esophagus pathophysiology Flashcards Preview

DEMS I > esophagus pathophysiology > Flashcards

Flashcards in esophagus pathophysiology Deck (40):
1

1. Understand the anatomy and function of the oropharynx and its associated structures.

includes teeth, lips, mouth (mastication and saliva), tongue, pharynx (movement of bolus from mouth to upper esophagus). Protection of airway and nasal passages via clsoure of nasopharynx (soft palate elevation), elevation of posterior tongue and epiglottis/vocal cord closure

2

Phases of deglutition (swallowing)

oral phase: voluntary, chewing and moving bolus to back of tongue. Pharyngeal phase: involuntary, bolus on upper pharynx, pharynx changes shape and contracts while UES relaxes, bolus transits from oropharynx to esophagus

3

Oropharyngeal dysfunction symptoms

•Oropharyngeal (transfer) dysphagia = inability to initiate a swallow or transfer food bolus into esophagus. Nasal regurgitation, aspiration into airway/lungs (coughing, choking, stridor, wheezing, cyanosis), aspiration pneumonitis (SOB or hypoxia) or pneumonia

4

Causes of oropharyngeal dysphagia

obstruction or neuromuscular (motility disorder)

5

aspiration pneumonitis vs pneumonia

Aspiration pneumonitis = lung injury from acidic or lipophilic properties food. Pneumonia if bacterial colonization occurs

6

Conditions which cause oropharyngeal disease

Neurologic: Stroke, Amyotrophic lateral sclerosis (ALS), Parkinson’s disease, Multiple sclerosis, Polio. Muscular: Myasthenia gravis, muscular dystrophy
Muscle injury (surgery, radiation therapy). Structural: Zenkers diverticulum, crycopharyngeal bar, thyromegaly, fibrosis, head and neck cancersNeurologic: Stroke, Amyotrophic lateral sclerosis (ALS), Parkinson’s disease, Multiple sclerosis, Polio. Muscular: Myasthenia gravis, muscular dystrophy
Muscle injury (surgery, radiation therapy). Structural: Zenkers diverticulum, crycopharyngeal bar, thyromegaly, fibrosis, head and neck cancersNeurologic: Stroke, Amyotrophic lateral sclerosis (ALS), Parkinson’s disease, Multiple sclerosis, Polio. Muscular: Myasthenia gravis, muscular dystrophy
Muscle injury (surgery, radiation therapy). Structural: Zenkers diverticulum, crycopharyngeal bar, thyromegaly, fibrosis, head and neck cancers

7

What is Zenkers diverticulum

–– outpouching of esophagus leading to food regurgitation or bacterial colonization (halitosis)

8

Oropharyngeal dysfunction diagnosis

history and PE!!! Also, modified barium swallow using X ray video, or neuro consult

9

Symptoms of esophageal motility disorders

dysphagia to solids and liquids, chest pain

10

Etiology of esophageal motility disorders

1. Achalasia: abnormal peristalsis, failure of LES relaxation. 2. Spastic Disorders of the Esophagus. 3. Weak Peristalsis. 4. Scleroderma

11

Diagnosis of esophageal motility disorders

Upper endoscopy or barium esophagram to exclude structural lesion, and esophageal manometry

12

Types of Achalasia and their manometry findings

1. Type I (Classic): Swallowing - no significant change in esophageal pressurization. 2. Type II: Swallowing - simultaneous pressurization spanning entire esophagus length. 3. Type III (Spastic): Swallowing - abnormal, lumen obliterating contractions/spasms

13

treatment of achalasia

Type II: Botox injections, pneumatic dilation, surgical myotomy work best. Type III: Botox injections, pneumatic dilation, surgical myotomy have poor outcomes

14

Pathophysiology of achalasia

LES pressure & relaxation regulated by excitatory and inhibitory neurotransmitters. Loss of inhibitory neurons in myenteric plexus causes hypertensive, non-relaxed lower esophageal sphincter

15

What is pseudoachalasia

Type of secondary achalasia due to direct mechanical obstruction of LES. Caused by Infiltrative submucosal invasion (esophageal/gastric malignancy), paraneoplastic tumors express neuronal Ag so T cells and Abs attack neurons of myenteric plexus (small cell lung cancer, pancreatic, prostate), or Chagas disease

16

Achalasia treatment

Surgical myotomy, Botox injections at GE junction (inhibits Ach release from nerve), balloon dilation to tear LES muscle fibers, Per-oral endoscopic myotomy, medical if contraindication for others (nitrates, Ca channel blockers, sildenafil)

17

What is scleroderma/progressive systemic sclerosis?

