Management Of Dysphagia Flashcards
Briefly describe the anatomy of the esophagus
• Muscular tube from the pharynx to the stomach (Outer circular and Inner longitudinal).
• Has 2 sphincters (UES & LES)
• It is about 38-40cm in men and 36cm women.
What are the 3 normal anatomic narrowing of the esophagus
• Cricopharyngeus
• Left mainstem/arch of aorta
• Diaphragmatic hiatus
The angle between the lower esophagus and gastric fundus is called?
Angle of His
Which area is the lower esophageal high pressure zone and what is the normal pressure in this zone
This is the 2cm of the abdominal esophagus.
Normal pressure in this zone is 15-30mmHg
List the esophageal contractions and describe them
Primary peristalsis
Triggered voluntarily by swallowing
Secondary peristalsis
Triggered by esophageal distention or irritation. Also called Housekeeper waves
Tertiary contractions
They are abnormal and can be in response to swallowing or can be spontaneous.
List the causes of dysphagia
1) Benign
• Congenital
• Acquired
2) Malignant
List the (benign) congenital causes of dysphagia
1) Esophageal atresia (with or without tracheo esophageal fistula)
2) Congenital esophageal fistula
3) Poorly developed GE junction with GERD.
List the (benign) acquired causes of esophageal dysphagia
Strictures
• Trauma
• Inflammatory diseases (infectious and eosinophilic esophagitis)
• GERD
• Motility disorder
• Acquired diverticulae
STIGMA
For eosinophilic esophagitis, which finding on biopsy is diagnostic?
Eosinophil count of 20 eosinophils per hpf