5.2 - ESOPHAGEAL DISORDERS Flashcards
What is Achalasia?
3
Primary esophageal motility of unknown cause
Insufficient lower esophageal sphincter (LES) relaxation
Loss of esophageal peristalsis
What are possible causes of Achalasia?
4
Hereditary
Degeneration
Autoimmune factors (antibodies)
Infectious factors
What are three symptoms of Achalasia?
Dysphagia for solids + liquids
Regurgitation
Chest pain
What are Diffuse Esophageal Spasms? (2)
What can they cause? (2)
Repetitive, high amplitude contractions of smooth muscle portion of the esophagus
The striated portion and LES relaxes normally
//
Histopathology (tissue changes)
Muscular hypertrophy (enlargement)
What is a colloquial name for Diffuse Esophageal Spasm?
‘Cork-screw esophagus’
What is Nutcracker Esophagus?
2
A variant of Diffuse Esophageal Spasm (DES)
Very high amplitude contractions in the distal (lower) esophagus
What are Strictures?
Any loss of lumen area within the esophagus
What is the width of a typical esophagus?
20 mm in diameter
What is the predominant clinical symptom of strictures?
When does this become “official”?
Dysphagia
When the lumens diameter is less than 15 mm.
What is Schatzki Ring?
What causes it?
Narrowing (stricture) of only the lower part of theesophagus.
The narrowing is caused by a ring ofmucosal/muscular tissue
What is the danger with GERD?
Mucosal damage produced by the abnormal reflux of gastric contents into the esophagus
What are the classic symptoms of GERD?
7
Frequent + persistent heartburn
Persistent sore throat
Hoarseness
Chronic cough
Asthma
Heart-like chest pain
A feeling of a lump in the throat
What causes GERD?
1+3
LES barrier impairment
- Relaxation of LES
- Low resting LES pressure
- Increased gastric pressure
How will chronic GERD affect swallowing?
2
Decreased clearance of refluxed materials from esophagus
Decreased esophageal mucosal resistance
What issues does GERD cause?
3
Erosion
Ulcers
Cancer (Barrett’s Esophagus)
What is LPR?
2
Laryngo-Pharyngeal Reflux
Gastric contents reach the level of UES and spill over into the laryngeal areas.
How will chronic LPR affect swallowing?
2
Erosion of laryngeal mucosa
Contact ulcers
What are the symptoms of LPR?
2
Vocal symptoms
Sometimes aspiration
How is LPR identified?
pH monitoring
What is Esophageal Diverticula?
What is the most common version?
Where are they usually located?
Sac that protrudes from the esophageal wall (continuously traps food)
Zenker’s diverticulum.
Killian’s triangle
What is Killian’s Triangle?
The area between the cricopharyngeal sphincter and the inferior pharyngeal constrictor muscle.
What is Esophageal Diverticula associated with?
5
Cough
Bad Breath (extremely)
Regurgitation of undigested food
Sometimes a visual bulge in the throat
Sometimes repeated Pneumonia
How is Esophageal Diverticula treated?
Surgery
What is Scleroderma?
Autoimmune disorder that causes tissue to thicken and/or harden
Affects connective tissue to weaken LES causing GERD
What does Scleroderma predominantly affect?
The smooth muscle region (lower 2/3 of the esophagus)
What are three symptoms of Scleroderma?
3
Hypomotility
Heartburn
Dysphagia
