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GINME > Week 2: Dysphagia > Flashcards

Week 2: Dysphagia Flashcards

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1
Q

Types of dysphagia

3 listed

A
  • Mechanical
  • dysmotility
  • or both
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2
Q

How long is the esophagus?

A

20-22 cm long muscular tube

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3
Q

Which muscular layer is most superficial?

A

outer longitudinal layer

Inner circular layer

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4
Q

Categories of causes of oropharyngeal dysphagia

A

Neuromuscular or Structural causes

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5
Q

Neuromuscular causes of oropharyngeal dysphagia

8 listed

A
  • CVA/stroke
  • ALS
  • Brain tumor
  • Poliomyelitis
  • Myasthenia gravis
  • Muscular dystrophies
  • Polymyositis and dermatomyositis
  • UES dysfunction
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6
Q

Structural causes of oropharyngeal dysphagia

A
  • Pharyngitis
  • Radiation injury
  • Cervical osteophyte
  • Head and Neck cancer
  • Thyromegaly/Goiter
  • Zencker’s diverticulum
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7
Q

What is dysphagia?

A

Symptoms that result from the slowing or cessation of a food or liquid bolus passing through the esophagus

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8
Q

nervous structure of the esophagus

A

Myenteric plexus

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9
Q

Oropharyngeal dysphagia presentation

8 listed

A
  • Difficulty initiating swallow
  • Double swallowing
  • Drooling
  • Cough, choking sensation “Can’t breathe”
  • Nasal regurgitation
  • Aspiration -> Pneumonia
  • Dysarthria and voice changes/weakness
  • Localization in throat or high neck
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10
Q

Categories of causes of Esophageal dysphagia

A

Structural

motility

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11
Q

Structural causes of Esophageal dysphagia

7 listed

A

Benign stricture

GERD

Eosinophilic esophagitis

Infectious esophagitis

Foreign bodies

Extrinsic compression

Esophageal CA

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12
Q

Motility causes of Esophageal dysphagia

5 listed

A
  • Achalasia disorders
  • Scleroderma
  • Esophageal spastic disorders
  • Chagas disease
  • Non-relaxing lower esophageal sphincter
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13
Q

Presentation of Esophageal dysphagia

4 listed

A
  • Food sticking retrosternally
  • Regurgitation or vomiting
  • Chest pain
  • Localization at sternal notch or below
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14
Q

Associated symptoms of dysphagia

6 listed

A
  • Slow eating
  • careful eating
  • Sips of beverage with solid food bolus
  • Walking around while eating
  • Avoiding restaurants and social meals
  • Restricted diet
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15
Q

Causes of sudden mechanical Dysphagia

A
  • Foreign body
  • Eosinophilic esophagitis
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16
Q

Causes of intermittent mechanical Dysphagia

A
  • Schatzki’s ring (reflux driven obstruction)
  • Webs (fibrous strands)
  • Ext. Compression (Mass or vascular structure)
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17
Q

Causes of progressive mechanical Dysphagia < 50 years old

A
  • Heartburn
  • GERD Stricture
  • Caustic, med-induced, radiation
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18
Q

Causes of progressive mechanical Dysphagia > 50 years old

A

Carcinoma

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19
Q

Overview of historical causes of mechanical obstruction dysphagia

A
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20
Q

Causes of recent neuromuscular or infectious dysphagia

A
  • Immunosuppression
  • Antibiotics
  • HIV infection
  • Candida
  • CMV
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21
Q

Causes of intermittent neuromuscular or infectious dysphagia

A

Chest pain?

