Esophagus Pathophysiology Flashcards Preview

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Flashcards in Esophagus Pathophysiology Deck (31):
1

What is the role of the upper esophageal sphincter? (3)

Barrier between pharynx and esophagus
Allows food in and belching/vomiting
Prevents air entry, reflux of gastric contents

2

What are the two sphincters of the gastroesophageal Junction?

Lower esophageal sphincter (LES)
Diaphragm

3

Describe the central control of the striated muscle portion of the esophagus

Nucleus ambiguous provides innervation

4

Describe the central control of peristalsis for the smooth muscle portion of the esophagus

Rostral Dorsal motor nuclei: excitatory pathways via ACh
Caudal dorsal motor nuclei: inhibitory pathways via NO

5

Which pathway is initiated first in swallowing

Inhibitory pathways are always initiated first followed by sequential activation

6

What is TLESR?

Transient lower esophageal sphincter relaxation: reflex arc that results in transient relaxation that can occur due to stomach distention

7

Describe symptoms of esophageal disorder (6)

Dysphagia: impediment of normal passage
Odynophagia: pain on swallowing
Globus: sensation of having something in throat
Regurgitation: return of gastric contents
Chest pain
Heartburn

8

Achalasia Presentation (4)

Dysphagia to solids/liquids
Regurgitation
Chest pain
Heartburn

9

Achalasia Epidemiology

M=W
Incidence is 1/100k with peak between 30-60yr

10

What is the etiology of achalasia

No lower esophageal sphincter relaxation!
Degeneration of myenteric plexus due to autoimmune, viral, neurodegenerative causes

11

Name some mimics of achalasia (4)

Pseudoachalsia: tumor at GEJ with myenteric plexus infiltration
Tight fundoplicatoin
Laporscopic gastric banding
Infection with trypanosoma cruzi

12

Describe the epidemiology of GERD

Western issue-- don't see it in East asia but up to 28% in North America

13

Describe possible etiologies of GERD

Too much food late at night-->distend fundus
Hiatal hernia
Decreased saliva
Poor gastric emptying (obesity!)

14

What is the role of obesity in GERD?

Increased intra-abdominal and intra-gastric pressure increases risk of hiatal hernia

15

Which patients with GERD do you test? What test (3)

Endoscopy-- people with alarming symptoms or that don't respond to PPIs
Manometry
pH testing

16

How does endoscopy usually look for patients with GERD?

Usually observe normal esophagus-- it is diagnosed based on symptoms

17

Treatment strategies for GERD (4)

Lifestyle
Antacids
Antisecretory therapy: Antihistamine, PPI
Antireflux surgery

18

What happens with cessation of PPI?

Relapse

19

What are some of the safety concerns with PPI use? (6)

Metabolic bone disease/hip fracture
(BnC2Rebound):
Infection: C diff, pneumonia
B12 deficiency
Hypomagnesemia
Interstitial nephritis
Microscopic colitis

20

Barrett's Esophagus: Epidemiology

1.5% population prevalence-- more common in men, increasing with age, associated with obesity
15% prevalence in pts with chronic GER symptoms

21

What is Barrett's Esophagus? What is its clinical significance?

Metaplasia of cells in lower esophagus to goblet cells

It is a common precursor to esophageal adenocarcinoma

22

Describe the process of carcinogenesis in Barrett's

oxidative stress and inflammation lead to metaplasia-->clonal population then begins replicating-->clones lose its cell cycle control

23

Treatment for Barrett's Esophagus

Antisecretory therapy
Surgery
Chemoprevention?
Endoscopic ablation

24

Describe findings of eosinophilic esophagitis:

Symptoms related to esophageal dysfunction
Histology: eosinophil predominant inflammation
Absence of GERD-- no response to PPI, normal pH

25

Epidemiology of eosinophilic esophagitis:

M>W
young people

26

Pathogenesis of eosinophilic esophagitis

Presentation of allergens to esophagus
Stimulation of Th2 cytokine response (IL13/IL5)
Cytokines stimulate esophageal epithelium to produce eotaxin-3

27

Clinical presentation of eosinophilic esophagitis (6)

solid food dysphagia
food impaction
chest pain
heartburn (despite therapy)
upper abdominal pain
esophageal perforation

28

Allergic phenotype of eosinophilic esophagitis

Food allergies
Asthma
Eczema
Chronic rhinitis
Environmental allergens

29

What is the therapy for EoE?

Diet
Dilation
PPI
Topical steroids

30

What happens if treatment delayed in EoE?

Progressive fibrosis leads to increased symptoms/severity

31

What is presentation of scleroderma?

Absent peristalsis and LESp
GERD
Dysphagia