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DEMS 1 > Oropharynx & Eso Pathophys > Flashcards

Oropharynx & Eso Pathophys Flashcards

(42 cards)

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1
Q

BENIGN STRUCTURAL
Zenker’s Diverticulum
(Info/Cause)

A

Outpouching of lower oropharynx due form muscle wall defect

ANY AGE

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2
Q

BENIGN STRUCTURAL
Zenker’s Diverticulum
(Pres/Diagnx/Treat)

A

Dysphagia, Halitosis
Detect with EGD
Surgical diverticulotomy

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3
Q

BENIGN STRUCTURAL
Cervical Osteophytes
(Info/Cause)

A

Osteophytes narrow oropharynx

RARE

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4
Q

BENIGN STRUCTURAL
Cervical Osteophytes
(Pres/Diagnx/Treat)

A

Often Hx of arthritis or neck surgery
Detect with EGD
Not treatment discussed

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5
Q

BENIGN STRUCTURAL
Cricopharyngeal Ring and HTN
(Info/Cause)

A

Cricopharyngeal muscle displaced or fails to relax –> UES compression

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6
Q

BENIGN STRUCTURAL
Cricopharyngeal Ring and HTN
(Pres/Diagnx/Treat)

A

Dysphagia
Detect with EGD
Treat with Cricopharyngeal myotomy

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7
Q

NEUROMUSCULAR
ALS, Parkinson’s, Muscular Dystrophy etc.
(Pres/Diagnx/Treat)

A

Dysphagia
Diagnx with H&P, neuro exam
Treat - underlying cause, - speech/swallow tx, - PEG tube (eventually)

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8
Q

GERD

info/risks/causes

A

Reflux of gastric juice into eso
Risk: Obesity, high fat diet, caffeine, EtOH, tobacco
Cause: HCl&raquo_space; enyzmes
Impaired eso peristalsis, hiatal hernias, dysmotility, obstruction, scleroderma
INAPPROPRIATE LES RELAXATION

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9
Q

GERD

presentation

A

HEARTBURN (substernal or epigastric, rises in chest)
Often after meals, large/fatty, may be worse lying down, acid taste
Rare: wheezing, stridor, hoarseness

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10
Q

GERD

Labs/Diagnx

A 
GOLD STANDARD: 24 hr pH study
Barium swallow (10-20% abormal)
EGD
LES relaxation on manometry
INCREASED EOSINOPHILS in DISTAL ESOPHAGUS
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11
Q

GERD

Treatment

A

Antacids
PPIs, H2 blockers
Change behavior
(5-10% may progress to Barrett’s - risk of cancer)

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12
Q

Achalasia

Info/cause

A

“No relaxation”
HYPERTONIC LES (vagal input to LES impaired [lack of ganglion cells], secondary to diabetic autonomic neuropath or malignancy)
Age 30-60, progressive, both genders, increased risk of squamous cell carc

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13
Q

Achalasia

Pres

A

SOLID AND LIQUID dysphagia
Feels like food stuck
Chest pain, regurg, weight loss
Halitosis

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14
Q

Achalasia

Diagnx

A

Gold Standard: Esophageal Manometry (LES does not relax, no linear peristalsis)
BIRDS BEAK on esophagram (dilated eso, narrow LES)
EGD/CT to rule out cancer
Absence of ganglia in distal eso and LES

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15
Q

Achalasia

Treatment

A

Dilate LES with BALLOON (1-2% perforation rate)
Surgical myotomy
Oral nitrates, CCBs, Botox into LES

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16
Q

Diffuse Esophageal Spasm (Info/Pres)

A

Uncoordinated contraction of esophagus body - dysphagia
May be post-prandial, related to swallowing, med side effect
CAN MIMIC ANGINA

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17
Q

Diffuse Esophageal Spasm (Diagnx/treat)

Study These Flashcards
A

Manometry

Give nitrates/anticholinegics

18
Q

Nutcracker Esophagus

Study These Flashcards
A

Unknown cause: high pressure, peristaltic contraction in esophageal body
Intermittent chest pain and dysphagia
Diagnx with manometry

19
Q

Scleroderma (info/pres)

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A

Multisystem, FIBROSIS OF MANY ORGANS

High incidence of stricture, GERD, dysphagia due to wek peristalsis, heartburn Extra-GI symptoms

20
Q

Scleroderma (Diagnx/Treat)

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A

Manometry
PRINCIPAL PATH is SM atrophy and gut wall FIBROSIS
Treat with PPIs

21
Q

Chemical Injury

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A

Corrosive, PILL ESOPHAGITIS ( pill stuck –> inlf, NSAIDs, K supplements), reflux esophagitis
Pres: ODYNOPHAGIA, +/- dysphagia
Diagnx: H&P, +/- endoscopy
Treat: discontinue offending agent (underlying cause)

22
Q

INFX

Herpes

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A 
Usually immunocompromised
Pres: PAIN WITH SWALLOWING (odynophagia), dysphagia, GI bleen
Diagnx: endoscopy: PUNCHED OUT ULCERS
Hist: INTRANUCLEAR VIRAL INCLUSION
Treat: Antivirals
23
Q

