Esophageal Disorders Lecture Flashcards
What is Zenker’s diverticulum?
pouch in the upper esophagus
What happens to the food in Zenker’s diverticulum?
the food gets stuck; “pocketed”
How can you tell if the food is getting “pocketed” in the Zenker’s diverticulum?
there is a lot of residue that isn’t moving; seen in a swallow study
What does the severity and treatment of Zenker’s diverticulum depend on?
the size of the pouch
What can cause Zenker’s diverticulum?
GERD or reflux that weakens the area
Where does the Zenker’s diverticulum typically form?
cricopharyngeus
What is a cricopharyngeal bar?
cricopharyngeus muscle is thickening and slower to relax so there is an obstruction of the flow
What is the common complaint a patient with a cricopharyngeus bar?
thicker and stickier textures are harder; feeling of food stuck in the neck
In what MBS component can you diagnose a cricopharyngeus bar?
component 14: PES opening
What is a Schatzki ring?
a circular membrane of tissue in the lower esophagus that causes a narrowing of the esophagus
What are symptoms of Schatzki ring?
more difficulty with solid food; feeling like food is impacted; chest pain
How big does a Schatzki ring have to be to by symptomatic?
<13mm
How do you treat a Schatzki ring?
dilation, PPI
What are causes of a Schatzki ring?
hiatal hernia; chronic acid reflux; Barrett’s esophagus
What is a hiatal hernia?
the upper part of the stomach bulging through the diaphragm and into your chest
What happens in a hiatal hernia?
food and acid can back up in the esophagus and cause reflux and heartburn
What two disorders are usually comorbid?
hiatal hernia and Schatzki ring
How can you correct hiatal hernia?
if bad enough it can be corrected surgically; smaller ones can be corrected with diet changes to reduce reflux
What is Barrett’s esophagus?
flat pink liniing of the esophagus becomes damaged by acid reflux causing the lining to thicken and become red
Can you see Barrett’s esophagus on a fluoroscopy?
no
Patients with Barrett’s esophagus are at risk for cancer. Why?
the irritation can cause pre-cancer to develop
What is achalasia?
narrowing or incomplete relaxation of the lower esophageal section and prevents passage of swallowed material into the stomach
What kind of regurgitation is common in achalasia?
late regurgitation of undigested food; emesis
Why do patients with an achalasia vomit?
food couldn’t pass into the stomach
What is GERD?
chronic acid reflux
How does GERD result?
from abrupt periods of relaxation of the LES during non-swallow events
T/F the LEW tone is usually normal in GERD
T
Why do you use pH monitoring in GERD patients?
to determine presence of and severity of reflux (the acid)
What does GERD stand for?
gastro-esophageal reflux disease
What is NERD?
GERD that does not result in esophagitis
T/F NERD doesn’t cause dysmotility and dysphagia symptoms
F
What is laryngopharyngeal reflux?
when stomach contents reach the laryngeal level and irritate the vocal folds
What does laryngopharyngeal reflux cause?
odynophagia, hoarseness, sore throat, globus sensation, and chronic throat clearing
What do you look for on a FEES exam to diagnose laryngopharyngeal reflux?
mucosal abnormalities on pos pharyngeal wall, edema of arytenoid cartilages, generalized erythema in laryngeal aditus
When do GERD patients experience the most symptoms?
when they are lying down
When do patients with laryngopharyngeal reflux experience symptoms?
day and night
What is esophageal stentosis?
narrowing of the lumen affecting ability of sold food to pass
T/F Patients can be fairly accurate when pointing to where the esophageal stenosis is
F
One third of patients with obstructing esophageal lesions think the problem is where?
the neck
What is benign stricture?
related to esophagitis
What can cause benign stricture?
pharmaceuticals (tetracycline, potassium, quinidine)
What is malignant stricture?
stricture caused by squamous cell carcinoma; adenocarcinoma
For whom is tracheoesophageal fistula common?
those who have had a laryngectomy; after radiation
How can cardiac issues cause esophageal complaints?
compression of the esophagus due to aortic aneurysm, cardiomegaly (enlarged heart), congenital deformities, lung cancer
T/F Esophageal diverticulum is rare
T
What causes esophageal diverticulum?
pressure in the esophagus resulting in bulging at a point of weakness
How can peristalsis issues affect the esophagus?
it can spasm
What is nutcracker esophagus?
chest pain, mean pressure of 180 mm Hg with manometry
What is eosinophilic esophagitis?
history of allergies, build up of esosinophils interfere with motility