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Clinical Medicine > Esophageal Disease > Flashcards

Esophageal Disease Flashcards

1
Q

Esophageal tube

A
  • 25cm
  • Connects pharynx to stomach
  • muscular
  • Bordered by high pressure sphincters
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2
Q

Curves of esophagus

A
  • 2 gentle curves corresponding to curvatures in cervical & thoracic sections of vertebral column
    1) just below start
    2) crossing descending thoracic aorta
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3
Q

Constrictions of esophagus

A

1) UES; narrowest point, around C6
2) Nonfunctional; clinically unimportant (no disease processes), due to crossing of the aortic arch & left main bronchus
3) LES

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4
Q

Sections of Esophagus

A

1) Cervical
2) Thoracic
3) Abdominal (smallest section)

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5
Q

Musculature & Nerve Supply of Esophagus

A
  • Upper 1/3 = striated muscle, recurrent laryngeal branches of vagus nerve
  • Lower 2/3 = smooth muscle, parasympathetic control via esophageal mesenteric plexus
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6
Q

Cervical Portion Blood Supply

A

Inferior Thyroid Artery

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7
Q

Thoracic Portion Blood Supply

A

Branches of thoracic aorta

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8
Q

Abdominal Portion Blood Supply

A

Left Phrenic & Left Gastric Arteries

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9
Q

Blockage of vessels supplying esophagus?

A

Such as emboli; abnormal esophageal function resulting in dysphagia

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10
Q

Microscopic Anatomy of Esophagus

A

-Mucosa composed of squamous epithelium continuous w/ pharyngeal mucosa; underlying layers contain vascular/nervous supply

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11
Q

Squamocolumnar Junction

A
  • aka Z-line
  • Epithelium changes from squamous to columnar cells
  • Normally at GE junction which is below diaphragm
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12
Q

Barrett’s Esophagus

A

Z-line migrates away from GE junction, up into esophagus b/c of disease pathology. Uncontrolled GERD for ex.

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13
Q

UES

A
  • Upper Esophageal Sphincter
  • Prevents aspiration & swallowing of excessive amounts of air
  • Held closed (resting position) by ELASTIC properties & firing of vagus nerve
  • Opened by inhibition of vagus causing contraction of musculature (Vagal damage increases risk of aspiration due to floppy UES)
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14
Q

LES

A
  • Lower Esophageal Sphincter

- Prevents reflux of GI contents; frequently fails for a variety of reasons

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15
Q

3 Stages of Swallowing

A
  • Requires well-coordinated peristalsis involving CN V, VII, IX, X, & XII
    1) Oral Stage
    2) Pharyngeal Stage
    3) Esophageal Stage
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16
Q

Oral Stage

A
  • Voluntary
  • Chew food & form bolus
  • Very important part, common problem for elderly
  • Tongue propels bolus to posterior oropharynx (OP)
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17
Q

Pharyngeal Stage

A
  • Involuntary
  • All about moving bolus from OP through UES in 5 steps
    1) Elevate & retract soft palate preventing nasopharyngeal aspiration
    2) Vocal cords close, epiglottis swings back to close larynx preventing aspiration
    3) UES relaxes
    4) Larynx pulls up stretching opening of esophagus & UES
    5) Pharyngeal muscles contract propelling food into esophagus
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18
Q

Esophageal Stage

A
  • Involuntary
  • Transports food from UES to stomach while LES is relaxed
  • Accomplished through peristalsis
19
Q

Dysphagia

A
  • Difficulty swallowing
  • Subjective sensation suggesting inability to normally pass liquids or solids from oral cavity to stomach
  • NEVER ATTRIBUTE TO GETTING OLD
20
Q

Odynophagia

A
  • Pain with swallowing

- ALARM SYMPTOM prompting an immediate workup

21
Q

4 Requirements of Proper Swallowing

A

1) Proper consistency & size of food bolus (proper chewing)
2) Adequate caliber of esophageal lumen (scar tissue? inflammation?)
3) Integrity of peristaltic contraction
4) Coordinated i./nhibition of UES & LES (so that they relax)
- Failure of any causes dysphagia

22
Q

Structural Dysphagia

A
  • Oversized bolus

- Narrow lumen

23
Q

Motor Dysphagia

A
  • Aka Propulsive dysphagia
  • Abnormal peristalsis
  • Poor sphincter relaxation
24
Q

