dysphagia

Question 1

what’s oropharygeal dysphagia?

Answer 1

difficulty initiating swallowing, w/in 1st secs leads to coughing, nasal regurgitation, hoarseness

Question 2

what 5 cranial nerves are assoc w/ the motor function of normal swallowing?

Answer 2

CN V, VII, IX, X, XII (5, 7, 9, 10, 12)

Question 3

what 3 cranial nerves are assoc w/ the sensory function in normal swallowing?

Answer 3

CH V, IX, X (5, 9, 10)

Question 4

what’s zenker’s diverticulum? who’s it commonly seen in? how can it be treated?

Answer 4

diverticulum leads to fibrotic UES so can’t open well, tx by cutting it
Commonly seen in elderly pts

Question 5

what are some common S/S of GERD?

Answer 5

substernal burning/regurg, postprandial, aggregavated by position change, relief by antacids

Question 6

what are the 2 normal components of anti-reflux barrier of the stomach?

Answer 6

1. LES - constant basal P

2. Crural diaphragm - kicks in when cough or exercise so reflux doesn’t occur

Question 7

what happens to the anti-reflux barrier of the stomach w/ a hiatal hernia?

Answer 7

separation of LES from crural diaphragm

Question 8

what are 4 common GERD complications

Answer 8

1. Stricture
2. Barrett esophagus
3. ulcers
4. hemorrhage

Question 9

what’s eosinophilic esophagitis and who’s it MC in?

Answer 9

rings in the esophagus - food gets stuck; likely to do w/ allergies and GERD, can lead to fibrosis
MC in men

Question 10

what’s the purpose of a manometry?

what’s it a good test for?

Answer 10

measures neuromuscular pathway of swallowing

good test for dysphagia of liquids and solids

Question 11

What’s achalasia?

Answer 11

neruomuscular problem where LES doesn’t open (bird beak sign) - liquid and solids dysphagia
see no perstalsis wave in manometry

Question 12

what would diffused esophageal spasm look like on a barium esophagram? manometry?

Answer 12

esophragram: corkscrew appearance
manometry: loss of peristalsis and high P waves

Question 13

how does scleroderma effect the GI system?
what part and what are s/s
what would a manometry look like?

Answer 13

esophagus involvement (CREST snydrome - calcinosis - raynauds - esophagus - sclerodactyl - telangiectasia)
distal 2/3 SM esophagus leads to dysphagia and heartburn
Manometry: activity only in upper 1/3 of esophagus

Question 14

what’s odynophagia?

Answer 14

painful swallowing

Question 15

what are 3 major causes of odynophagia

Answer 15

1. pill esophagitis - elderly (doxi/tetracyclines)
2. immunocomp’d pts - cancer, HIV (often assoc w/ candiditis or herpes)
3. severe ulcerative esophagitis - rare

Question 16

what are the 3 major featuresof reflux esophagitis pathology?

Answer 16

1. intraepithelial eosinophils and/or neutropihs
2. basal zone hyperplasia
3. elongation of lamina propria papillae