Flashcards in Swallowing and Not-Swallowing Deck (18)
symptoms: fluctuating muscle weakness and fatigability, difficulty in swallowing
causes: autoimmune disease, antibodies against Ach receptors
symptoms: gurgling, oropharyngeal dysphagia, raised intrapharyngeal pressure
causes: herniation of the pharyngeal mucosa between the cricopharyngeus and thyropharyngeus muscles due to hypertensive UES
dx: A barium swallow should be done to visualize the pharyngeal pouch
symptoms: difficulty initiating swallowing, choking and aspiration
causes: Zenker’s diverticulum, Hypertensive UES with incomplete relaxation
symptoms: CREST syndrome (Calcinosis, Raynaud’s phenomenon, Esophageal involvement, Sclerodactyly, Telangiectasia. Raynaud’s = vasospastic disorder affecting fingers, toes and sometimes other tissues. Sclerodactyly = localized thickening and tightness of the skin of the fingers and toes. Telangiectasia = small dilated blood vessels)
causes: Smooth muscle atrophy and fibrosis of the lower two-thirds of the esophagus -> hypotensive LES and aperistalsis in the esophageal body -> GERD -> (strictures)
dx: >90% patients with anticentromere autoantibodies have CREST syndrome
symptoms: Increased frequency of transient LES relaxation
causes: delayed gastric emptying, hiatal hernia and decreased esophageal motility are all causes of GERD, the most common cause is decreased LES tone
tx: Fats, chocolate, caffeine, acidic foods, alcohol and smoking all decrease lower esophageal sphincter pressure. Avoid these environmental factors.
symptoms: Eating solids hurts and acidic liquids such as fruit juices cause piercing, sharp, burning sensations, deep ulcers, sharply demarcated ulcers with “punched out” appearance
symptoms: dherent, grey and white pseudomembranes on erythematous mucosa of the mouth (oral thrush) and esophagus, no ulcers
causes: does not produce ulcers
Herpes Simplex infection
symptoms: ulcers, widely involve the esophagus. The ulcers are usually shallow and erosive, but may progress to “punched out” ulcers
dx: Eosinophilic intranuclear inclusions (Cowdry type A) are seen in multinuclear squamous cells at the margins of the ulcers
symptoms: Dysphagia, multiple grayish-purple plaques are seen in the esophagus
causes: caused by Human herpesvirus 8 and is one of the AIDS-related illnesses
dx: On biopsy, spindle cell stroma and vascular slits with hemorrhage are seen
symptoms: presence of smooth tapering of the lower esophagus leading to a closed LES, resembling a bird's beak. GERD unlikely, chest pain from spasms, Cholinergic innervation is intact, Aperistalsis of the distal esophagus
causes: "un-relaxation" loss if inhibitory nitric oxide-producing-neurons (ganglion cells in the myenteric plexus) contributes to the inability to relax the LES during swallowing
dx: barium swallow
tx: Injection of botulinum toxin during endoscopy may temporarily ameliorate dysphagia by reducing lower esophageal sphincter pressure. BOTOX should be reserved for the treatment of achalasia in patients who are poor candidates for surgery (e.g., high anesthesia risk), and poor candidates for balloon dilation (e.g., patients with sigmoid esophagus).
VIP- relaxes s. musc.
SP- stimulates LES, propagates peristalsis
Ach- contracts s. musc, relaxes sphincters
(or Meissner’s plexus) is where pre-ganglionic parasympathetic neurons synapse with post-ganglionic nerve fibers that supply the secretomotor activity of the muscularis mucosae.
(Auerbach’s plexus) lies between the two layers of muscle. It provides motor innervation to the mucosa, having both parasympathetic and sympathetic input. It is present in the GI tract from esophagus to rectum.
symptoms: (aka esophageal metaplasia) heartburn, dysphagia
causes: exposure of the mucosa to acidic reflux -> metaplasia -> adenocarcinoma
dx: squamous epithelium above the Z-line is replaced by columnar epithelium