Esophageal Disorders Lecture

Question 1

What is Zenker’s diverticulum?

Answer 1

pouch in the upper esophagus

Question 2

What happens to the food in Zenker’s diverticulum?

Answer 2

the food gets stuck; “pocketed”

Question 3

How can you tell if the food is getting “pocketed” in the Zenker’s diverticulum?

Answer 3

there is a lot of residue that isn’t moving; seen in a swallow study

Question 4

What does the severity and treatment of Zenker’s diverticulum depend on?

Answer 4

the size of the pouch

Question 5

What can cause Zenker’s diverticulum?

Answer 5

GERD or reflux that weakens the area

Question 6

Where does the Zenker’s diverticulum typically form?

Answer 6

cricopharyngeus

Question 7

What is a cricopharyngeal bar?

Answer 7

cricopharyngeus muscle is thickening and slower to relax so there is an obstruction of the flow

Question 8

What is the common complaint a patient with a cricopharyngeus bar?

Answer 8

thicker and stickier textures are harder; feeling of food stuck in the neck

Question 9

In what MBS component can you diagnose a cricopharyngeus bar?

Answer 9

component 14: PES opening

Question 10

What is a Schatzki ring?

Answer 10

a circular membrane of tissue in the lower esophagus that causes a narrowing of the esophagus

Question 11

What are symptoms of Schatzki ring?

Answer 11

more difficulty with solid food; feeling like food is impacted; chest pain

Question 12

How big does a Schatzki ring have to be to by symptomatic?

Answer 12

<13mm

Question 13

How do you treat a Schatzki ring?

Answer 13

dilation, PPI

Question 14

What are causes of a Schatzki ring?

Answer 14

hiatal hernia; chronic acid reflux; Barrett’s esophagus

Question 15

What is a hiatal hernia?

Answer 15

the upper part of the stomach bulging through the diaphragm and into your chest

Question 16

What happens in a hiatal hernia?

Answer 16

food and acid can back up in the esophagus and cause reflux and heartburn

Question 17

What two disorders are usually comorbid?

Answer 17

hiatal hernia and Schatzki ring

Question 18

How can you correct hiatal hernia?

Answer 18

if bad enough it can be corrected surgically; smaller ones can be corrected with diet changes to reduce reflux

Question 19

What is Barrett’s esophagus?

Answer 19

flat pink liniing of the esophagus becomes damaged by acid reflux causing the lining to thicken and become red

Question 20

Can you see Barrett’s esophagus on a fluoroscopy?

Answer 20

no

Question 21

Patients with Barrett’s esophagus are at risk for cancer. Why?

Answer 21

the irritation can cause pre-cancer to develop

Question 22

What is achalasia?

Answer 22

narrowing or incomplete relaxation of the lower esophageal section and prevents passage of swallowed material into the stomach

Question 23

What kind of regurgitation is common in achalasia?

Answer 23

late regurgitation of undigested food; emesis

Question 24

Why do patients with an achalasia vomit?

Answer 24

food couldn’t pass into the stomach

Question 25

What is GERD?

Answer 25

chronic acid reflux

Question 26

How does GERD result?

Answer 26

from abrupt periods of relaxation of the LES during non-swallow events

Question 27

T/F the LEW tone is usually normal in GERD

Answer 27

T

Question 28

Why do you use pH monitoring in GERD patients?

Answer 28

to determine presence of and severity of reflux (the acid)

Question 29

What does GERD stand for?

Answer 29

gastro-esophageal reflux disease

Question 30

What is NERD?

Answer 30

GERD that does not result in esophagitis

Question 31

T/F NERD doesn't cause dysmotility and dysphagia symptoms

Answer 31

F

Question 32

What is laryngopharyngeal reflux?

Answer 32

when stomach contents reach the laryngeal level and irritate the vocal folds

Question 33

What does laryngopharyngeal reflux cause?

Answer 33

odynophagia, hoarseness, sore throat, globus sensation, and chronic throat clearing

Question 34

What do you look for on a FEES exam to diagnose laryngopharyngeal reflux?

Answer 34

mucosal abnormalities on pos pharyngeal wall, edema of arytenoid cartilages, generalized erythema in laryngeal aditus

Question 35

When do GERD patients experience the most symptoms?

Answer 35

when they are lying down

Question 36

When do patients with laryngopharyngeal reflux experience symptoms?

Answer 36

day and night

Question 37

What is esophageal stentosis?

Answer 37

narrowing of the lumen affecting ability of sold food to pass

Question 38

T/F Patients can be fairly accurate when pointing to where the esophageal stenosis is

Answer 38

F

Question 39

One third of patients with obstructing esophageal lesions think the problem is where?

Answer 39

the neck

Question 40

What is benign stricture?

Answer 40

related to esophagitis

Question 41

What can cause benign stricture?

Answer 41

pharmaceuticals (tetracycline, potassium, quinidine)

Question 42

What is malignant stricture?

Answer 42

stricture caused by squamous cell carcinoma; adenocarcinoma

Question 43

For whom is tracheoesophageal fistula common?

Answer 43

those who have had a laryngectomy; after radiation

Question 44

How can cardiac issues cause esophageal complaints?

Answer 44

compression of the esophagus due to aortic aneurysm, cardiomegaly (enlarged heart), congenital deformities, lung cancer

Question 45

T/F Esophageal diverticulum is rare

Answer 45

T

Question 46

What causes esophageal diverticulum?

Answer 46

pressure in the esophagus resulting in bulging at a point of weakness

Question 47

How can peristalsis issues affect the esophagus?

Answer 47

it can spasm

Question 48

What is nutcracker esophagus?

Answer 48

chest pain, mean pressure of 180 mm Hg with manometry

Question 49

What is eosinophilic esophagitis?

Answer 49

history of allergies, build up of esosinophils interfere with motility