Esophageal disorders Flashcards
What type of tissue is found in the esophagus, rectum, and remained of the bowel?
esophagus & rectum = stratified squamous epithelium
REmainder of bowel is columnar or cubiodal epithelium
Esophagus:
- what are the layers?
- what are the two types of movement?
- total length?
Inner circular muscle (propulsion of food forward) & outer longitudinal muscle
NO serosa*** this makes it dangerous if there is an infection, for this reason it is known as an unforgiving organ. Cancer will spread very rapidly into the mediastinum.
What are the two types of movement:
- peristaltic = moves food forward
- segmental = mixing
18-24cm
Etiologies of Dysphagia:
- in the lumen
- in the wall
- outside the wall
- neuromuscular
Lumen: tumor
In Wall:
- achalsia* (stricture of esophagus & dilation above stricture)
- tumor *
- GERD*
- Plummer Vinson Syndrome (Fe deficiency anemia)
- Scleroderma (CT disorder)
- chagas ( parasite, causes heart problems and esophageal dysphagia)
Outside of wall:
- pressure of enlarged LN***
- thoracic aortic aneurysm (runs behind and to the left of esophagus)
- bronchial carcinoma
- goiter (atopic thyroid tissue not in normal place)
Neuromuscular:
- MS
- Stroke
Normal phases of swallowing :
- voluntary
- involuntary
- between swallowing
Voluntary: oropharyngeal phase- bolus is moved into pharynx
involuntary: UES relaxation, persistalsis, LES relaxation
Between swallowing: UES prevents air entering the esophagus during inspiration and prevents esophagopharyngeal reflux.
-LES prevents gastroesophageal reflux.
Sx of esophageal dysfunction
pain, obstruction (dysphagia), bleeding
Upper Esophageal Motility Disorders:
- sx
- etiologies
Sx; oropharyngeal dysphagia, difficulty swallowing, tracheal aspiration
etiologies:
- stroke
- parkinsons
- poliomyelitis
- ALS
- MS
- DM
- Myasthenia Gravis
- dermatomyositis and polymyositis
Achalasia
- what is this?
- etiologies
- hx findings
- PE findings
incomplete relaxation of LES during swallowing leading to functional obstruction and proximal dilation. Ganglion cells of myenteric plexus(longitudinal muscle) are diminished or absent.
Etiologies:
-may be d/t autoimmune or viral infection b/c on histology they see inflammation.
Hx findings suggestive of achalasia;
- dysphagia*
- regurgitation
- chest pain (retrosternal)
- heartburn
- weight loss
- PNA d/t aspiration
PE is NONCONTRIBUTORY
Achalasia:
- lab studies
- imaging studies
- Tx
labs:
- noncontributory
Imaging:
- UGI (Upper GI series) : birds beak
- EGD(esophagogastroduodenoscopy) : normal or dilated esophagus. normal mucosa color is white/tan
- Monometry (measures the function of the LES) use pressure catheter
- barium swallow* Exam of choice! (fluoroscopy)
-Tx:
goal is to relieve sx by eliminating the outflow resistance cause by the hypertensive and non-relaxing LES.
Medical Management;
- btoulinum toxin
- Ca2+ channel blocker/smooth muscle dilator (Nifedipine/Isosorbide dinitrate)
Surgical Management;
- myomectomy
- balloon dilation of LES.
Achalasia:
-MC finding on barium swallow?
-Birds beak.
Diffuse Esophageal Spasm
- sx
- often confused with what other disorder?
Sx:
- chest pain
- intermittent dysphagia
- segmental non-peristaltic contractions
- corkscrew esophagus
- muscular hypertrophy of esophagus
-often confused with an MI, need to get EKG to differentiate.
Nutcracker Esophagus
-what is this?
What: high pressure peristaltic contractions. extremely painful b/c there is spasm,… ischemiaessentially of the esophageal muscle, claudication of the esophagus.
Esophageal atresia:
- what is this?
- why is this dangerous?
- how can you confirm this?
- tx
what: congenital abnormality in which the mid portion of the esophagus is absent.
Dangerous b/c upper portion comes to a blind end, undigested food being vomitted back up.
Lower portion connects to the distal portion of the trachea, stomach secretions into trachea.
-on plain xray, NG tube will not reach the stomach. There is also absence of gas in the abdomen.
Tx: surgical repair
GERD
- definition
- Pathophys
- what are the 4 major physiologic mechanisms protecting against esophageal acid injury?
definition: mucosal damage produced by the abnormal reflux of gastric contents into the esophagus.
Patho:
-LES and diaphragm barrier are disrupted and acid is able to leak from the stomach to the esophagus.
4 mechanism:
- clearance mechanisms
- mucosal integrity
- LES competence
- Gastric emptying
GERD
- sx
- Extra-esophageal sx
Sx:
- heart burn (pyrosis): substernal burning discomfort
- regurgitation: bitter, acidic fluid in the mouth when lying down or bending over.
extraesophageal manifestations:
- Pulmonary: asthma, aspiration pneumonia, chronic bronchitis, pulmonary fibrosis
- ENT: hoarseness, laryngitis, pharyngitis, chronic cough, globus sensation(feels like something stuck in throat), dysphonia, sinusitis, subglottic stenosis, laryngeal cancer
- other: chest pain, dental erosion
Oral laryngopharyngeal signs assigned with GERD.
- edema and hyperemia of larynx
- vocal cord erythema, polyps, granulomas, ulcers
- hyperemia and lymphoid hyperplasia of posterior pharynx
- interarytenyoid changes
- dental erosion
- subglottic stenosis
- laryngeal cancer
