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Esophageal Disorders Flashcards

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1
Q

Esophagus

A

Muscular tube that conveys food from pharynx to stomach

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2
Q

Two Layers of Muscle in the Esophagus

A

Inner circular muscle

Outer longitudinal muscle

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3
Q

How does food pass through the esophagus?

A

Perstalsis

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4
Q

What are the two types of movement?

A

Perstaltic

Segmental

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5
Q

What kind of movement is peristaltic?

A

Moves food forward

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6
Q

What kind of movement is segmental?

A

Mixing

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7
Q

3 locations where dysphagia can occur?

A

In the lumen
In the wall
Outside the wall

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8
Q

Dysphagia in the Lumen

A

Tumor

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9
Q

Dysphagia in the Wall

A 
Achalasia
Tumor of the esophagus
GERD
Plummer Vinson syndrome
Scleroderma
Chagas' disease
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10
Q

Define Achalasia

A

Neurological disturbance of the dilation of the LES

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11
Q

What is Plummer Vinson Syndrome?

A

Iron deficiency anemia

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12
Q

Define Scleroderma

A

Normal collagen replaced with tissue with no contractility

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13
Q

Dysphagia Outside the Wall

A

Pressure of enlarged lymph nodes
Thoracic aortic aneurysm
Bronchial carcinoma
Retrosternal goiter

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14
Q

Dysphagia due to Neuromuscular Disorders

A

Myasthenia gravis

Stroke

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15
Q

What is the responsibility of the circular muscles of the esophagus?

A

Propulsion down the esophagus

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16
Q

3 Parts of the Esophageal Anatomy

A

UES
Esophageal body
LES

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17
Q

UES

A

Closes

Relaxes

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18
Q

LES

A

Has base line tone
Closed
Semi-closed

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19
Q

Which muscles are used for peristalsis?

A

Longitudinal muscle

Circular muscle

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20
Q

Electrode Sleeve Catheter

A

Measures pressure changes in the esophagus

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21
Q

Normal Phases of Swallowing

A

Voluntary
Involuntary
Between swallows

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22
Q

Voluntary Swallowing

A

Bolus is voluntarily moved into the pharynx

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23
Q

Involuntary Swallowing

A

UES relaxation
Peristalsis
LES relaxation

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24
Q

Between Swallowing

A

UES prevents air entering esophagus
UES prevents esophagopharyngeal reflux
LES prevents gastroesophageal reflux
Peristaltic & non-peristaltic contractions
Capacity for retrograde movement and decompression