Motility disorder

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22
Q

Causes of progressive neuromuscular or infectious dysphagia

A
  • Achalasia
  • Scleroderma
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23
Q

Overview of historical causes of neuromuscular or infectious dysphagia

A
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24
Q

Physical exam for dysphagia

A
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25
Types of tests for dysphagia
* Barium swallow * Endoscopy
26
Barium swallow capabilities for dysphagia
27
Endoscopy capabilities for dysphagia
28
Describe diffuse esophageal spasm via barium swallow
spastic "Corkscrew appearance"
29
Describe eosinophilc esophagitis via barium swallow
corrugated appearance from furrows that form from the scarring from eosinophilic infiltration
30
What is depicted by barium swallow?
Diffuse Esophageal Spasm
31
What is depicted by barium swallow?
Eosinophilic Esophagitis
32
Describe esophagitis via endoscopy
breaks in mucosa (represents esophageal injury
33
What is depicted via endoscopy?
Achalasia
34
What is depicted via endoscopy?
Adeno Carcinoma
35
What is depicted via endoscopy?
Candida
36
What is depicted via endoscopy?
Esophagitis
37
What is depicted via endoscopy?
Schatzki ring
38
What is depicted via endoscopy?
Peptic stricture
39
What is depicted via endoscopy?
Diffuse Esophageal spasm
40
What is depicted via endoscopy?
Eosinophilic Esophagitis
41
Describe peptic stricture via endoscopy
scarred down needs to be dilated or stretched out
42
Describe Schatzski ring via endoscopy
doesnt expand any further can be broken up by biopsy cuts to open it up
43
Describe adenocarcinoma via endoscopy
lumen is narrowed by neoplasm
44
Describe Candida via endoscopy
growth of fungus
45
Describe eosinophilic esophagitis via endoscopy
corrugated rings or could be linear corrugation
46
Describe achalasia via endoscopy
the sphincter is super tight
47
Describe Diffuse eosphageal spasm via endoscopy
"corkscrew" spasming
48
Approach to dysphagia
49
What is a high-resolution manometry catheter?
basically an EKG of esophagus
50
High-resolution manometry catheter data
51
Normal swallow under High-resolution manometry catheter
52
Describe Achalasia by barium swallow
53
HRM AKA
High-resolution manometry catheter
54
HRM of type II Achalasia
Failure of LES to relax
55
Subtypes of achalasia
56
Upper endoscopy of Achalasia
57
Describe Type I Achalasia HRM
Absent peristalsis No peristaltic waves, no movement
58
Describe Type II Achalasia HRM
Panesophageal pressurizations occur after a swallow but could keep going
59
Describe Type III Achalasia HRM
Hypercontraction but not a productive peristaltic spasm food still gets trapped and patient still feels bolus stuck
60
Why does achalasia occur?
* Loss of myenteric neurons such as by immune-mediated neuronal death * Imbalance between excitatory and inhibitory forces
61
Describe achalasia by loss of myenteric neurons
62
Describe achalasia by excitatory/inhibitory imbalance
63
Achalasia type I causation
loss of myenteric nerves
64
Achalasia type II causation
Loss of myenteric neurons
65
Achalasia type III causation
Excitatory/inhibitory force imbalance
66
Pharmacological therapy of Achalasia
(botox is kind of the go to)
67
Surgical interventions of achalasia
* Pneumatic dilation (balloon) * Heller Myotomy (cut the circular muscle fibers)
68
Response rates of achalasia treatments
69
POEM for achalasia
70
POEM outcomes
71
Achalasia means?
"Failure to relax"
72
The predominant feature of achalasia
poorly relaxing LES
73
Symptoms of Achalasia
* Dysphagia * Regurgitation * Heatburn * CP * Cough * Choking * Aspiration pneumonia * Weight loss
74
Achalasia Manometric abnormalities
* Abnormal LES residual pressure * No normal peristalsis
75
Is achalasia ever cured? What treatments are there?
Never cured and treatment is aimed at reducing the pressure across the LES * Pneumatic dilation * Heller Myotomy * POEM * Botox, CCB, nitrates
76
What is pseudoachalasia?
77
Dysphagia workup pathway
78
What is the patient's diagnosis?
Pseudoachalasia
79
Is this achalasia
80
EGD pseudoachalasia

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