Esophagus and GERD Flashcards
(19 cards)
Odynophagia
pain on swallowing
Dysphagia
symptom resulting from failure to move food from mouth to stomach
Normal Swallowing
Transfer –> liquids/solids move from mouth to esophagus
Transport –> liquids/solids move length of esophagus
Emptying –> liquids/solids delivered to stomach
Contributing factors to dysphagia?
- Inadequate preparation of swallowing –> saliva/mastication, neuromuscular disorder
- Abnormal muscle strength/function –> neuromuscular disorder
- Esophageal passageway narrowing –> mechanical obstruction
Oropharyngeal dysphagia
difficulty initiating swallowing Goals of therapy - protect airway - maintain nutrition - relieve dysphagia Therapies - speech/swallowing therapy - esophageal dilation - surgical myotomy - NPO with nutrition support
Esophageal dysphagia
food stops/sticks after swallowing initiated
Anatomic causes of dysphagia
Benign –> peptic strictures, rings/webs, caustic
Cancer –> primary esophageal, extrinsic compression
Neuromuscular causes of dysphagia
Primary esophageal disease
- Achalasia
- Chagas’
Achalasia
loss of inhibitory innervation to LES
- non-relaxing LES, esophageal aperistalsis
- bird’s-beak narrowing, dilated esophagus
Treatment of achalasia
- Nifidepine
- Botulinum toxin
- Balloon dilation
- Esophageal myotomy
Heartburn
Classic symptom of GERD
- substernal burning w/ or w/o regurgitation
- post-prandial
- aggravated by change in position
- prompt relief with antacids
Therapy of GERD
LIFESTYLE MODIFICATIONS
- elevate head
- no food 3 hrs before bed
- modify diet –> decrease fat, volume, and acid
Barrett’s Esophagus
columnar epithelium replaces squamous epithelium in distal esophagus (distal 1/3)
- occurs as a result of long-standing GERD in 10-15% patients
- major cancer risk for esophageal adenocarcinoma
Peptic Esophageal Stricture
10% of patients who have reflux esophagitis
- ulceration stimulates fibrosis –> associated with NSAIDs
Solids Dysphagia
Intermittent –> lower esophageal ring
Progressive –> peptic stricture or cancer
Solids and Liquids Dysphagia
Intermittent –> diffuse spasm
Progressive –> achalasia or scleroderma
Anatomical Disorders causing dysphagia
Postcricoid web
Cervical osteophyte
Hypopharyngral diverticulum
Head and neck tumors
Muscular disorders causing dysphagia
oculopharyngeal muscular dystrophy
myotonic dystrophy
myasthenia gravis
Neurological disorders causing dysphagia
cerebrovascular accidents poliomyelitis amyotropic lateral sclerosis parkinson's cerebral palsy tumors
