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GI Exam > Disorders of the Esophagus > Flashcards

Disorders of the Esophagus Flashcards

1
Q

anatomy of the esophagus

A

*mucosa: non-keratinized stratified squamous epithelium
*upper 1/3 = skeletal muscle
*middle = combination of smooth & skeletal muscle
*lower 1/3 = smooth muscle
*circular & longitudinal layers of muscle

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2
Q

gastroesophageal reflux disease (GERD) - overview

A

*key event = reflux of gastroduodenal contents (acid, pepsin, bile) into the esophagus
*mucosal defenses in the esophagus are minimal and are easily overwhelmed by the acid

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3
Q

pathophysiology of GERD

A

*transient LES (lower esophageal sphincter) relaxation
*hypotensive LES
*hiatal hernia
*decreased esophageal clearance (peristalsis, salivary function)

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4
Q

GERD - symptoms

A

*heartburn (pyrosis)
*epigastric abdominal pain
*regurgitation
*nausea
*belching
*dysphagia
*chest pain
*hiccups
*respiratory symptoms

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5
Q

complications of GERD

A

*erosions/ulcers
*stricture
*Barrett’s esophagus
*adenocarcinoma

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6
Q

GERD - treatment

A

*lifestyle modifications
*antacids
*H2 receptor antagonists
*PROTON PUMP INHIBITORS
*antireflux surgery (fundoplication)

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7
Q

Barrett’s Esophagus - overview

A

*occurs when the normal epithelium of the esophagus (non-keratinized, stratified squamous) is replaced by INTESTINAL EPITHELIUM containing GOBLET CELLS (aka intestinal metaplasia of the esophagus)
*metaplasia can progress to dysplasia and then to carcinoma

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8
Q

maintenance of Barrett’s Esophagus

A

*proton pump inhibitors
*routine surveillance (EGD with biopsy every 3-5 years) to monitor for potential progression to cancer
*if dysplasia, endoscopic therapy to get rid of the dysplasia

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9
Q

lifestyle modifications for GERD

A

1) sleep (sleep on left side; raise head of bed)
2) diet (avoid carbonated beverages)
3) habits (stop smoking, reduce alcohol intake)
4) body weight (lose weight)

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10
Q

antacids - overview

A

*contain ingredients such as aluminum hydroxide, magnesium hydroxide, calcium carbonate
*neutralize stomach acid
*work only on a short-term basis

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11
Q

common causes of infectious esophagitis

A
  1. CANDIDA (most common)
  2. herpes simplex (HSV-1)
  3. cytomegalovirus

*primarily occurs in immunocompromised individuals

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12
Q

odynophagia

A

*pain with swallowing
*causes: infectious esophagitis, pill-induced esophagitis, radiation esophagitis

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13
Q

pill esophagitis

A

*medications causing pill esophagitis include:
-tetracycline, doxycycline
-KCl, quinidine, alendronate
-chemotherapy (5-FU, daunorubicin, bleomycin)

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14
Q

Boerhaave’s Syndrome

A

*effort rupture of the esophagus (usually distal esophagus)
*typically presents with severe substernal chest pain and upper abdominal pain following forceful vomiting
*often associated with overeating or heavy alcohol use
*physical findings: tachypnea, fever, subcutaneous emphysema, shock
*chest X-ray: pneumomediastinum, free peritoneal air, subQ emphysema

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15
Q

caustic ingestions

A

*strong alkalis tend to injure esophagus > stomach: ex = drain cleaners

*strong acids tend to injure stomach > esophagus: ex = battery acid or toilet bowl cleaner

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16
Q

oropharyngeal dysphagia

A

*disorders of the pharynx or upper esophageal sphincter

17
Q

esophageal dysphagia

A

*disorders of the esophageal body or lower esophageal sphincter

18
Q

symptoms of oropharyngeal dysphagia

A

*difficulty initiating swallowing
*difficulty propelling the food bolus from the mouth through the throat to the esophagus
*repeated attempts to swallow
*pt localizes sx to throat or cervical esophagus
*nasal regurgitation of liquids
*coughing/choking with swallowing

19
Q

causes of oropharyngeal dysphagia

A

*neurologic: STROKE, parkinson’s, MS, etc
*skeletal muscle disorders: polymyositis, MD, MG
*mechanical: pharyngeal tumors, Zenker’s diverticulum, etc

20
Q

Zenker’s diverticulum

A

*a posterior pharyngeal pouch formed by the herniation of the pharyngeal mucosa through the cricopharyngeal muscle
*commonly seen in elderly population
*presents with dysphagia, regurgitation, aspiration, and bad breath

21
Q

diagnostic evaluation of oropharyngeal dysphagia

A

*modified barium swallow
*functional endoscopic evaluation of swallowing
*esophageal manometry

22
Q

symptoms of esophageal dysphagia

A

*pt feels that the food bolus stops somewhere in the chest (from suprasternal notch to xyphoid process)
*if food bolus is regurgitated, it consists of bland chewed food or swallowed liquid (does not have a bitter or acidic taste; does not contain yellow or green fluid of gastric or biliary secretions)

23
Q

diagnostic evaluation of esophageal dysphagia

A

*barium esophagram
*esophagoscopy (EGD)
*esophageal manometry

24
Q

esophageal diseases that may present as dysphagia

A

1) mucosal disease - peptic stricture, Schatzki ring, Zenker’s diverticulum, eosinophilic esophagitis
2) neuromuscular disease - achalasia, scleroderma esophagus, nonspecific esophageal motility disorders

25
Q

eosinophilic esophagitis - overview

A

*clinical sx of esophageal dysfunction (usually solid-food dysphagia and food impactions)
*typically a disease of young males
*many w/ PMHx of atopy/allergy
*> 15 eosinophils/high-power field (presence of eosinophils in esophageal mucosa)
*both genetic and environmental factors are important

26
Q

eosinophilic esophagitis - treatment

A

*PROTON PUMP INHIBITORS + topical steroids
*elimination diets?

27
Q

achalasia - overview

A

*a disorder of esophageal emptying characterized by:
-incomplete LES relaxation with swallowing
-aperistalsis of the esophageal body

*pathophysiology related to loss of nitric-oxide producing inhibitory ganglion cells

28
Q

achalasia - clinical presentation

A

*liquids and solids dysphagia
*chest pain
*postprandial regurgitation
*weight loss
*highest incidence in older people but can occur at any age

29
Q

achalasia - differential dx

A

*malignancy
*Chagas’ disease

30
Q

achalasia - treatment

A

*POEM (PerOral Endoscopic Myotomy)
*botulinum toxin injection
*pneumatic dilation
*surgical myotomy

31
Q

scleroderma of the esophagus - overview

A

*a disorder of esophageal emptying characterized by:
-decreased amplitude and frequency of peristaltic contractions in the distal esophagus
-reduced LES pressure

*pathophysiology relates to submucosal fibrosis & smooth muscle atrophy involving the distal 2/3 of the esophagus

32
Q

scleroderma of the esophagus - clinical presentation

A

*heartburn
*liquids and solids dysphagia (motility disorder; peptic stricture of the esophagus)
*nocturnal aspiration

33
Q

esophageal scleroderma - treatment

A

PROTON PUMP INHIBITORS

34
Q

manometric features of achalsia

A

*peristalsis = absent distally
*LES pressure = increased or normal; INCOMPLETE RELAXATION with swallowing

35
Q

manometric features of scleroderma esophagus

A

*peristalsis = decreased frequency & decreased amplitude
*LES pressure = decreased

GI Exam (54 decks)

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