Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

SBM GI > 02-13 Esophageal Physiology, Motility Disorders & GERD > Flashcards

02-13 Esophageal Physiology, Motility Disorders & GERD Flashcards

1
Q

define dysphagia

A

difficulty swallowing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

define: odynophagia

A

pain w/ swallowing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

define globus

A

A sensation of fullness in the upper throat; typically improves with swallowing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

define pyrosis

A

heartburn

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

define water brash

A

spontaneous salivation from reflux

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

define rumination

A

“chewing one’s cud”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

dysphagia aortica

A

“mechanical dysphagia caused by compression of the esophagus by the dilated aorta, and it occurs mainly in elderly women with short stature, hypertension and kyphosis”

From: Song, Sang-Wook, Ju-hye Chung, and Se-Hong Kim. “A Case of Dysphagia Aortica in an Elderly Patient.” International Journal of Gerontology 6.1 (2012): 46-48.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

dysphagia lusoria

A

“difficulty in swallowing caused by aberrant right subclavian artery” [Wiki]

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

types of muscle in the esophagus

A
  • upper 5%, circular (striated) muscle only
  • middle 1/3 is both
  • lower 1/2, longitudinal (smooth) muscle only
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

REVIEW: which structures pass through the aorta at which thoracic level (mnemonic = ?)

A

I 8 - IVC

10 Eggs - Esophagus

At 12 - aorta & azygous

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Forces that contribute to normal resting LES pressure

A
  1. intrinsic pressure of the LES
  2. pressure from diaphragm
  3. pressure from phrenoesophageal ligament
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

UES is made up of?

A

cricopharyngeal muscle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

REVIEW: 4 histo layers of esophagus

A
  1. mucosa (strat squam epithel)
  2. submucosa
  3. muscularis propria (inner = circular; outer = longitudinal)
  4. outermost adventitia

**no outer serosal lining (unlike rest of GIT)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Blood supply to esophagus

A
  • Upper: inf. thyroid a.
  • Middle: L & R bronchial aa.
  • Lower: small brs. of aorta + esophageal br. of L gastric a.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

R.O.S. questions for dysphagia

A
  • How long have symptoms been present?
  • Are the symptoms intermittent, constant, progressive?

Is it difficult to move the food from the back of the throat or through the chest?

  • Nasal regurg or cough?
  • What kind of food elicits symptoms?
    • If both liquids and solids, was it solids first and then liquids?
  • Heartburn present or past?
  • “Red flag” symptoms? (weight loss, anemia, melena, hematemesis)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Where do Zenker’s diverticula occur?

A

inf to inf. constrictors

sup to cricopharyngeal

17
Q

S/Sx + DDx of Oro-pharyngeal dysphagia

A

Oro-Pharyngeal (Transfer) Dysphagia

S/Sx

  • Difficulty initiating a swallow
  • “sticks in throat”, nasal regurg, cough during swallowing

DDx

  • Neuro
    • Stroke/TIA, CN palsy
    • ALS, MS, PD, HD
    • Wilson’s
    • neurosyph (tabes dorsalis)
    • polio
    • botulism, tetanus, diptheria
  • Muscular
    • PM/DM, metab myopath
    • MG
    • myotonic dystrophy
    • oculopharyngeal dystrophy
    • amyloidosis
  • Structural
    • tumor
    • Zencker’s
    • inflammation
    • post surg/rad
    • compression from other structure
18
Q

Esophageal Dysphagia

  • S/Sx
  • DDx
A

Esophageal Dysphagia

S/Sx:

  • Food “sticks in chest”
    • not necess. where patient thinks b(/c innerv not specific)
  • R/O red flags: wt loss, anemia, melena, hematemesis

DDx

  • intra-luminal obstruction
  • structural
    • ring
    • stricture
    • extrinsic compression at one of 4 places:
      • pharynx
      • aortic arch
      • L main bronchus
      • diaphragm
  • functional
    • spasm
    • motor failure (e.g. achalasia)
19
Q

Steps in swallowing

A
  1. bolus pushed back as tongue thrusts up + back
  2. soft palate elevates closes nasopharynx
  3. larynx elevates, vocal cords close, epiglottis tips up
  4. UES opens, LES opens
  5. pharynx contracts
  6. peristalsis is initiated.

^Takes approximately 1s, although actual passage of food to stomach may take 3-8s.

  • Once started, peristalsis is auto, governed by SMM muscle of esophagus.
20
Q

3 types peristalsis

A
  1. Primary peristalsis of the esophagus is initiated by a swallow
  2. secondary peristalsis can be initiated anywhere in the esophagus by luminal distention
  3. Tertiary contractions may be seen in some people – these are ineffective, non-peristaltic contractions.
21
Q

Tests for motility include EGD, barium swallow and manometry. Classify manometry findings in dysphagia

A

Hypercontractile

  • Achalasia (at LES)
  • Diffuse Esophageal Spasm
  • Nutcracker esophagus

Hypocontractile

  • scleroderma/CREST
  • achalais (in upper section)
  • Hypotensive LES, Transient LES Relaxations (TLESrs)
22
Q

27 yo medical student presents with 9 months of progressive dysphagia to solids and liquids. Has lost 14 pounds due to decreased po intake. Has nocturnal cough in recumbency, and some post-prandial chest fullness and pressure. No pyrosis or odynophagia.

  • Diagnosis?
  • Pathophysiology
  • Testing?
  • Treatment?
A

Dx → Achalasia

Pathophys

  • Cause unknown: ?genetic, ?inflamm of myent. plex, ?s/sp infx, ?auto-imm, ?degen
  • Best evidence so far: Injured ganglion cells in myent. plexus → loss of NO-producing neurons → LES can’t relax + no peristalsis
    • Messes up the ACh/NO balance controlling contractility

Testing

  • CXR → air fluid level, no gastric bubble
  • barium → dilated eso., aperistalsis, bird beak [pic here], no gastric bubble
    • occurs slower than tumor which would happen too fast for bird beak to develop
  • Manometry = gold std
    • ​aperistalsis
    • LES hypertense
  • Endoscopy
    • use to exclude pseudo-achalasia (tumor at GE jct)
    • would see: bunch of food, pinhole LES that’s hard to push thru

Tx

  • pneumatic dilation
  • myotomy
    • POEM = PerOral Endoscopic Myotomy
  • drugs: BoTox, CCBs, nitrates
23
Q

A 72 y/o man presents w/ intractable chest pain accompianed by reflux. Cardiac work-up is benign. [Barium image below]

  • Dx?
  • Pathophys?
  • Work-Up
  • Tx options?
A

Diffuse Esophageal Spasm

  • neuromuscular d/o

Work-Up

  • barium swallow → corkscrew
  • manometry → crazed variety but key finding is “excess numbers of simultaneous contractions in the distal esophagus” (UpToDate)

Tx (per UptoDate)

  • Supported by clinical trials
    • CCB (eg, diltiazem)
    • Antidepr (eg, trazodone, imipramine)
  • Positive anecdotal results
    • Nitrates (eg, nitro, isosorbide)
    • Anticholinergics (eg, dicyclomine)
    • dilatation
    • BoTox
    • PDE inhibs (eg, sildenafil)
24
Q

Nutcracker Esophagus, briefly

A

“high amplitude peristaltic contractions in the distal 10 cm of the esophagus, with average distal esophageal peristaltic pressures > 220 mmHg” (UptoDate)

25
Q

esophageal webs and rings, briefly

A

Web - Mucosa & Submucosa only

  • (E.g. Plummer-Vincent = Fe++ def w/ muc ring)
  • “B” or “Schatzki’s” ring = mucosal web above hiatal hernia
    • Technically a web! [eMedcine]

Ring - all 3 esophag. layers (incl muscle)

  • “A” ring = muscular ring
26
Q

Name this finding.

  • Dx?
  • A.K.A.?
  • Endoscopy would show?
  • Biopsy shows?
A

Eosinophilic esophagitis (a.k.a. feline esophagitis)

  • Endoscopy shows these rings (image here, looks like cat’s esophagus)
  • Biopsy shows > 15 eos/hpf
27
Q

35 y/o HIV+ pt. complains of odynophagia and presents w/ this barium finding.

  • What’s your ddx?
  • If dx were most common cause, what would endoscopy show?
    *
A

Infectious esophagitis in HIV

  • Candidiasis (50%) endoscopy attached here
  • HSV (~12%)
  • CMV (~12%)
28
Q

Dysphagia flow chart

A
29
Q

GERD Spectrum

A
  1. Typical
    • ENRD - Erosion-Negative Reflux Disease
    • Erosive RD
  2. Atypical RD
    • asthma
    • cough
    • laryngitis
    • c.p.
    • globus
    • dental erosions
  3. Complicated RD
    • Stricture
    • Ulcer
    • Barrett’s (Metaplasia)
    • Cancer (adeno-ca)
30
Q

Pathophy of GERD

A

Multiple Causes, from top down:

  • ↓ HCO3-/saliva production
  • mucosal problem
  • hiatal hernia
  • TLESRs/↓ LES basal tone
  • excess H+ prod
  • delayed gastric emptying

Aggrevated by:

  • preg/posture/obesity
  • smoking/EtOH
  • caffeine/chocolate/juices
  • drugs that open LES (theophyllin, diazepam)
31
Q

Dx possibilties for GERD

A
  • Barium swallow/UGI
  • Upper endoscopy
  • Esophageal Manometry
  • Bravo pH capsule
    • test of choice to answer “Is there reflux?”
    • done OFF meds
  • Impedance catheter
    • test of choice “why meds not working?”
    • done ON meds
  • Bilitec probe
    • uses bilirubin as a marker for the detection of duodeno-oesophageal reflux
32
Q

What is this? Expected histo findings?

A

Barrett’s metaplasia

Stratified squamous → simple columnar w/ goblet cells

SBM GI (29 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions