Anatomy & Diseases Flashcards
What is Peristalsis?
When the upper esophageal sphincter opens, food enters the esophagus, where waves of muscular contractions (peristalsis) propel the food downward.
What is Achalasia?
Disease of the muscle of the lower esophageal sphincter (LES) and prevents relaxation of the sphincter
Creates an absence of contractions (or peristalsis)
What are sympotoms of Achalasia?
Dysphagia (difficulty swallowing)
Chest pain
Regurgitation
Heartburn
Weight loss
Distended esophagus / fills with food / unable to pass
What causes Achalasia?
- Nobody is exactly sure how achalasia develops, but the most common theory is that a person gets an infection that causes the immune system to “turn on” and fight it. Unfortunately, the immune system can mistake the nerves in the esophagus as the cause of the infection and as a result destroy the nerves, causing achalasia.
- Genetic: Very rare, accounting for only 1 to 2 percent of patients.
- Degenerative: A small percentage of people with achalasia, especially older patients, seem to get it from slow destruction of their nerves caused by an unknown neurological problem.
How do you diagnose Achalasia?
- Esophageal manometry: test that shows how well the esophagus is working. It measures muscle contractions of the esophagus as water moves through to the stomach.
- Upper endoscopy: surgical endoscopist looks to see if there is food or fluid in the esophagus, whether or not the esophagus is dilated because the wall muscles are weak, if the LES appears tight and if there are any other causes behind the swallowing difficulties.
What are treatments for Achalasia?
- Dilation
- Oral Medications
- Direct Injections
- Surgery (POEM)
Which surgery is speficially for Achalasia?
POEM
What is Barrett’s Esophagus?
Condition where normal cells in the distal esophagus (squamous cells) change to abnormal columnar cells.
The Z-Line is where this tissue change SHOULD occur.. It moves past that with Barrett’s. The esophagus cells start to mimic the stomach cells.
Is Barrett’s malignant?
It is a non-malignant condition, however, patients with this condition have a higher risk of developing esophageal cancer.
What are the symptom’s of Barrett’s Esophagus?
- Usually mimic those of GERD or esophagitis
- Benign esophageal strictures
What are the causes of Barrett’s Esophagus?
- Long-term severe GERD (10% of patients with GERD see a progression to Barrett’s Esophagus)
- Esophagitis
- Hiatal Hernia
How do you diagnose Barrett’s Esophagus?
Dependent upon the presence of dysplasia
1. Endoscopic (EGD) Examination
2. Biopsy using the Seattle Protocol
What is the Seattle Protocol?
There is a very specific tissue sampling protocol for Barrett’s Esophagus. The goals of the procedure are to establish diagnosis of Barrett’s, verify its length, identify any dysplasia. The protocol is referred to as a 4-quadrant protocol; it’s also known as the Seattle protocol.
What is the treatment for Barrett’s?
- No dysplasia: Monitor cell change using periodic EGDs & provide treatment for GERD
- Low-grade dysplasia: Endoscopic resection or radio-frequency ablation
- High-grade dysplasia: Cryo-therapy, surgery, or photodynamic therapy
What is Esophagitis?
Esophagitis is a non-malignant inflammation that may damage the tissue of the esophagus.
Need to know what caused it before you can treat it.
What are symptoms of Esophagitis?
- Dysphagia
- Heartburn/acid regurgitation
- Bitter taste in mouth
- A feeling of food sticking in chest after swallowing
- Chest pain, particularly behind the breastbone, that occurs with eating
What are complications of Esophagitis?
- Scarring or narrowing (stricture) of the esophagus
- Tearing of the esophagus lining tissue from retching (if food gets stuck) or during endoscopy
- Barrett’s esophagus
Treatment of Esophagitis?
- EGD
- Biopsy: For esophagitis, the clinician takes tissue samples to: Determine if there is an infection, rule out inflammation associated with GERD, and determine if any ulcers are malignant.
- Imaging: X-rays can show narrowing of the esophagus etc.
What is GERD?
Disorder that affects the lower esophageal sphincter (LES) and causes stomach acid or bile to irritate the esophagus
Can sometimes change the esophageal makeup
What are symptoms of GERD?
- Heartburn, usually after eating
- Chest pain
- Bloating
- Burping
- Dysphagia
- Regurgitation
Potential causes of GERD?
- LES is weak or relaxes inappropriately
- Hiatal Hernia
- Diet
- Obesity
- Pregnancy
- Smoking
- Alcohol/Coffee
Treatment Options for GERD?
- Lifestyle Modifications
- Medications (antiacid, proton pump inhibitors)
- Fundoplication
- LINX Device
- Transoral Incisionless Fundoplication
- Stretta
- Medigus Ultrasonic Surgical Endostapler
What are the types of Esophageal Cancer?
Squamous Cell: This type of esophageal cancer can develop along the entire esophagus in the squamous cells that line the inner esophagus. Typically occurs in the upper and middle portions of the esophagus.
Adenocarcinoma (most common in the United States
Potential causes of Esophageal Cancer?
- Barrett’s esophagus
- Excessive smoking or use of alcohol
- Chronic inflammation of the esophagus
- Persistent reflux/GERD
- Nutritional deficiency
- Achalasia
