal reflux of gastric contents into the esophagus

29

PP of GERD?

-Primary barrier to gastroesophageal reflux is the lower esophageal sphincter

-LES normally works in conjunction with the diaphragm

-If barrier disrupted, acid goes from stomach to esophagus**

30

WHat are the four major physiological mechanisms that protect against esophageal acid injury?