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Esophageal Disorders Flashcards

1
Q

Esophagus

A

Muscular tube that conveys food from pharynx to stomach

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2
Q

Two Layers of Muscle in the Esophagus

A

Inner circular muscle

Outer longitudinal muscle

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3
Q

How does food pass through the esophagus?

A

Perstalsis

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4
Q

What are the two types of movement?

A

Perstaltic

Segmental

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5
Q

What kind of movement is peristaltic?

A

Moves food forward

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6
Q

What kind of movement is segmental?

A

Mixing

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7
Q

3 locations where dysphagia can occur?

A

In the lumen
In the wall
Outside the wall

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8
Q

Dysphagia in the Lumen

A

Tumor

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9
Q

Dysphagia in the Wall

A 
Achalasia
Tumor of the esophagus
GERD
Plummer Vinson syndrome
Scleroderma
Chagas' disease
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10
Q

Define Achalasia

A

Neurological disturbance of the dilation of the LES

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11
Q

What is Plummer Vinson Syndrome?

A

Iron deficiency anemia

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12
Q

Define Scleroderma

A

Normal collagen replaced with tissue with no contractility

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13
Q

Dysphagia Outside the Wall

A

Pressure of enlarged lymph nodes
Thoracic aortic aneurysm
Bronchial carcinoma
Retrosternal goiter

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14
Q

Dysphagia due to Neuromuscular Disorders

A

Myasthenia gravis

Stroke

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15
Q

What is the responsibility of the circular muscles of the esophagus?

A

Propulsion down the esophagus

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16
Q

3 Parts of the Esophageal Anatomy

A

UES
Esophageal body
LES

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17
Q

UES

A

Closes

Relaxes

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18
Q

LES

A

Has base line tone
Closed
Semi-closed

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19
Q

Which muscles are used for peristalsis?

A

Longitudinal muscle

Circular muscle

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20
Q

Electrode Sleeve Catheter

A

Measures pressure changes in the esophagus

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21
Q

Normal Phases of Swallowing

A

Voluntary
Involuntary
Between swallows

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22
Q

Voluntary Swallowing

A

Bolus is voluntarily moved into the pharynx

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23
Q

Involuntary Swallowing

A

UES relaxation
Peristalsis
LES relaxation

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24
Q

Between Swallowing

A

UES prevents air entering esophagus
UES prevents esophagopharyngeal reflux
LES prevents gastroesophageal reflux
Peristaltic & non-peristaltic contractions
Capacity for retrograde movement and decompression

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25
Q

Types of Esophageal Disorders

A 
Motility
Anatomic & Structural
Reflux
Infectious
Neoplastic
Perforation
Burns
Bleeding
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26
Q

Presentation of Esophageal Reflux

A

Pain
Obstruction (dysphagia)
Bleeding

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27
Q

Upper Esophageal Motility Disorders

A

Oropharyngeal dysphagia
Pharyngoesophageal neuromuscular disorders
UES dysfunction/HTN

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28
Q

Pharyngoesophageal Neuromuscular Disorders

A 
Stroke
Parkinson's
Poliomyelitis
ALS
MS
DM
Myasthenia graves
Dermatomyositis & polymyositis
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29
Q

Example of UES Dysfunction/HTN

A

Lou Gehrig’s Disease

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30
Q

Define Achalasia

A

Incomplete relaxation of lower sphincter during swallowing leading to functional obstruction and proximal dilatation

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31
Q

Which ganglion cells are diminished or absent in achalasia

A

Myenteric plexus

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32
Q

Histology of Achalasia

A

Inflammation in the area of myenteric plexus

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33
Q

Hypotheses of Etiology of Achalasia

A

Autoimmune

Viral infections

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34
Q

Important History of Achalasia

A 
Dysphagia
Regurgitation
Chest pain
Heartburn
Weight loss
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35
Q

Workup of Achalasia

A

Lab studies

Imaging Studies

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36
Q

Lab Studies for Achalasia Workup

A

Monometry

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37
Q

Imaging Studies for Achalasia Workup

A

UGI: Bird’s beak
EGD: normal or dilated esophagus
Manometry

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38
Q

What is the radiologic examination of choice for the diagnosis of achalasia?

A

Barium swallow study under fluoroscopic guidance

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39
Q

What is Esophageal Manometry Used for?

A

Assess LES pressure & peristalsis

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40
Q

Treatment of Achalasia

A

Medical management

Surgical management

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41
Q

What is the goal of therapy for achalasia?