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25
Types of Esophageal Disorders
``` Motility Anatomic & Structural Reflux Infectious Neoplastic Perforation Burns Bleeding ```
26
Presentation of Esophageal Reflux
Pain Obstruction (dysphagia) Bleeding
27
Upper Esophageal Motility Disorders
Oropharyngeal dysphagia Pharyngoesophageal neuromuscular disorders UES dysfunction/HTN
28
Pharyngoesophageal Neuromuscular Disorders
``` Stroke Parkinson's Poliomyelitis ALS MS DM Myasthenia graves Dermatomyositis & polymyositis ```
29
Example of UES Dysfunction/HTN
Lou Gehrig's Disease
30
Define Achalasia
Incomplete relaxation of lower sphincter during swallowing leading to functional obstruction and proximal dilatation
31
Which ganglion cells are diminished or absent in achalasia
Myenteric plexus
32
Histology of Achalasia
Inflammation in the area of myenteric plexus
33
Hypotheses of Etiology of Achalasia
Autoimmune | Viral infections
34
Important History of Achalasia
``` Dysphagia Regurgitation Chest pain Heartburn Weight loss ```
35
Workup of Achalasia
Lab studies | Imaging Studies
36
Lab Studies for Achalasia Workup
Monometry
37
Imaging Studies for Achalasia Workup
UGI: Bird's beak EGD: normal or dilated esophagus Manometry
38
What is the radiologic examination of choice for the diagnosis of achalasia?
Barium swallow study under fluoroscopic guidance
39
What is Esophageal Manometry Used for?
Assess LES pressure & peristalsis
40
Treatment of Achalasia
Medical management | Surgical management
41
What is the goal of therapy for achalasia?
Relieve symptoms by eliminating outflow resistance caused by HTN and non relaxing LES
42
Symptoms of Diffuse Esophageal Spasm (DES)
``` Chest pain Intermittent dysphagia Segmental non-peristaltic contractions Corkscrew esophagus Muscular hypertrophy ```
43
What is diffuse esophageal spasm mistaken for?
MI
44
Nutcracker Esophagus
High pressure peristaltic contractions
45
Define Esophageal Atresia
Congenital abnormality in which the mid-portion of the esophagus is absent
46
Gasless Abdomen
Absence of gas in the abdomen suggests that the patient has either atresia without a fistula or atresia with a proximal fistula only
47
GERD
Mucosal damage produced by the abnormal reflux of gastric contents into the esophagus
48
What is the primary barrier to GERD is the lower esophageal sphincter?
LES
49
What happens when the LES is disrupted?
Acid goes from the stomach to the esophagus
50
4 Major Physiologic Mechanisms Protect Against Esophageal Acid Injury
Esophageal clearance mechanisms Esophageal mucosal integrity LES competence Gastric emptying
51
Classic GERD Symptoms
Heartburn | Regurgitation
52
Define Heartburn
Sub-sternal burning discomfort
53
Define Regurgitation
Bitter, acidic fluid in the mouth when lying down or bending over
54
Pulmonary Manifestations of GERD
Asthma Aspiration pneumonia Chronic bronchitis Pulmonary fibrosis
55
ENT Manifestations of GERD
``` Hoarseness Laryngitis Pharyngitis Chronic cough Globus sensation Dysphonia Sinusitis Subglottic stenosis Laryngeal CA ```
56
Other Manifestations of GERD
Chest pain | Dental erosion
57
Oral & Laryngopharyngeal Signs with GERD
``` Edema/hyperemia of larynx Vocal cord erythema Polyps Granulomas Ulcers Hyperemia & lymphoid hyperplasia of posterior pharynx Interarytenoid changes Dental erosion Subglottic stenosis Laryngeal CA ```
58
GERD Etiology
``` Hiatal hernia Incompetent LES Decreased esophagus clearance Decreased gastric emptying Medications Anything that results in esophageal irritation and inflammation ```
59
Define Hiatal Hernia
Herniation of portion of stomach adjacent to the esophagus through an opening in the diaphragm
60
Types of Hiatal Hernias
Sliding | Paraesophageal/rolling
61
Sliding Hiatal Hernia
Hernia which protrudes through the diaphragm at the opening where the esophagus enters the abdominal cavity
62
Contributing Factors of a Hiatal Hernia
Shortening of esophagus Weakness of diaphragm Increased abdominal pressure
63
Etiology of Hiatal Hernia
Structural changes Obesity Pregnancy Heavy lifting
64
Complications of Hiatal Hernia
``` GERD Hemorrhage Stenosis of esophagus Ulcerations Strangulation of hernia Regurgitation Increased risk for respiratory disease ```
65
What happens in a Paraesophageal Hiatal Hernia
