5.2 - ESOPHAGEAL DISORDERS

Question 1

What is Achalasia?

3

Answer 1

Primary esophageal motility of unknown cause

Insufficient lower esophageal sphincter (LES) relaxation

Loss of esophageal peristalsis

Question 2

What are possible causes of Achalasia?

4

Answer 2

Hereditary

Degeneration

Autoimmune factors (antibodies)

Infectious factors

Question 3

What are three symptoms of Achalasia?

Answer 3

Dysphagia for solids + liquids

Regurgitation

Chest pain

Question 4

What are Diffuse Esophageal Spasms? (2)

What can they cause? (2)

Answer 4

Repetitive, high amplitude contractions of smooth muscle portion of the esophagus

The striated portion and LES relaxes normally

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Histopathology (tissue changes)

Muscular hypertrophy (enlargement)

Question 5

What is a colloquial name for Diffuse Esophageal Spasm?

Answer 5

‘Cork-screw esophagus’

Question 6

What is Nutcracker Esophagus?

2

Answer 6

A variant of Diffuse Esophageal Spasm (DES)

Very high amplitude contractions in the distal (lower) esophagus

Question 7

What are Strictures?

Answer 7

Any loss of lumen area within the esophagus

Question 8

What is the width of a typical esophagus?

Answer 8

20 mm in diameter

Question 9

What is the predominant clinical symptom of strictures?

When does this become “official”?

Answer 9

Dysphagia

When the lumens diameter is less than 15 mm.

Question 10

What is Schatzki Ring?

What causes it?

Answer 10

Narrowing (stricture) of only the lower part of theesophagus.

The narrowing is caused by a ring ofmucosal/muscular tissue

Question 11

What is the danger with GERD?

Answer 11

Mucosal damage produced by the abnormal reflux of gastric contents into the esophagus

Question 12

What are the classic symptoms of GERD?

7

Answer 12

Frequent + persistent heartburn

Persistent sore throat

Hoarseness

Chronic cough

Asthma

Heart-like chest pain

A feeling of a lump in the throat

Question 13

What causes GERD?

1+3

Answer 13

LES barrier impairment

• Relaxation of LES
• Low resting LES pressure
• Increased gastric pressure

Question 14

How will chronic GERD affect swallowing?

2

Answer 14

Decreased clearance of refluxed materials from esophagus

Decreased esophageal mucosal resistance

Question 15

What issues does GERD cause?

3

Answer 15

Erosion

Ulcers

Cancer (Barrett’s Esophagus)

Question 16

What is LPR?

2

Answer 16

Laryngo-Pharyngeal Reflux

Gastric contents reach the level of UES and spill over into the laryngeal areas.

Question 17

How will chronic LPR affect swallowing?

2

Answer 17

Erosion of laryngeal mucosa

Contact ulcers

Question 18

What are the symptoms of LPR?

2

Answer 18

Vocal symptoms

Sometimes aspiration

Question 19

How is LPR identified?

Answer 19

pH monitoring

Question 20

What is Esophageal Diverticula?

What is the most common version?

Where are they usually located?

Answer 20

Sac that protrudes from the esophageal wall (continuously traps food)

Zenker’s diverticulum.

Killian’s triangle

Question 21

What is Killian’s Triangle?

Answer 21

The area between the cricopharyngeal sphincter and the inferior pharyngeal constrictor muscle.

Question 22

What is Esophageal Diverticula associated with?

5

Answer 22

Cough

Bad Breath (extremely)

Regurgitation of undigested food

Sometimes a visual bulge in the throat

Sometimes repeated Pneumonia

Question 23

How is Esophageal Diverticula treated?

Answer 23

Surgery

Question 24

What is Scleroderma?

Answer 24

Autoimmune disorder that causes tissue to thicken and/or harden

Affects connective tissue to weaken LES causing GERD

Question 25

What does Scleroderma predominantly affect?

Answer 25

The smooth muscle region (lower 2/3 of the esophagus)

Question 26

What are three symptoms of Scleroderma?

3

Answer 26

Hypomotility

Heartburn

Dysphagia