Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

MBBS 3: Surgery > Dysphagia and Achalasia > Flashcards

Dysphagia and Achalasia Flashcards

1
Q

What is the esophagus?

A
  • a posterior mediastinal structure
  • Esophagus 25 cm long(cricoid cartilage to cardiac orifice), 2 cm in diameter
  • 43 cm from incisor teeth
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Layers of the esophagus?

A
  1. mucosa
    —surface epithelium, lamina propria, and glands.
  2. submucosa
    —connective tissue, blood vessels, and glands.
  3. muscularis (middle layer)
    - upper third, striated muscle
    - middle third, striated + smooth
    - lower third, smooth
  4. adventitia
    —connective tissue that merges with connective tissue of surrounding structures.
    Note: no serosal layer - only on distal part
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

3 types of esophagus?

A

cervical, thoracic and abdominal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Vasculature of the esophasgus?

A
  1. cervical oesophagus
    - is supplied by the inferior thyroid artery
  2. The thoracic oesophagus
    - is supplied by the brachial and oesophageal branches of the thoracic aorta
  3. abdominal esophagus
    - left gastric artery
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

The 3 natural constriction points of the esophagus?

A
  1. cricopharyngeal junction
  2. where left bronchus cross it
  3. gastroesophageal junction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is dysphagia?

A

difficulty swallowing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

2 categories of dysphagia?

A
  1. oropharyngeal dysphagia
  2. esophageal dysphagia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Oropharyngeal dysphagia?

A

results from a functional impairment in the initiation of swallowing: the oral and pharyngeal phases
- This form is most commonly a sequela of systemic neurologic or myopathic syndromes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Esophageal dysphagia?

A

dysphagia involves intrinsic functional (motor) and anatomic abnormalities of the esophagus resulting in difficulty swallowing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Things to ask on history taking of a dysphagia patient?

A
  1. timing of dysphagia
  2. painful swallowing
  3. location (cervical vs thoracic)
  4. intolerance of solid or liquid food
  5. onset/progression
  6. associated symptoms
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Hx of timing of dysphagia?

A

Described with respect to swallow: immediate vs. delayed
1. Oropharyngeal dysphagia
- Immediate coughing, choking regurgitation
2. Esophageal dysphagia
- Sensation of food “sticking”, getting “caught”, or delayed regurgitation of undigested food
3. “Globus sensation”
- Benign, constant, nonpainful sensation of fullness in neck / throat
- Should not be associated with swallowing difficulties

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Hx of painful swallowing?

A

Odynophagia is not typically associated with dysphagia
- Prompts consideration of infectious / inflammatory etiologies
e.g. Pharyngitis, mucositis following radiation therapy, caustic ingestion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

HX of location of dysphagia?

A

Patients will self localize: cervical, retrosternal, epigastric regions
- Accurate to within 4 cm of lesion via patient history in up to 74% of cases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

History of solid vs liquid intolerance?

A
  1. both solids and liquids - functional/ neuromuscular cause
  2. Solid food only - mechanical/anatomic cause
  3. Progression from purely solid to both - narrowing attributable to evolving mechanical obstruction (eg., esophageal cancer)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Hx of onset/progression of dysphagia?

A
  1. Intermittient, nonprogressive - suggestive of intrinsic motor dysfunction
  2. Short duration, or rapidly progressive - must rule out malignancy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Hx of associated symptoms of dysphagia?

A
  1. Anorexia or weight loss
    • Suggests underlying malignancy (associated peptic stricture may cause dysphagia without GERD in up to 25-35% of cases)
    • Achalasia can also be cause
  2. Passive regurgitation of undigested food
    • Achalasia, cricopharyngeal or esophageal diverticulae
  3. Retrosternal chest pain (once cardiac etiologies eliminated)
    • Esophageal spasm, GERD, eosinophilic esophagitis
  4. Medication lists must be reviewed to rule out drug-induced injury
    • Alendronate, doxy cy dine, NSAIDs, MMF
17
Q

Examining a dysphagia patient?

A
  1. The head and neck
    - size of the thyroid gland, any lymphadenopathy or masses.
  2. The cranial nerves
    - may demonstrate deficits contributing to oropharyngeal dysphagia
    - corresponding neurologic assessment may reveal signs of a cerebrovascular accident (CVA), myasthenia gravis, or Parkinson disease.
  3. The chest and abdomen
    - presence of subcutaneous nodules or masses that may indicate underlying malignancy.
  4. Dermatologic rashes
    - may indicate a paraneoplastic syndrome or a primary autoimmune disorder.
  5. Murmurs or thrills on cardiac auscultation
    - may represent atrial enlargement (secondary to mitral valvular stenosis), causing extrinsic esophageal compression
18
Q

Etiologies of oropharyngeal dysphagia?