A

Relieve symptoms by eliminating outflow resistance caused by HTN and non relaxing LES

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42
Q

Symptoms of Diffuse Esophageal Spasm (DES)

A 
Chest pain
Intermittent dysphagia
Segmental non-peristaltic contractions
Corkscrew esophagus
Muscular hypertrophy
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43
Q

What is diffuse esophageal spasm mistaken for?

A

MI

44
Q

Nutcracker Esophagus

A

High pressure peristaltic contractions

45
Q

Define Esophageal Atresia

A

Congenital abnormality in which the mid-portion of the esophagus is absent

46
Q

Gasless Abdomen

A

Absence of gas in the abdomen suggests that the patient has either atresia without a fistula or atresia with a proximal fistula only

47
Q

GERD

A

Mucosal damage produced by the abnormal reflux of gastric contents into the esophagus

48
Q

What is the primary barrier to GERD is the lower esophageal sphincter?

A

LES

49
Q

What happens when the LES is disrupted?

A

Acid goes from the stomach to the esophagus

50
Q

4 Major Physiologic Mechanisms Protect Against Esophageal Acid Injury

A

Esophageal clearance mechanisms
Esophageal mucosal integrity
LES competence
Gastric emptying

51
Q

Classic GERD Symptoms

A

Heartburn

Regurgitation

52
Q

Define Heartburn

A

Sub-sternal burning discomfort

53
Q

Define Regurgitation

A

Bitter, acidic fluid in the mouth when lying down or bending over

54
Q

Pulmonary Manifestations of GERD

A

Asthma
Aspiration pneumonia
Chronic bronchitis
Pulmonary fibrosis

55
Q

ENT Manifestations of GERD

A 
Hoarseness
Laryngitis
Pharyngitis
Chronic cough
Globus sensation
Dysphonia
Sinusitis
Subglottic stenosis
Laryngeal CA
56
Q

Other Manifestations of GERD

A

Chest pain

Dental erosion

57
Q

Oral & Laryngopharyngeal Signs with GERD

A 
Edema/hyperemia of larynx
Vocal cord erythema
Polyps
Granulomas
Ulcers
Hyperemia & lymphoid hyperplasia of posterior pharynx
Interarytenoid changes
Dental erosion
Subglottic stenosis
Laryngeal CA
58
Q

GERD Etiology

A 
Hiatal hernia
Incompetent LES
Decreased esophagus clearance
Decreased gastric emptying
Medications
Anything that results in esophageal irritation and inflammation
59
Q

Define Hiatal Hernia

A

Herniation of portion of stomach adjacent to the esophagus through an opening in the diaphragm

60
Q

Types of Hiatal Hernias

A

Sliding

Paraesophageal/rolling

61
Q

Sliding Hiatal Hernia

A

Hernia which protrudes through the diaphragm at the opening where the esophagus enters the abdominal cavity

62
Q

Contributing Factors of a Hiatal Hernia

A

Shortening of esophagus
Weakness of diaphragm
Increased abdominal pressure

63
Q

Etiology of Hiatal Hernia

A

Structural changes
Obesity
Pregnancy
Heavy lifting

64
Q

Complications of Hiatal Hernia

A 
GERD
Hemorrhage
Stenosis of esophagus
Ulcerations
Strangulation of hernia
Regurgitation
Increased risk for respiratory disease
65
Q

What happens in a Paraesophageal Hiatal Hernia

A

Funds of the stomach enters the chest cavity lateral to the esophagus opening

66
Q

Clinical Manifestations of Hiatal Hernia

A 
Asymptomatic
Heartburn
Dysphagia
Reflux with lying down
Pain, burning when bending over
67
Q

Treatment Goals for GERD

A

Eliminate symptoms
Manage or prevent complications
Maintain remission

68
Q

Lifestyle Modifications for GERD

A

Avoid large meals
Avoid acidic foods, alcohol, caffeine, chocolate, onions, garlic, peppermint
Decrease fat intake
Avoid lying down within 3-4 hours after a meal
Elevate head of bed 4-8 inches
Avoid meds that may potentiate GERD
Avoid clothing that is tight around the waist
Lose weight
Stop smoking

69
Q

Treatment of GERD

A

Antacids

Antireflux surgery

70
Q

Acid Suppression Therapy for GERD

A

H2-receptor antagonists (H2RAs)

Proton pump inhibitors (PPIs)

71
Q

Examples of H2-Receptor Antagonists

A

Cimetidine (Tagamet)
Ranitidine (Zantac)
Famotidine (Pepcid)
Nizatidine (Axid)

72
Q

Examples of Proton Pump Inhibitors

A 
Omeprazole (Prilosec)
Lansoprazole (Prevacid)
Rabeprazole (Aciphex)
Pantoprazole (Protonix)
Esomeprazole (Nexium)
73
Q

What PPI is safer in pregnant women?

