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Esophageal Disorders Flashcards

1
Q

sphincters and esophagus

A

upper esophageal sphincter and lower esophageal sphincter

both close between swallowing to prevent entry of air

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2
Q

3 phases of swallowing

A
  1. oral phase (voluntary control)
  2. pharyngeal phase
  3. esophageal phase
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3
Q

types of dysphagia

A
  1. oropharyngeal dysphagia

2. esophageal dysphagia

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4
Q

oropharyngeal dysphagia

A

difficulty INITIATING swallowing

caused by: neurologic or muscular disease (dementia, Parkinson, CVA, MS, MG, ALS)

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5
Q

esophageal dysphagia

A

food stops/sticks after swallowing

mechanical causes

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6
Q

oral dysfunciton

A

drooling, food spillage, pocketing, qsialorrhea

difficulty imitating swallow, dysarthria

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7
Q

esophageal dysfunciton

A

symptom onset following swallow

reflux, globus senstation, pain, spasm

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8
Q

pharyngeal dysfunction

A

food getting stuck, immediately upon swallowing

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9
Q

infectious esophagitis

A

rare in immunocompetent patients

HIV, underlying malignancy, significant immunosuppression

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10
Q

MC pathogens causing infectious esophagitis

A

candida, HSV 1, CMV, HIV

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11
Q

esophageal disease s/s +mc cause

A

mc 2/2 motor disorder

s/s: heartburn, dysphagia, odynophaga, globus sensation, chest pain

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12
Q

infectious esophagitis diagnosis

A

esophageal biopsy and culture (determine causative agent)

EGD

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13
Q

barium study of candy esophagitis

A

fine erosions and small plaques

immunocompromised

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14
Q

tx of oropharyngeal infxn esophagitis

A

clotrimazole troches or nystatin suspension (swish and spit)

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15
Q

esophageal candidiasis tx

A

systemic

fluconazole PO or IV

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16
Q

tx of HSV 1 esophagitis

A

immunocompetent: acyclovir 7-10 days
immunocompromised: -ciclovir 14-21 days

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17
Q

CMV esophagitis

A

ganciclovir or foscarnet

tx HIV w/ HAART

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18
Q

pill-induced esophagitis

A

pill is swallowed and causes esophageal irritation and ulceration due to prolonged contact

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19
Q

high risk for pill-induced esophagitis

A

swallowed without liquid

swallowed when supine (hospitalized or bed bound)

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20
Q

symptoms of pill-induced esophagitis

A

severe retrosternal ches pain, odynophagia, dysphagia hours after taking pill

radiates to back

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21
Q

management of pill esophatiits

A

treatment is symptomatic (viscous lidocaine)

prevention by taking pills with water and remain upright

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22
Q

eosinophilic esophagitis

A

inflammatory disorder characterized by dense eosinophilic infiltration of esophageal mucosa causing structural abnormalities and dysmotility

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23
Q

cause of eosinophilic esophagitis

A

delayed hypersensitivity reactions to food or allergens outside GI

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24
Q

epidemiology eosinophilic esophagitis

A

caucasians, young adult males (20-30)

most pts have another atopic disorder

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25
symptoms of eosinophilic esophagitis in adults
dysphagia food impaction heartburn refractory to antacids/PPI epigastric pain
26
symptoms fo eosinophilic esophagitis in children
feeding difficultuies
27
endoscopic findings eosinophilic esophagitis
narrowed lumen and strictures feline esophagus what papule (micro abscesses)
28
when is a dx biopsy obtained?
2 months of PPI tx that fails to relieve symptoms
29
eosinophilic esophagitis tx
``` allergist non pharm (elimination, dilation of stricture) ``` pharm (PPI, swallowed inhaled steroids)
30
fluticasone
swallowed corticosteroid without a space and sprays WITHOUT inhaling
31
rings mc occur
distal esophagus
32
webs mc occur
anteriorly, cervical esophagus
33
esophageal webs
congenital associated with Fe decency anemia (plumber Vinson) immunologic and term conditions
34
Schatski ring
distal esophagus, very common but not often symptomatic hiatal hernia and GERD (increased risk) symptom: food impaction
35
tx of webs and rings
dilation | endoscopic electrosurgical incision
36
zenker's diverticula
herniation of mucosa between two pharyngeal muscles
37
pathophys zenker's diverticula
high intrabolus pressure during swallowing resistance to swallowing due to abnormalities
38
epidemiology zenker's diverticula
MC in caucasians (north European) men, elderly
39
zenker's diverticula s/s
insidiously over years in older patients vague oropharyngeal dysphagia ASPIRATION risk, nocturnal choking, spontaneous regurgitation
40
complications of zenker's diverticula
aspiration pneumonia ulceration and bleeding carcinoma
41
diagnosis of zenker's diverticula
barium swallow
42
esophageal stricture
narrowing of lumen dysphagia of solids and liquids
43
majority of benign strictures are due to
long standing GERD
44
etiologies of esophageal stricture
1. intrinsic disease (narrowed lumen) 2. extrinsic disease (direct invasion, enlargement of lymph node) 3. diseases that disrupt peristalsis and or LES function
45
RF of esophageal stricture
GERD prolonged NG tube corrosive substance infection
46
diagnosis and tx of esophageal stricture
dx: endoscopy or barium swallow txL endoscopic balloon dilation and underlying cause
47
primary esophageal motility disorder
achalasia spasm hyper and hypo contraction of esophagus
48
secondary motility disorders
scleroderma chagas DM chronic GERD
49
diagnositic w/u of dysphagia barium swallow for
suspected injury h.o. surgery for esophageal or laryngeal CA suspected achalasia
50
endoscopy if
barium swallow fails or another disease supsected
51
esophageal manometry if
endoscopy is normal | neuro cause suspected
52
achalasia patho
idiopathic degernation of neurons of myenteric plexus and vagal nuclei
53
neuronal degeneration results in (achalasia)
1. failure of LES to relax properly | 2. dilated peristaltic esophagus above hyper contracted LES
54
achalasia s/s
insidious dz ``` gradual progressive dysphagia regurgitation substernal discomfort difficulty belching weight loss ```
55
diagnostic signs achalasia | barium esophageam
bird's beak (req. verification) esophageal dilation
56
test that confirms achalasia
esophageal monometry
57
tx of choice achalasia
surgical therapies pneumatic dilation surgical myotomy
58
pneumatic dilation
weakness in LES by tearing fibers less invasive than sx
59
surgical myotomt
laparoscopically success rates up to 90%
60
Botox achalasia
injected in LES blocking excitatory neurons increase LES smooth muscle tone and producing therapeutic decrease in LES
61
diffuse esophageal spasm
repetitive simultaneous and prolonged duration contractions causes chest pain and dypshagia to both liquids and solids
62
scleroderma
immune system activation, endothelial dysfunction and fibroblast activity coarsening distal 2/3 of esophagus
63
diagnosis of scleroderma esophagus
confirms diagnosis, barium swallow maybe LES with low resting pressure free reflux no peristalsis tx PPI
64
chagas dz
considered in pts from south and Central America indistinguishable from achalasia caused by parasite
65
pseudoachalasia
primary or metastatic tumor that invades GE junction

GI 1 (12 decks)

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