INFX

Candida

Study These Flashcards
A

Most frequent, also immunocompromised
Pres: Odynophagia, +/- dysphagia, or asymptomatic
Diagnx: endoscopy: WHITE PLAQUES, fibrinopurulent exudate
Hist: PSEUDOHYPHAE, budding yeast in tissue (special stains GMS, PAS)
Treat: Antifungals

24
Q

INFX

CMV

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A

Immunocomprimised, usu in combo with candida
Pres: Odynoophagia, +/- dysphagia, GI bleeding
Diagnx: endoscopy: punched out ulcers in distal eso
Hist: CYTO and NUCLEOMEGALY, intraCYTOPLASMIC inclusions
Treat: antiviral

25
Eosinophilic Esophagitis (cause/info/pres)
Caused by eosinophilic infiltrate, diffuse narrowing of esophagus, MALES,
26
Eosinophilic Esophagitis (diagnx/treat)
Endoscopy: concentric rings, burrows, nodular plaques and exudates Biopsy: diffuse sheet of eosinophils, frequent degranulated forms (dust, microabscesses), MID-ESOPHAGUS Treat: TOPICAL STEROIDS (oral spray), dilation may be necessary, endoscopic removal of bolus, no response to anti-reflux tx
27
Barrett's Esophagus (cause/risks/pres)
consequence of GERD (F, decreased LES resting pressure, smoking obesity Increasing in prevalence Pres: USUALLY ASYMPTOMATIC OR HEARTBURN
28
Barrett's Esophagus (Diagnx/treat)
METAPLASIA (squamous-->glandular containing columnar (goblet) epithelium) this is an effort of the esophagus to protect itself rorm acid Salmon colored patch on endoscopy Alcian BLUE stain highlights GOBLET cells (no goblet cells in stomach) Treat: GERD treatment, also increase screening
29
Benign Strictures
Minority of pts with reflux eso get peptic stricture of distal eso (due to fibrosis from relfux) PRES: SOLID FOOD DYSPHAGIA Diagnx: EGD (biopsy to rule out cancer and tx dilation) Treat: GERD treatment, also with EGD dilation
30
Mucosal ("Schatzki") Rings
congenital esophageal rings --> narrow lumen and cause infl (similar to benign stricture) Pres: dysphagia Diagnx: EGD Treat: EGD dilation
31
Esophageal Perforation
after profound retching/vomiting, esp EtOH or malnourished, can be complication of surgery procedure Pres: upper GI bleed, high morbidity/mortality Diagnx: EGD Treat: urgent stent/surgical intervention
32
Mallory-Weiss Tear
linear superficial tear esp in alcoholics
33
Esophageal Cancer
4% of cancer deaths in men (not top 10 in women) | Pres: dysphagia, weight loss, no symptoms until advanced dz, rarer: bloody vomit, chest pain, anemia
34
Adenocarcinoma
Risk with GERD/Barretts, more than half of all eso cancers, more common in elderly, Caucasian, mean Pres: solid food dysphagia, weight loss Diagnx: EGD, DISTAL eso, big bulky tumor with GLANDS Treat: RESECTION if early, also CHEMO/radiation and metal STENT placement
35
Squamous Cell Carcinoma
Risks: smoking, EtOH, casutic injury (hot tea), hx of head & neck cancer, mean age 65, poor oral health/poverty Pres: eso stricture--> dysphagia, weight loss Diagnx: UPPER/MID eso (50-60%), more ulcerative tumor, NO glands Treat: RESECTION if early, also CHEMO/radiation and metal STENT placement
36
Other cancers
Malignant: neuroendocrine (carcinoud), GISTS, lymphomas, metastases Benign: leiomyomas, hemangiomas, lymphangiomas
37
Oropharynx (involved in .../phases ...)
``` Swallowing (deglutition) Normal = 600x /day Oral phase (voluntary): biting,licking, chewing, initiation of swallow Pharyngeal phase (involuntary): once bolus gets to posterior 1/3 of tongue, pharnyx contracts and changes shape (hyoid/larynx up and anterior), UES relaxes, soft palate elevates to close nasopharynx and protect airway ```
38
Esophagus (upper & lower)
Upper 1/3 is skeletal muscle, lower 1/3 is smooth (middle is mixed) BUT ENTIRE ACTION OF ESOPHAGUS IS INVOLUNTARY
39
Work Up Protocol | Dysphagia
coughing, aspiration, sitting up food suspect neuromuscular dz, benign obstruction or neoplasia BARIUM SWALLOW
40
Work Up Protocol | Esophageal Motility Dysfunction
pain and/or dysphagia suspect GERD, achalasia, diffuse esophageal spasm, nutcracker esophagus MANOMETRY (and pH study for GERD)
41
Work Up Protocol | Benign Structural Disorder
painless +/- solid food dysphagia suspect strictures, eosinophilic esophagitis, prior trauma ENDOSCOPY (EGD)
42
Work Up Protocol | Neoplasia
Painless +/- solid food dysphagia + cancer sx suspect esophageal cancer ENDOSCOPY and BIOPSY

DEMS 1 (16 decks)

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