Multisystem disorder characterized by: Obliterative small vessel vasculitis and Connective tissue proliferation with fibrosis of multiple organs. GI manifestations in 80-90%: smooth muscle atrophy and gut wall fibrosis

18

Symptoms of scleroderma/PSS

dysphagia (weak peristalsis), GERD (weak LES), stricture (unrepentant GERD)

19

Spastic disorders of esophagus

peristalsis is preserved, but chest pain and dysphagia possibly due to overactivity of excitatory nerves or smooth muscle response

20

List structural esophageal disorders

strictures (GERD, radiation, caustic causes), Schatzkis ring, eosinophilic esophagitis (benign), compression, cancer, metastasis

21

Esophageal strictures cardinal symptom

dysphagia to solids

22

Esophageal strictures cardinal treatment

endoscopic dilation using balloons or dilator

23

What is eosinophilic esophagitis

•Chronic immune/antigen-mediated esophageal disease. Symptoms of esophageal dysfunction. Eosinophilic infiltrate in the esophagus. Absence of other potential causes of esophageal eosinophilia

24

eosinophilic esophagitis endoscopic features

fixed esophageal rings, narrow caliber esophagus, longitudinal furrows running parallel to axis, white plaques/exudates, crepe paper mucosa that tears easily

25

eosinophilic esophagitis treatment

Drugs (topical steroids via asthma preparations), diet (allergen free effective in children or 6-food elimination milk, eggs, wheat, soy, seafood, nuts), dilation

26

6. Understand the pathophysiology, symptoms, and treatment for gastroesophageal reflux disease (GERD).

•Pathologic reflux of gastric juice Acid into esophagus. Symptoms: heartburn (postprandial), regurgitation with acid taste, cough, throat clearing, rarely wheezing, stridor/ treatment: antacids or anti-secretory

27

Causes of GERD

LES relaxation, hiatal hernia (righ crus catches on fundus causing obstruction), gastric/esophageal surgery, dysmotility, obstruction, rare: Zollinger-Ellison, Sjogrens, Scleroderma

28

GERD risk factors

obesity, tobacco, meds, pregnancy

29

Complications of GERD

erosion, Barrett's esophagitis,

30

GERD diagnosis

symptoms (heartburn +/- regurg), response to acid suppressive therapy, endoscopy for refractory symptoms, transnasal catheter or wireless capsule pH testing in esophagus,

31

Barretts esophagus risk factors

male, white, central adiposity, advanced age, chronic gerd

32

Barretts treatment

esophagectomy if high grade dysplasia or cancer, ablation of Barretts tissue or endoscopic resection of visible lesions

33

What is Barretts a precursor to?

adenocarcinoma of esophagus

34

2 Main types of esophageal cancer ypes

squamous cell and adenocarcinoma

35

risk Factors for squamous cell carcinoma and location

age, alcohol/tobacco, caustic injuries. Anywhere is esophagus

36

risk factors for adenocarcinoma and locations

age, smoking, obesity, GERD, BARRETTS esophagus. Usually in distal esophagus or gastric cardia

37

List symptoms, examples and diagnosis of oropharyngeal obstructions

Sx: choking, cough, nasal regurg, aspiration. Dz: head and neck cancer, zenkers diverticulum, radiation therapy. Diagnosis: barium swallow

38

List symptoms, examples and diagnosis of oropharyngeal propulsion/motility issues

sx: Transfer Dysphagia, Cough, Nasal regurgitation, Aspiration. Dz: neuro conditions (stroke, ALS, MS, parkinsons), myasthenia gravis, muscular dystrophy. Diagnosis: barium swallow

39

List symptoms, examples and diagnosis of esophageal obstructions

Sx: Dysphagia to solids, Food impaction (EoE), Weight loss, Vomiting, Regurgitation. Dz: esophageal strictures, esophageal rings, EoE, extrinsic compression. Diagnosis: EGD, esophagram

40

List symptoms, examples and diagnosis of esophageal propulsion/motility issues

sx: solid and liquid dysphagia, chest pain. Dz: achalasia, esophageal spasm, scleroderma, esophageal cancer. Diagnosis: esophagram, EGD, esophageal manometry