Chapter 28 - Pharynx and Esophagus (CHERI NOTES) Flashcards
The _____ ; also called a ___ ;is a barium examination of the alimentary tract from the pharynx to the ligament of treitz. (p.734)
UPPER GASTROINTESTINAL (UGI)SERIES (aka BARIUM MEAL)
A ____ or _____ is a study more dedicated
to the evaluation of swallowing disorders and suspected
lesions of the pharynx and esophagus. (p.734)
BARIUM SWALLOW or ESOPHAGOGRAM
Distention of the pharynx is provided by
having the patient ____. (p.734)
PHONATE
Distention of the esophagus is attained by
having the patient __.
(p.734)
HAVE THE PATIENT INGEST GAS-PRODUCING
CRYSTALS
___ views are collapsed views of the bariium-coated
esophagus. (p.734)
MUCOSAL VIEWS
TRUE OR FALSE.
CT is poor at evaluating the musosa and
generally cannot differentiate inflammatory and
neoplastic conditions. (p.734)
TRUE
MR is preferred over CT for evaluation of the
nasopharynx and is an alternative to CT for
demonstrating the extent of disease.
____ is useful for demonstration of tumor
penetration of the esoophageal wall. (p.734)
ENDOSCOPIC SONOGRAPHY
7 symptoms of abnormal oral or pharyngeal
swallowing. (p.737)
- Difficulty initiating swallowing
- Globus sensatuib (lump in throat)
- Cervical Dysphagia
- Nasal Regurgitation
- Hoarseness
- Coughing
- Choking
4 symptoms suggesting ESOPHAGEAL
DYSFUNCTION. (p.737)
- HEARTBURN
- DYSPHAGIA
- “INDIGESTION”
- CHEST PAIN
___ is defined as the awareness of swallowing
difficulty during the passage of solids or liquids
from mouth to stomach. (p.734)
DYSPHAGIA
- odynophagia (painful swallowing)
TRUE OR FALSE.
In Esophageal Motility disorders; the patient’s
subjective assessment of the location of the
abnormality is not reliable. (p.737)
TRUE
4 signs of PHARYNGEAL DYSFUNCTION
p.737
- PHARYNGEAL STASIS
- LARYNGEAL PENETRATION
- ASPIRATION
- NASAL REGURGITATION
- LARYNGEAL PENETRATION and tracheobronchial ASPIRATION are associated with increased risk of developing pneumonia especially in hospitalized patients.
_____; indicative of impaired pharyngeal transport;
is seen as increased residual volume of swallowed
material filling the valleculae and piriform sinuses.
(p.737)
PHARYNGEAL STASIS
____ is defined as entry of barium into the laryngeal
vestibule without passage below the vocal cords.
(p.737)
LARYNGEAL PENETRATION
____ implies barium passage below the vocal cords
p.737
ASPIRATION
____ occurs when the soft palate does not make a
good seal against the posterior pharyngeal wall.
(p.737)
NASAL REGURGITATION
-causes include neurologic impairment;
muscular dystrophies; and structural
defects in the palate.
______ is attibutable to failure of complete relaxation
of the UES ; commonly resulting in dysphagia and
aspiration. (p.737)
CRICOPHARYNGEAL ACHALASIA
In CRICOPHARYNGEAL ACHALASIA;
barium swallo demonstrates a shelf-like impression
(CRICOPHARYNGEAL BAR) on the barium column
at the pharyngoesophageal junction at the level
of ____. (p.737)
C5-C6 level
- the pharynx is distended and barium may overflow
into the larynx and trachea.
Narrowing of the lumen greater than ___ %
is generally accepted as a definite cause of dysphagia
(p.737).
greater than 50%
- cricopharyngeal dysfuntion is commonly associated
with neuromuscular disorders of the pharynx.
_____ of the esophagus is a disease of unknown
eitology characterized by:
1. absence of peristalsis in the body of the esophagus
2. marked increase in resting pressure of the LES
3. failure of the LES to relax with swallowing
(p.737)
ACHALASIA
- the abnormal peristalsis and LES
spasm result in a failure of the
esophagus to empty - pathologically; cases show a deficiency
of ganglion cells in the myenteric plexus
(Auerbach plexus) throughout the esophagus. - clinical presentation is insidious;
usually at 30 to 5 years; with dysphagia;
regurgitation; foul breath and aspiration.
5 Radiographic signs of
ACHALASIA (p.738)
1. Uniform dilatation of the esophagus; usually with an air-fluid level present 2. Absence of peristalsis; with tertiary waves common in the early stages of the disease 3. Tapered "beak" deformity at the LES because of failure of relaxation 4. Findings of esophagitis including ulceration 5. Increased incidence of Epiphrenic Diverticulum and Esophageal CA
- treatment of Achalasia is BALLOON DILATION
or HELLER MYOTOMY
3 Diseases that may mimic
Esophageal Achalasia. (p. 738)
- Chagas Disease
- Carcinoma of the GEJ
- Peptic Strictures
\_\_\_\_\_ is caused by the destruction of ganglion cells of the esophagus due to a neurotoxin released by the protozoa; Trypanosoma cruzi; endemic to South America; esp. eastern Brazil. (p.738)
CHAGAS DISEASE
- The radiographic appearance of the esophagus is identical to achalasia.
- Associated abnormalities include cardiomyopathy;
megaduodenum; megaureter and megacolon
\_\_\_\_\_ may mimic achalasia but tends to involve a longer (> 3.5 cm) segment of the distal esophagus; is rigid; and tends to show more irregular tapering of the distal esophagus and mass effect. (p.738)
CARCINOMA OF THE GEJ
When findings of achalasia are present on barium studies; it is important to evaluate the \_\_\_\_\_\_\_\_\_\_\_\_ and \_\_\_\_to rule out an underlying malignant tumor at the GEJ as the cause of these findings. (p.738)
GASTRIC CARDIA and FUNDUS
- The cardia and fundus is however not adequately evaluated radiographically in all patients because of delayed emptying of barium from the esophagus. - Therefore; it is important to be aware of the limitations of barium studies in evaluating the cardia and fundus in patients with suspected achalasia.
\_\_\_ strictures are usually associated with normal primary esophageal peristalsis. A hiatal hernia is usually present. (p.738)
PEPTIC STRICTURES
\_\_\_\_ is a syndrome of unknown cause characterized by multiple tertiary esophageal contractions; thickened esophageal wall; and intermittent dyphagia and chest pain. (p.738)
DIFFUSE ESOPHAGEAL SPASM
- primary peristalsis is usually present but contractions are infrequent. - Most patients are middle-aged - The LES is frequently dysfunctional and the conditions commonly improves with injection of Clostridium botulinum toxin at the GEJ wth endoscopic balloon dilatation of the LES.
\_\_\_ is characterized on barium studies by intermittently absent or weakened primary esophageal peristalsis with simultaneous; nonperistaltic contractions that compartmentalize the esophagus; producing a classic corkscrew appearance. (p.738)
DIFFUSE ESOPHAGEAL SPASM
- CT reveals circumferential thickening
(5 to 15 mm) of the wall of the
distal 5 cm of the esophagus in
20% of patients.
______ disorders are a common
cause of abnormalities of the
oral; pharyngeal; or esophageal
phases of swallowing. (p.738)
NEUROMUSCULAR disorders
The most common cause
of neurologic dysfunction is
_____ and ____. (p. 738)
CEREBROVASCULAR DISEASE and
STROKE
- additional causes include Parkinsonism;
Alzheimer disease; multiple sclerosis;
neoplasms of the CNS and posttraumatic
CNS injury.
Diseases of the striated esophageal muscle; such as muscular dystrophy; myasthenia gravis; and dermatomyositis; predominantly affect the \_\_\_ and \_\_\_\_\_\_ of the esophagus. (p.738)
PHARYNX and PROXIMAL THIRD
(striated muscle portion) of the
esophagus.
\_\_\_\_ is a systemic disease of unknown cause characterized by progressive atrophy of smooth muscle and progressive fibrosis of affected tissues. (p.739)
SCLERODERMA
- women are most commonly affected; usually aged 20 to 40 years at the onset of disease. - the esophagus is affected in 75% to 80% of patients
4 Radiographic findings of
Scleroderma (p.739)
1. Weak to absent peristalsis in the distal two-thirds (smooth muscle portion) of the esophagus. 2. Delayed esophageal emptying 3. A stiff dilated esophagus that does not collapse with emptying 4. Wide gaping LES with free gastroesophageal reflux.
- despite free reflux; tight strictures
of the distal esophagus are uncommon.
TRUE OR FALSE. Postoperative states; including surgery for malignancy of the tongue;larynx and the pharnyx; commonly impair swallowing function as well as alter the morphology.
TRUE
- surgical resection is aimed at providing
at least a 1-cm margin free of tumor and
often results in removing large blocks of
tissue and functionally altering the
structures that remain.
\_\_\_\_ frequently results in abnormal esophageal motility and esophageal motility and visualization of tertiary esophageal contractions. (p.739)
ESOPHAGITIS
\_\_\_\_ occurs as a result of incompetence of the LES. The resting pressure of the LES is abnormally decreased and fails to increase with raised intraabdominal pressure. (p.739)
GASTROESOPHAGEAL REFLUX
DISEASE (GERD)
- as a result; increases in intraabdominal
pressure exceed LES pressure;
and gastric contents are allowed to
reflux into the esophagus. - GERD is classified as a spectrum of
conditions: nonerosive reflux disease;
erosive esophagitis; and Barett esophagus.
3 symptoms of GERD.
p.739
1. SUBSTERNAL BURNING PAIN
("heartburn")
2. POSTURAL REGURGITATION
(in supine position)
3. DEVELOPMENT OF
REFLUX ESOPHAGITITS;
DYSPHAGIA AND ODYNOPHAGIA.3 complications of GERD (p.739)
- REFLUX ESOPHAGITIS
- STRICTURE
- DEVELOPMENT OF BARRETT
ESOPHAGUS
TRUE OR FALSE. Thhe radiographic diagnosis of GERD may be difficult because 20% of normal individuals show spontaneous reflux on UGI examination; and patients with pathologic GERD may not demonstrate reflux without provocative tests. (p.739)
TRUE
5 Findings associated with
GERD on barium esophagrams.
(p.739)
1. HIATAL HERNIA; associated with presence of reflux esophagitis 2. SHORTENING OF THE ESOPHAGUS; a finding of importance to treating GERD surgically 3. IMPAIRED ESOPHAGEAL MOTILITY 4. GASTROESOPHAGEAL REFLUX; often demonstrated by provocative maneuvers such as Valsalva; leg raising; and cough 5. Prolonged clearance time of refluxed gastric contents.
- low volume reflux is not considered a
significant finding.
Most sensitive means of
diagnosing abnormal GERD
(p.739)
MONITORING OF ESOPHAGEAL pH for
24 hours in an ambulatory patient.
- GERD is managed medically with agents
that inhibit gastric acid production or
surgically with fundoplication
___ hernia is often considered
synonymous with GERD. (p.739)
HIATUS hernia
- most patients with hiatus hernia do not have gastroesophageal reflux or evidence of esophagitis. - Hiatus hernia is therefore NOT LIKELY as a PRIMARY CAUSE OF REFLUX. - However; up to 90% of patients with GERD have a hiatus hernia. - The presence of hiatus hernia delays the clearance of reflux and promotes development of RE.
Simply defined as protrusion
of any portion of the stomach
into the thorax. (p.740)
HIATUS hernia
- highly prevalent affecting
40% to 60% of adults.
3 types of hiatal hernia (p.740)
- SLIDING HIATUS HERNIA
- PARAESOPHAGEAL HIATUS HERNIA
- MIXED OR COMPOUND HIATAL
HERNIA
Most common type of hiatal hernia (95%).
p.740
SLIDING HIATUS HERNIA
Type of hiatal hernia where the the GEJ is displaced more than 1 cm above the hiatus. The esophageal hiatus is often abnormally widened to 3 to 4 cm. (p.740)
SLIDING HIATUS HERNIA
- the gastric fundus may be displaced above
the diaphragm and present as a
retrocardiac mass on chest radiographs. - the presence of an air-fluid level in the
mass suggests the diagnosis. - small; sliding hiatus hernias commonly
reduce in the upright position. - the function of the LES and the presence
of pathologic gastroesophageal reflux
are the crucial factors in producing
symptoms and causing complications.