A
  1. Fixed mechanical obstruction
    - Oropharyngeal cancer
    - Webs
    - Previous neck surgery or radiation treatment
    - Extrinsic compression
  2. Intrinsic motor disorders
    - Cricopharyngeal (Zenker) diverticulum
  3. Systemic conditions
    - Cerebrovascular accident
    - Myasthenia gravis
  4. Inflammatory
    - Eosinophilic esophagitis
    - HSV /CMV /Candida
    - Caustic ingestion
19
Q

Etiologies of esophageal dysphagia?

A
  1. Fixed mechanical obstruction
    Neoplasms
    Peptic stricture
    Webs
    Rings
    Extrinsic compression
  2. Intrinsic motor disorders
    Achalasia
    Esophageal spasms
  3. Systemic conditions
    Scleroderma
    Diabetes mellitus
  4. Inflammatory
    Eosinophilic esophagitis
    HSV /CMV /Candida
    Caustic ingestion
20
Q

Diagnostic testing for dysphagia?

A
  1. primary test
  2. upper endoscopy
  3. endoscopic ultrasonography
  4. 24 hr pH monitoring
  5. impedance monitoring
  6. esophageal manometry
  7. CT and MRI
  8. F-FDG-PET scan
21
Q

Management of dysphagia?

A

Depend on the cause
1. Resuscitation
2. Supportive/palliative care

22
Q

What is primary motility disorder?

A
  1. diffuse esophageal spasm (DES)
  2. nutcracker esophagus
  3. hypertensive LES
23
Q

What is the treatment for primary motility disorders?

A
  1. Is based on smooth muscle relaxation using nitrates such as isosorbide dinitrate or calcium channel blockers such as diltiazem.
  2. Balloon dilatation may be effective for isolated hypertensive LES
24
Q

What is secondary motility disorder?

A

the esophageal symptoms are a manifestation of a generalized systemic process

25
Q

What is the etiology of secondary motility disorder?

A

is thought to be progressive neuropathy and subsequent fibrosis.

26
Q

Most common diseases associated with secondary motility disorder?

A

scleroderma and diabetes mellitus

27
Q

Management of secondary motility disorder?

A

Management is directed toward treating the underlying disease process

28
Q

Zenkers diverticulum and it’s management?

A

esophageal pouch that develops in the upper esophagus that causes debilitating dysphagia (difficulty swallowing) and regurgitation of food.
- excision/myotomy

29
Q

Webs and their management?

A

Esophageal webs are thin membranes that grow across the inside of the upper part of the esophagus and may cause difficulty swallowing
- mechanical dilatation using Savary bougies or endoscopic balloons

30
Q

Rings and their management?

A

Rings are bands of normal esophageal tissue that form constrictions around the inside of the esophagus. They occur in the lower esophagus
- mechanical dilatation using Savary bougies or endoscopic balloons

31
Q

Strictures and their management?

A

An esophageal stricture refers to the abnormal narrowing of the esophageal lumen
- careful repeated dilatations combined with effective acid suppression therapy/ surgery/antibiotics/ antifungal

32
Q

Management of CA esophagus?

A

surgery/palliation

33
Q

What is achalasia?

A

This progressive disease
Result from a loss of inhibitory neurons in the Auerbach plexus, altering neural input to the LES and preventing normal relaxation.

34
Q

Etiology of achalasia?

A

The majority are idiopathic

35
Q

Epidemiology of achalasia?

A

females and males equally affected at a rate of one per 100,000 individuals per year.
The usual age at presentation is between 20 and 50 years, but it has been described in all age groups

36
Q

Presentation of achalasia?

A

The disease is slowly progressive and presents typically at an advanced stage

37
Q

Symptoms of achalasia?

A

progressive dysphagia to both solids and liquids, accompanied by regurgitation of food particles, chest pain, and weight loss

38
Q

Diagnostic testing for achalasia?

A
  1. Plain X-rays
  2. Manometry
  3. Endoscopic assessment
39
Q

Management of achalasia?

A

The aim of achalasia management is palliation of dysphagia by enhancing LES compliance and lowering the resting LES pressure
1. Endoscopic injection
2. Balloon dilation
3. Endoscopic myotomy( POEM/Heller)

MBBS 3: Surgery (42 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions