Esophageal Disorders Flashcards
What is the esophagus?
Muscular tube that conveys food from pharynx to stomach
Muscle layers of the esophagus? 2
What is it missing?
Food passes through quickly because of what?
- Inner circular muscle
- Outer longitudinal muscle
No serosa
peristalsis
Which part of the muscle is contracting during swallowing and which is relaxaing?
- Circular muscle contraction after the bolus
- Circular muscle relaxation before the bolus
What are the two types of movement in the esophagus and describe them?
Dysphagia common etiologies
- Originating in the lumen? 1
- Originating in the wall? 3 main ones, 3 more rare
- Originating outside the wall? 1 main, 3 more rare
- Neuromuscular disorders? 1 main, 1 more rare
- ^ In the lumen
- Tumor - ^ In the wall
- Achalasia*
- Tumor of the esophagus*
- GERD*
- Plummer Vinson syndrome- iron deficiency anemia
- Scleroderma- replaced with collagen tissue that has no contractibility
- Chagas’ disease- infectious. - ^ Outside the wall
- Pressure of enlarged lymph nodes*
- Thoracic aortic aneurysm
- Bronchial carcinoma
- Retrosternal Goiter - ^ Neuromuscular disorders
- Myesthenia gravis
- Stroke*
- UES moves how?
- LES moves how?
- Longitudinal and circular muscle moves how?
- UES….closes and relaxes
- LES….base line tone. Mostly stays shut
- Longitudinal and circular muscle…peristalsis
Normal phases of swallowing
- The voluntary part of swallowing consists of what?
- Involuntary swallowing consists of what? 3
Voluntary
- Oropharyngeal phase – bolus is voluntarily moved into the pharynx
Involuntary
- UES relaxation
- peristalsis (aboral movement)
- LES relaxation
Between swallows:
- UES prevents what? 2
- LES prevents what? 1
1.
- prevents air entering the esophagus during inspiration and
- prevents esophagopharyngeal reflux
2. gastroesophageal reflux
Esophageal disorders
6
- Motility
- Anatomic & Structural
- Reflux
- Infectious
- Neoplastic
- Miscellaneous (Perforation, Burns, Bleeding)
What kind of epithethium makes up the esophagus?
squamous
Oropharyngeal dysphagia (transfer dysphagia)
- Patients complain of what?
- What may cause symtpoms?
- patients complain of difficulty swallowing
- tracheal aspiration may cause symptoms
What are some pharyngoesophageal neuromusclar disorders?
8
- stroke
- Parkinson’s
- poliomyelitis
- ALS
- multiple sclerosis
- diabetes
- myasthenia gravis
- dermatomyositis and polymyositis
Upper esophageal sphincter dysfunction/HTN aka?
cricopharyngeal
What is a achalasia?
Incomplete relaxation of lower sphincter during swallowing leading to functional obstruction and proximal dilatation
(failure to relax)
Achalasia:
- PP: 3 contributing factors?
- What structures are usually dimished or absent?
- Histology findings?
- Hypotheses for etiologies? 2
- 5% develop what?
1.
- Aperistalsis,
- incomplete relaxation,
- increased resting tone
2. Ganglion cells of the myenteric plexus are diminished or absent
3. Histology: Inflammation in the area of M. plexus
4. Hypotheses: autoimmune, viral infections
5. 5% develop squamous cell carcinoma
Clincial picture of Achalasia:
History? 5
- Dysphagia (most common)
- Regurgitation
- Chest pain
- Heartburn
- Weight loss
Achalasia:
1. 25-50% report episodes of what?
2. 80-90% experience spontaneous what?
3. some patients may present with signs or symptoms of what?
- retrosternal chest pain
2. regurgitation.
3. pneumonia
Lab studies for Achalasia? 1
Imaging studies? 3 (and what will the findings be?)
The radiologic examination of choice in the diagnosis of achalasia is what?
Lab Studies
- Laboratory studies are noncontributory.
Imaging Studies
- UGI: Bird’s Beak.
- EGD: Normal or dilated esophagus.
- Manometry
Test of Choice: a barium swallow study performed under fluoroscopic guidance.
Normal esophageal mucosa appears what color?
white to tan
What is esophageal manometry used to assess? 2
Used to assess LES pressure & peristalsis
- The goal of therapy for achalasia is to do what?
- What are our two types of treatment?
- relieve symptoms by eliminating the outflow resistance caused by the hypertensive and nonrelaxing LES.
2.
- Medical Management
- Surgical Management
Diffuse Esophageal Spasm (DES) Characteristics
5
- Chest pain
- Intermittent dysphagia
- Segmental non-peristaltic contractions
- Corkscrew esophagus
- Muscular hypertrophy
What is a nutcracker esophagus characterized by?
High pressure peristaltic contractions
(Nutcracker esophagus, or Hypertensive peristalsis, is a disorder of the movement of the esophagus characterized by contractions in the smooth muscle of the esophagus in a normal sequence but at an excessive amplitude or duration.)
What is esophageal atresia?
congenital abnormality in which the mid-portion of the esophagus is absent
What is a TE fistula?
What are the etiologies depending on age? 2
A tracheoesophageal fistula is an abnormal connection (fistula) between the esophagus and the trachea.
TEF is a common congenital abnormality, but when occurring late in life is usually the sequela of surgical procedures such as a laryngectomy.
What will show that the tube has not reached the abdomen suggesting either atresia or a fistula?
A plain radiograph will confirm the tube has not reached the stomach
Absence of gas in the abdomen suggests that the patient has either what or what?
- atresia without a fistula or
- atresia with a proximal fistula only
Gastroesophageal reflux (GERD) is defined as what?
Mucosal damage produced by the abnormal reflux of gastric contents into the esophagus
PP of GERD?
- Primary barrier to gastroesophageal reflux is the lower esophageal sphincter
- LES normally works in conjunction with the diaphragm
- If barrier disrupted, acid goes from stomach to esophagus**