The upper limit of normal hiatal
width is __ mm; most easily
measured by CT. (p.740)
15 mm
type of hiatal hernia where the the GEJ remains in normal location; while a portion of the stomach herniates above the diaphragm. (p.740)
PARAESOPHAGEAL HIATUS HERNIA
\_\_\_\_\_is the most common type of paraesophageal hernia. The GEJ is displaced into the thorax with a large portion of the stomach; which is usually abnormally rotated.
MIXED OR COMPOUND HIATAL HERNIA
TRUE OR FALSE. Paraesophageal hernis; esp. when large with most of the stomach in the thorax; are at risk for volvulus; obstruction and ischemia. (p.740)
TRUE
___ are protrusions of pharyngeal
mucosa through areas of
weakness of the lateral
pharyngeal wall. (p.741)
LATERAL PHARYNGEAL DIVERTICULA
Most common regions of
Lateral Pharyngeal Diverticula.
(p.741)
TONSILLAR FOSSA and the
THYROHYOID MEMBRANE
These condition reflects
increased intrapharyngeal pressure and are seen most
commonly in wind instrument
players. (p.741)
LATERAL PHARYNGEAL DIVERTICULA
\_\_\_\_ arises in the hypopharynx just proximal to the UES. It is located in the posterior midline at the cleavage plane, known as Killian dehiscence; between the circular and the oblique fibers of the crico- pharyngeus muscle. (p.741)
ZENKER DIVERTICULUM
- the diverticulum has a small neck that is higher than the sac; resulting in food and liquid being trapped within the sac. - the distended sac may compress the cervical esophagus - symptoms include dysphagia; halitosis and regurgitation of food.
\_\_\_\_\_ diverticula which originate on the anterolateral wall of the proximal cervical esophagus in a gap just below the cricopharyngeus and lateral to the longitudinal tendon of the esophagus (i.e. the Killian- Jamieson space). (p.741)
KILIAN-JAMIESON DIVERTICULA
- less common and considerably smaller than Zenker diverticulum and appear on pharyngoesophagography as persistent left-sided or; less frequently; bilateral outpouchings from the proximal cervical esophagus below the cricopharyngeus.
- less likely to cause symptoms
and are less likely to be associated with
overflow aspiration or gastroesophageal
reflux than is Zenker Diverticulum
Midesophageal diverticula
may be ___ or ___ diverticula.
(p.742)
PULSION or TRACTION DIVERTICULA
- midesophageal diverticula have large
mouths; empty well and are usually
asymptomatic
____ diverticula occur as a result
of disordered esophageal
peristalsis. (p.742)
PULSION DIVERTICULA
\_\_\_\_ diverticula occur because of fibrous inflammatory reactions of adjacent lymph nodes and contain all esophageal layers. (p.742)
TRACTION DIVERTICULA
_____ diverticula occur just above
the LES; usually on the right side.
They are rare and usually found
with esophageal motility disorders.
- because of a small neck;
higher than the sac; they may trap
food and liquids and cause symptoms
(p.742)
EPIPHRENIC DIVERTICULA
____ are small outpouchings
of the esophagus that
usually occur as a sequela of
severe esophagitis. (p.742)
SACCULATIONS
- thought to result from the healing and scarring of ulcerations - tend to change in size and shape during fluoroscopic observation - smooth contours help to differentiate sacculations from ulcerations
\_\_\_\_\_ are the dilated excretory ducts of deep mucous glands of the esophagus. - they appear as flask-shaped barium collections that extend from the lumen or as lines and flecks of barium outside the esophageal wall. (p.742)
INTRAMURAL PSEUDODIVERTICULA
- tend to occur in clusters and in
association with strictures.
- linear tracks of barium ("intramural
tracking") commonly bridge adjacent
pseudodiverticula.
7 radiographic signs of
ESOPHAGITIS (p.743)
1. Thickened esophageal folds (>3 mm) 2. Limited esophageal distensibility (asymmetric flattening) 3. Abnormal motility 4. Mucosal plaques and nodules 5. Erosions and ulcerations 6. Localized stricture 7. Intramural pseudodiverticulosis (barium filling of dilated 1 to 3 mm submucosal glands)