A

Pantoprazole (Protonix)

74
Q

What is the importance of antireflux surgery?

A

Reduce hiatal hernia
Repair diaphragm
Strengthen GE junction

75
Q

Principles of Anti-Reflux Surgery

A

Restore Intra-abdominal esophagus
Approximate diaphragmatic crurae
Reduce hiatal hernia
Perform fundoplication

76
Q

Complications of GERD

A

Erosive esophagitis
Stricture
Barrett’s esophagus

77
Q

Erosive Esophagitis

A

Severity of symptoms often fail to match severity of erosive esophagitis

78
Q

Esophageal Stricture

A

Result of healing of erosive esophagitis

May need dilation

79
Q

Barrett’s Esophagus

A

Acid damages lining of esophagus
Damaged area heals in a metaplastic process
Metaplasia can progress to dysplasia & adenocarcinoma

80
Q

When to Perform Diagnostic Tests

A 
Uncertain diagnosis
Atypical symptoms
Symptoms associated with complications
Inadequate response to therapy
Recurrent symptoms
81
Q

Diagnostic Tests for GERD

A

Barium swallow
Endoscopy
Ambulatory pH monitoring
Esophageal manometry

82
Q

What is the first diagnostic test for patients with dysphagia

A

Stricture (locations, length)
Mass (locations, length)
Bird’s beak
Hiatal hernia (size, type)

83
Q

What does esophageal manometry assess?

A

LES pressure
LES location
LES relaxation
Peristalsis

84
Q

Infection-induced Esophagitis due to

A

Candida
Herpes
Cytomegalovirus

85
Q

Eosinophilic Esophagitis

A

Associated with food allergies

86
Q

Treatment of Eosinophilic Esophagitis

A

Oral fluticasone

87
Q

Types of Esophageal Bleeding

A

Mallord-Weiss tear

Esophageal varicies

88
Q

Cause of Mallory-Weiss tear

A

Severe retching and vomiting

89
Q

Where does a Mallory-Weiss tear occur?

A

Junction of the esophagus and stomach (longitudinal tear)

90
Q

What are esophageal arise secondary to?

A

Cirrhosis

Anything that increases pressure

91
Q

Clinical Picture of Mallory-Weiss Syndrome

A

Pain
Bleeding
Superimposed infection

92
Q

Define Esophageal Varices

A

Tortuous dilated veins in the submucosa of distal esophagus

93
Q

Etiology of Esophageal Varices

A

Portal hypertension secondary to liver cirrhosis

94
Q

Define Esophageal Diverticula

A

Saclike outputting of one or more layers of the esophagus

95
Q

Where is a Zenker’s diverticulum located?

A

UES

96
Q

Symptoms of Zenker’s Diverticulum

A 
Dysphagia
Weight loss
Regurgitation
Chronic cough
Aspiration
97
Q

Location of Epiphrenic Diverticulum

A

Distal esophagus

Just above diaphragm

98
Q

Treatment of Esophageal Diverticula

A

Clients learn to empty it by applying pressure
Limit foods
Endoscopic surgery

99
Q

Scleroderma Motility Pattern

A

Proximal 1/3 striated muscle (normal)

Distal 2/3 smooth muscle (impaired motility)

100
Q

Etiology of Esophageal Perforation

A

Iatrogenic

Boerhaave syndrome

101
Q

Define Boerhaave Syndrome

A

When the esophagus is ruptured due to over eating frequently

102
Q

Esophageal Perforation Mortality

A

High

Most lethal GI perforation

103
Q

Complications of a Esophageal Perforation

A

Necrotizing mediastinitis & polymicrobial infection
Rapidly progressive infection/shock in pleural/peritoneal space
Empyema

104
Q

Define Empyema

A

Pus in chest between pleural space and lung

105
Q

Common FB in Adults

A

Meat

Bones

106
Q

Common FB in Peds

A

Coins
Toys
Crayons
Pen caps

107
Q

Common FB in Pysch Patients & Prisoners

A

Unlikely objects
Spoons
Razors

GI (20 decks)

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