Two Major Categories of Dysphagia

A
  • Oropharyngeal

- Esophageal

25
Q

Oropharyngeal Dysphagia

A
  • Aka Transfer Dysphagia

- Dysfunction of the oropharynx, larynx, or UES (something wrong from lips to UES)

26
Q

Esophageal Dysphagia

A
  • Dysfunction of the esophageal body, LES, or cardia (something wrong from UES to LES)
  • Usually mechanical problem or motility disturbance
27
Q

Functional Dysphagia

A

-Dysphagia with which no cause can be identified

28
Q

Three Questions for History in Dysphagia Pt’s

A

1) What do you mean by trouble swallowing? Difficulty initiating a swallow (coughing, choking, nasal regurgitation) or globus sensation after initiating a swallow? (Former = oropharyngeal, latter = esophageal)
2) Solids & liquids or just solids? (Former = motor disorder, latter = mechanical obstruction)
3) How often does it happen? Is it getting progressively worse?

29
Q

Differential Diagnosis

A

Take a broad complaint and think of every possible cause for it to create an initial list. Through questioning and physical exam the list is narrowed down, ticking things off the list based on workup.

30
Q

Structural Oropharyngeal Dysphagia Diagnoses

A
  • Zenker’s Diverticulum
  • Cancer
  • Cervical web
  • Post-radiation
  • CP Bar
31
Q

Neurogenic Propulsive Oropharyngeal Dysphagia Diagnoses

A
  • CVA
  • Parkinsons
  • MS
  • ALS
32
Q

Propulsive Esophageal Dysphagia Diagnoses

A
  • GERD w/ weak peristalsis
  • Achalasia
  • Diffuse Esophageal Spasm (DES)
  • Scleroderma Esophagus
  • Note that because this is propulsive in nature, it is dealing with solid & liquid dysphagia
33
Q

Structural Esophageal Dysphagia w/ Odynophagia Diagnoses

A
  • Pill Esophagitis

- Infectious Esophagitis

34
Q

Intermittent Structural Esophageal Dysphagia Diagnoses

A
  • Schatzki Ring

- Esophageal Web

35
Q

Progressive Structural Esophageal Dysphagia Diagnoses

A

-Neoplasm

36
Q

2 Phases of Oropharyngeal Dysphagia

A

1) Oral

2) Pharyngeal

37
Q

Oral Phase Dysphagia

A
  • Inability to make food bolus & poor control of it
  • Drooling
  • Aspiration (either tracheal or nasopharyngeal)
  • Premature spillage of food into hypopharynx (laryngopharynx)
38
Q

Pharyngeal Phase Dysphagia

A
  • Retention of food in pharynx
  • Poor tongue &/or pharyngeal propulsion
  • Obstruction at UES
39
Q

3 Categories of Oropharyngeal Dysphagia Causes

A

1) Iatrogenic
2) Neurologic
3) Structural

40
Q

Iatrogenic Oropharyngeal Dysphagia

A
  • Head/neck surgery

- Radiation secondary to cancer

41
Q

Neurologic Oropharyngeal Dysphagia

A
  • CNS issues (CVA)

- Degenerative Diseases (Parkinsons, ALS, MS)

42
Q

Structural Oropharyngeal Dysphagia

A
  • aka Obstructive Lesion
  • Zenker’s Diverticulum
  • CP Bar fibrosis (hard for UES to open)
  • Cancer (extrinsic or intrinsic)
  • Cervical Web
43
Q

Relevant PMH for Oropharyngeal Dysphagia

A
  • Hx of alcoholism, smoking, unintentional weight loss (malignancy)
  • Hx of dry eye/mouth (poor saliva production)
  • Hx of radiation to head/neck
  • Meds like anticholinergics, antihistamines, & antihypertensives can cause dry mouth
44
Q

Oropharyngeal Dysphagia Presentation

A
  • Symptoms immediately upon swallow or during swallow
  • Typically progressive
  • Occasionally globus sensation in cervical region
  • Repositioning of body to optimize alignment of bolus
  • Cough (generally; early in swallow = neuromuscular, late in swallow = obstructive)

Clinical Medicine (1 decks)

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