Esophageal Disorders and GERD Clinical Flashcards
How do odynophagia and dysphagia differ?
odynophagia is pain on swallowing
dysphagia is a symptom resulting from the failure to move a food bolus from the mouth to the stomach - more of a discomfort than pain
In general, what are three factors that contribute to dysphagia?
- inadequate preparation (reduced saliva, imparied mental functoin)
- abnormal lunch strength or function (neuromusclar disorders or motility disturbances)
- esophageal passageway narrowed
What is dysphagia which includes difficulty initiating swallowing?
oropharyngeal dysphagia
What is dysphagia where food stops and “sticks” after swallowing is initiated?
esophageal dysphagia
What are some anatomical causes of oropharyngeal dysphagia?
postcricoid web
cervical osteophyte
hypopharyngeal diverticulum
head and neck tumors
What are some muscular diseases that cause oropharyngeal dysphagia?
oculopharyngeal muscle dystrphy
myotonic dystrophy
myasthenia gravis
What are some neurological disorders that can cause oropharyngeal dysphagia?
CVA poliolyelitis ALS parkinson's disease cerebral palsy tumors
What are the three main goals of treatment in oropharyngeal dysphagia?
protect the airway
maintain nutrition
relieve dysphagia
What are the 4 general therapeutic modalities for oropharyngeal dysphagia?
speach/swallowing therapy
esophageal dilation
surgical myotomy
NPO with nutrition support
What are some anatomic causes of esophageal dysphagia?
peptic strictures
rings and webs
caustic scars
cancer - either primary esophageal or extrinsic compression
What are some neuromuscular causes of esophageal dysphagia?
achalasia from chagas’ disease
other motor disorders
What is achalasia?
It’s basically where the lower esophageal sphincter is constantly constricted - they have ACh causing contraction, but they lose the inhibitory neurons that would secrete VIP and NO so you never get relaxation (or inappropriate relaxation)
How do most people with achalasia present?
with progressive lifelong dysphagia that starts with solids and then progresses to both solids and liquids.
How can we diagnose achalasia?
manometry to measure pressures - will show a non-relaxing LES and aperistalsis in the esophagus
barium swallow will show a bird’s-beak narrowing at the LES and a dilated esophagus
Why do you always get endoscopy after a barium swallow suggests achalasia?
carcinoma at the esophagogastric junction can mimic achalasia and you wouldn’t be able tot tell the difference on a barium swallow
How can we treat achalasia? Drugs and procedures….
calcium channel blockers and botulinum toxin, balloon dilation and esophagogastric myotomy
What happens in diffuse esophageal spasm?
you get different parts of the esophagus contracting simultaneously instead o f in a wave-like pattern like it’s supposed to. this means food doesn’t get pushed down
contractions can be severe and painful
make sure you rule out heart attack though!
What affect can systemic sclerosis from scleroderma have on the esophagus?
it basically paralyzes it such that they don’t get peristaltic contractions and there’s no tone in the LES. Basically the esophagus becomes a lead pipe and they’ll have constant reflux and dysphagia
What’s the most common cause of GERD?
transient LES relaxations
What are some other causes of GERD?
weak or failed esophageal peristalsis hypotensive LES at baseline gastroparesis duodenogastric reflux hiatal hernia
dysphagia for solids only, intermittent….
lower esophageal ring
dysphagia for solids only, progressive….
peptic stricture or cancer (esp if over 50)
Dysphagia for solids and liquids, intermittent…
diffuse esopahgeal spasm
NEMD
nutcracker
Dysphagia for solids and liquids, progressive…
achalasia or scleroderma