Funds of the stomach enters the chest cavity lateral to the esophagus opening
66
Clinical Manifestations of Hiatal Hernia
``` Asymptomatic Heartburn Dysphagia Reflux with lying down Pain, burning when bending over ```
67
Treatment Goals for GERD
Eliminate symptoms Manage or prevent complications Maintain remission
68
Lifestyle Modifications for GERD
Avoid large meals Avoid acidic foods, alcohol, caffeine, chocolate, onions, garlic, peppermint Decrease fat intake Avoid lying down within 3-4 hours after a meal Elevate head of bed 4-8 inches Avoid meds that may potentiate GERD Avoid clothing that is tight around the waist Lose weight Stop smoking
69
Treatment of GERD
Antacids | Antireflux surgery
70
Acid Suppression Therapy for GERD
H2-receptor antagonists (H2RAs) | Proton pump inhibitors (PPIs)
71
Examples of H2-Receptor Antagonists
Cimetidine (Tagamet) Ranitidine (Zantac) Famotidine (Pepcid) Nizatidine (Axid)
72
Examples of Proton Pump Inhibitors
``` Omeprazole (Prilosec) Lansoprazole (Prevacid) Rabeprazole (Aciphex) Pantoprazole (Protonix) Esomeprazole (Nexium) ```
73
What PPI is safer in pregnant women?
Pantoprazole (Protonix)
74
What is the importance of antireflux surgery?
Reduce hiatal hernia Repair diaphragm Strengthen GE junction
75
Principles of Anti-Reflux Surgery
Restore Intra-abdominal esophagus Approximate diaphragmatic crurae Reduce hiatal hernia Perform fundoplication
76
Complications of GERD
Erosive esophagitis Stricture Barrett's esophagus
77
Erosive Esophagitis
Severity of symptoms often fail to match severity of erosive esophagitis
78
Esophageal Stricture
Result of healing of erosive esophagitis | May need dilation
79
Barrett's Esophagus
Acid damages lining of esophagus Damaged area heals in a metaplastic process Metaplasia can progress to dysplasia & adenocarcinoma
80
When to Perform Diagnostic Tests
``` Uncertain diagnosis Atypical symptoms Symptoms associated with complications Inadequate response to therapy Recurrent symptoms ```
81
Diagnostic Tests for GERD
Barium swallow Endoscopy Ambulatory pH monitoring Esophageal manometry
82
What is the first diagnostic test for patients with dysphagia
Stricture (locations, length) Mass (locations, length) Bird's beak Hiatal hernia (size, type)
83
What does esophageal manometry assess?
LES pressure LES location LES relaxation Peristalsis
84
Infection-induced Esophagitis due to
Candida Herpes Cytomegalovirus
85
Eosinophilic Esophagitis
Associated with food allergies
86
Treatment of Eosinophilic Esophagitis
Oral fluticasone
87
Types of Esophageal Bleeding
Mallord-Weiss tear | Esophageal varicies
88
Cause of Mallory-Weiss tear
Severe retching and vomiting
89
Where does a Mallory-Weiss tear occur?
Junction of the esophagus and stomach (longitudinal tear)
90
What are esophageal arise secondary to?
Cirrhosis | Anything that increases pressure
91
Clinical Picture of Mallory-Weiss Syndrome
Pain Bleeding Superimposed infection
92
Define Esophageal Varices
Tortuous dilated veins in the submucosa of distal esophagus
93
Etiology of Esophageal Varices
Portal hypertension secondary to liver cirrhosis
94
Define Esophageal Diverticula
Saclike outputting of one or more layers of the esophagus
95
Where is a Zenker's diverticulum located?
UES
96
Symptoms of Zenker's Diverticulum
``` Dysphagia Weight loss Regurgitation Chronic cough Aspiration ```
97
Location of Epiphrenic Diverticulum
Distal esophagus | Just above diaphragm
98
Treatment of Esophageal Diverticula
Clients learn to empty it by applying pressure Limit foods Endoscopic surgery
99
Scleroderma Motility Pattern
Proximal 1/3 striated muscle (normal) | Distal 2/3 smooth muscle (impaired motility)
100
Etiology of Esophageal Perforation
Iatrogenic | Boerhaave syndrome
101
Define Boerhaave Syndrome
When the esophagus is ruptured due to over eating frequently
102
Esophageal Perforation Mortality
High | Most lethal GI perforation
103
Complications of a Esophageal Perforation
Necrotizing mediastinitis & polymicrobial infection Rapidly progressive infection/shock in pleural/peritoneal space Empyema
104
Define Empyema
Pus in chest between pleural space and lung
105
Common FB in Adults
Meat | Bones
106
Common FB in Peds
Coins Toys Crayons Pen caps
107
Common FB in Pysch Patients & Prisoners
Unlikely objects Spoons Razors

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