Swallowing and Not-Swallowing Flashcards Preview

Chandy- GI Physiology > Swallowing and Not-Swallowing > Flashcards

Flashcards in Swallowing and Not-Swallowing Deck (18)
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1

myasthenia gravis

symptoms: fluctuating muscle weakness and fatigability, difficulty in swallowing

causes: autoimmune disease, antibodies against Ach receptors

tx:

2

Zenker’s diverticulum

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

tx:

3

oropharyngeal dysphagia

symptoms: difficulty initiating swallowing, choking and aspiration

causes: Zenker’s diverticulum, Hypertensive UES with incomplete relaxation

4

systemic sclerosis

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

tx:

5

GERD

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

dx:

tx: Fats, chocolate, caffeine, acidic foods, alcohol and smoking all decrease lower esophageal sphincter pressure. Avoid these environmental factors.

6

Cytomegalovirus infection

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

causes:

dx:

tx:

7

Candida albicans

symptoms: dherent, grey and white pseudomembranes on erythematous mucosa of the mouth (oral thrush) and esophagus, no ulcers

causes: does not produce ulcers

dx:

tx:

8

Herpes Simplex infection

symptoms: ulcers, widely involve the esophagus. The ulcers are usually shallow and erosive, but may progress to “punched out” ulcers

causes: infection

dx: Eosinophilic intranuclear inclusions (Cowdry type A) are seen in multinuclear squamous cells at the margins of the ulcers

tx:

9

Kaposi’s sarcoma

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

tx:

10

esophagus lymphoma

symptoms:

causes:

dx:

tx:

11

achalasia cardia

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).

12

something

symptoms:

causes:

dx:

tx:

13

inhibitory neurons

VIP- relaxes s. musc.

14

excitatory neurons

SP- stimulates LES, propagates peristalsis
Ach- contracts s. musc, relaxes sphincters

15

submucosal plexus

(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.

16

Myenteric plexus

(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.

17

Barrett's esophagus

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

tx:

18

Mallory-Weiss syndrome

symptoms: massive hematemesis

causes: Prolonged retching and vomiting results in lacerations usually at the gastro-esophageal junction, which extend to submucosal arteries. Often follows binge drinking

dx:

tx: