1 - Esophageal Dz

Question 1

4 steps of oropharyngeal phase of swallowing

Answer 1

initiation
closing off nasopharynx w/ soft palate
protection of airway w/ epiglottis
clearing

Question 2

little pocket behind epiglottis where food can get stuck

Answer 2

vallecula

Question 3

when does lower esophageal sphincter open during a normal swallow?

Answer 3

shortly after initiation of swallow

Question 4

esophagus is innervated by

Answer 4

vagus nerve (dorsal motor nucleus and nucleus ambiguus)

Question 5

is smooth muscle inhibition greater or less as you move down the esophagus?

Answer 5

greater

Question 6

2 broad etiologies for disordered esophageal phase of swallowing

Answer 6

structural abnormality

abnormal motility

Question 7

globus sensation

Answer 7

sensation of a lump in the throat, does not actually interfere w/ swallowing though

Question 8

dysphagia + odynophagia

most likely due to

Answer 8

infection

Question 9

most important consequence of oropharyngeal swallowing problems

Answer 9

aspiration - may have to make NPO if this risk is too high and feed w/ NG tube or something

Question 10

dx: intermittent dysphagia for solids only

Answer 10

esophageal ring or eosinophilic esophagitis

Question 11

dx: progressive dysphagia for solids only + chronic heartburn

Answer 11

peptic stricture

Question 12

dx: progressive dysphagia for solids only + older age + wt loss

Answer 12

esophageal malignancy

Question 13

dx: intermittent dysphagia for solids and liquids + chest pain

Answer 13

diffuse esophageal spasm

Question 14

dx: progressive dysphagia for solids and liquids + chronic heartburn

Answer 14

scleroderma

Question 15

dx: progressive dysphagia for solids and liquids + bland regurg, wt loss

Answer 15

achalasia

Question 16

dx: dysphagia + odynophagia

Answer 16

infection or pill esophagitis

Question 17

sx of esophageal dz

Answer 17

hearburn, regurg, chest pain, dysphagia, odynophagia, globus sensation

Question 18

hiatus hernia

Answer 18

top of stomach herniates up through esophageal hiatus of diaphragm

Question 19

Schatzki’s ring

Answer 19

benign mucosal ring in the esophagus
can be treated by being stretched
acid suppression reduces recurrence

Question 20

tx of achalasia

Answer 20

botox
pneumatic dilation (more intensive than just balloon endoscopic dilation)
Heller myotomy

Question 21

tx of distal esophageal spasm

Answer 21

Ca channel blockers
nitrates
sildenafil
possibly botox

Question 22

how does esosinophilic esophagitis appear on barium swallow?

Answer 22

multiple rings

Question 23

how does achalasia appear on barium swallow?

Answer 23

bird’s beak - severe constriction at distal part with dilation of upper part

Question 24

tx of eosinophilic esophagitis

Answer 24

elimination diet (find food that is causing reaction)
acid suppression
steroids
careful esophageal dilation if still not responsive