Chapter 17: GIT- Esophagus Obstruction Flashcards

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1
Q

For food and fluids to be delivered efficiently from the esophagus to the stomach, swallowing
must be accompanied by a coordinated wave
ofperistaltic contractions.

Esophageal dysmotility
interferes with this process and can take several forms.

A
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2
Q

What is nutcracker esophagus?

A

High-amplitude esophageal
contractions in which the outer longitudinal layer of smooth muscle contracts before the inner
circular layer occur in some patients.

Such lack of coordination results in a syndrome termed
nutcracker esophagus that can cause periodic short-lived esophageal obstruction.

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3
Q

What is diffuse esophageal spasm?

A

motor disorders of the esophagus which can also result in functional obstruction.

Because it increases esophageal wall stress, diffuse esophageal spasm can cause small diverticulae to form.

These small mucosal outpouchings, which are more
accurately described as pseudo-diverticulae
becausethey lack a true muscularis, are
uncommon, probably because of the dense and continuous esophageal musculature.

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4
Q

Where is the Zenker diverticulum (pharyngoesophageal diverticulum) located?

A

is located immediately above the upper
esophageal sphincter

What’s ZUp?

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5
Q

The traction diverticulum occurs near where?

A

midpoint of the esophagus;

TM

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6
Q

Epiphrenic diverticulum is located where?

A

immediately above the lower esophageal sphincter.

Mnemonic: Elow

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7
Q

Why does Zenker diverticulae may produce symptoms that include regurgitation and producing a mass ?

A

may reach several centimeters in size and accumulate significant amounts of food

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8
Q

Passage of food can also be impeded by esophageal stenosis, or narrowing of the lumen, what is the general cause of this?

A

. This is generally caused by fibrous thickening of the submucosa and is associated with atrophy of
the muscularis propria as well as secondary epithelial damage
.

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9
Q

Although occasionallycongenital, stenosis is most often due to what?

A
  • inflammation and scarring that may be caused by:
    • chronic gastroesophageal reflux,
    • irradiation, or
    • caustic injury.
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10
Q

The course of dysphagia is associated with
stenosis is usuailly what?

A

progressive, first affecting the ability to eat solids and only later interfering with ingestion of liquids.

Because obstruction develops slowly, patients may subconsciously modify their diet to favor soft foods and liquids and be unaware of their condition until the
obstruction is nearly complete.

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11
Q

What is an Esophageal mucosal webs?

A

are uncommon ledge-like protrusions of mucosa that may causeobstruction.

The pathogenesis is unknown, but webs are encountered most frequently in
women over age 40.

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12
Q

Esophageal mucosal webs encountered most frequently in what sex and age?

A

women over age 40.

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13
Q

Webs are often associated with what?

A
  • gastroesophageal reflux,
  • chronic graftversus- host disease
  • , or blistering skin diseases
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14
Q

Upper esophageal webs accompanied by .what?

A
  • irondeficiency anemia,
  • glossitis, and cheilosis are part of the Paterson-Brown-Kelly or Plummer- Vinson syndrome
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15
Q

Esophageal webs are most common where?

A

in the upper esophagus

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16
Q

What is the apperance of Esophageal Web esp in the upper esophagus?

A
  • generally semicircumferential,
  • eccentric lesions that protrude less than 5 mm and
  • have athickness of 2 to 4 mm.
17
Q

What is the microscopic appearance of Esophageal Web?

A

composed of a fibrovascular connective

tissue and overlying epithelium.

18
Q

What is the main symptom of Webs?

A
  • *dysphagi**a associated with
  • *incompletely chewed food.**
19
Q

What is Plummer-Vinson or Paterson-Kelly syndrome?

A

presents as a classical triad of dysphagia, iron-deficiency anemia and esophageal webs

20
Q

What is Plummer-Vinson or Paterson-Kelly syndrome?

A

presents as a classical triad of:

  • dysphagia,
  • iron-deficiency anemia
  • and esophageal webs
21
Q

What are Esophageal rings, or Schatzki rings?

A

, are similar to webs, but are circumferential and thicker.
Rings include mucosa, submucosa, and, in some cases, hypertrophic muscularis propria.

22
Q

When will the Esophageal rings, or Schatzki rings be termed A rings?

A

When
present in the distal esophagus, above the gastroesophageal junction, they are termed A rings
and are covered by squamous mucosa

23
Q

When will the Esophageal rings, or Schatzki rings be termed B rings?

A

located at the squamocolumnar
junction of the lower esophagus are designated B rings and may have gastric cardia-type mucosa on their undersurface.

Babang esophagus

24
Q

What is ACHALASIA?

A

Increased tone of the lower esophageal sphincter (LES), as a result of impaired smooth muscle
relaxation
, is animportant cause of esophageal obstruction.

25
Q

What allows the LES to relax during swallowing?

A

Release of nitric oxide and
vasoactive intestinal polypeptide from inhibitory neurons, along with interruption of normal
cholinergic signaling, allows the LES to relax during swallowing.

26
Q

Achalasia is characterized by
the triad of what?

A
  • incomplete LES relaxation,
  • increased LES tone, and
  • aperistalsis of the esophagus.
27
Q

Primary achalasia is caused by what?

A
  • *failure of distal esophageal inhibitory neuron**s and is, by
  • *definition, idiopathic**. [5]

Degenerative changes in neural innervation, either intrinsic to the esophagus or within the extraesophageal vagus nerve or the dorsal motor nucleus of the
vagus, may also occur

28
Q

When does secondary achalasia arise?

A

Secondary achalasia may arise in Chagas disease, in which Trypanosoma cruzi infection causes destruction of the myenteric plexus, failure of peristalsis,
and esophageal dilatation.

Duodenal, colonic, and ureteric myenteric plexi can also be affected in Chagas disease.

29
Q

Achalasia-like disease may be caused by what?

A
  • diabetic autonomic neuropathy;
  • infiltrative disorders such as malignancy, amyloidosis, or sarcoidosis;
  • and lesions of dorsal motor nuclei, particularly polio or surgical ablation.
30
Q

What are treatment options for primary and

secondary achalasia?

A
  • include laparoscopic myotomy and
  • pneumatic balloon dilatation.
  • Botulinum neurotoxin (Botox) injection, to inhibit LES cholinergic neurons, can also be effective.
31
Q
A