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A1-G Surg Note Esophagus > Esophageal Function Tests > Flashcards

Esophageal Function Tests Flashcards

1
Q

What is the esophagus?

A

muscular, tubelike structure located in the posterior mediastinum

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2
Q

Where does the esophagus span from and to?

A

spans from the posterior oropharynx to the cardia of the stomach.

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3
Q

What are the three functional regions of the esophagus?

A

upper esophageal sphincter (UES), esophageal body, and lower esophageal sphincter (LES).

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4
Q

What is the primary purpose of endoscopic or radiologic examination in patients with esophageal symptoms?

A

To rule out structural lesions such as malignancy.

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5
Q

What is considered after ruling out structural lesions in patients with esophageal symptoms?

A

Functional disorders secondary to esophageal dysmotility.

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6
Q

What are some indications for esophageal function tests in patients with noncardiac chest pain or heartburn?

A

Noncardiac chest pain or heartburn that does not improve with acid suppression and has no explanation on radiologic or endoscopic examination.

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7
Q

What are esophageal function tests indicated for in patients with dysphagia or odynophagia?

A

Nonobstructive dysphagia or odynophagia that is unexplained

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8
Q

Why might esophageal function tests be conducted before foregut surgery?

A

to evaluate esophageal peristalsis

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9
Q

What is one indication for localizing the lower esophageal sphincter (LES) before a specific study?

A

to place an impedance probe in preparation for a pH monitoring study

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10
Q

What is the indication for esophageal function tests after foregut surgery?

A

Evaluating dysphagia after foregut surgery.

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11
Q

What disease is esophageal function testing part of the workup for?

A

Scleroderma.

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12
Q

What is a contraindication for esophageal function tests in patients with esophageal masses?

A

Esophageal mass causing obstruction.

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13
Q

Why is abnormal nasal-oropharyngeal anatomy a contraindication for esophageal function tests?

A

It may preclude catheter placement.

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14
Q

Why are nonresponsive patients contraindicated for esophageal function tests?

A

Because they are unable to follow commands.

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15
Q

Why are patients on anticoagulation at high risk of bleeding contraindicated for esophageal function tests?

A

Due to the high risk of bleeding.

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16
Q

Esophageal motility disorders on high-resolution manometry

A

see pic

17
Q

What is the gold standard for assessing esophageal motility?

A

Esophageal manometry.

18
Q

What does esophageal manometry evaluate?

A

contractility and coordination of esophageal muscles.

19
Q

How does conventional esophageal manometry work?

A

It uses sensors placed at fixed locations (~5 cm apart) on a catheter inserted transnasally into the esophagus, with its distal tip in the stomach.

20
Q

What anatomical structures can be recognized by the pressure waveforms during manometry after a swallowing event?

A

The UES, esophageal body, LES, and gastric cardia.

21
Q

What is high-resolution manometry (HRM)?

A

A manometry system that uses closely spaced sensors to create smooth contour plots of pressure points, providing a detailed image of esophageal function

esophageal pressure topography (EPT) or Clouse plots.

22
Q

How long must patients fast before undergoing esophageal manometry?

A

Patients must fast for a minimum of 4 hours.

23
Q

What does Integrated Relaxation Pressure (IRP) measure?

A

The average deglutitive relaxation pressure in a 4-second window beginning at UES relaxation.

24
Q

What is the Distal Contractile Integral (DCI)

A

The product of amplitude, duration, and length of the distal esophageal contraction

25
Q

What is Distal Latency in esophageal manometry?

A

interval between UES relaxation and the contractile deceleration point.

26
Q

What are Pressurization Patterns in esophageal manometry?

A

Patterns of intraluminal pressure that indicate how effectively the esophagus is moving contents downward.

27
Q

How does the Chicago Classification categorize esophageal motility disorders?

A

Into disorders of esophagogastric junction (EGJ) outflow or of peristalsis

28
Q

What is the preferred diagnostic tool for evaluating esophageal motor function when other studies fail to explain symptoms?

A

High-resolution manometry (HRM).

29
Q

What medications should patients stop before undergoing HRM to avoid interference with testing

A

H2-blockers, proton pump inhibitors, opioids, nitrates, and calcium channel blockers

30
Q

What conditions may lead to false readings in HRM?

A

A history of esophageal surgery
peptic stricture,
the presence of a current hiatal hernia.

31
Q

How is a catheter-based pH monitoring device inserted and positioned?

A

inserted transnasally with the distal pH probe placed approximately 5 cm above the lower esophageal sphincter (LES).

32
Q

What is the DeMeester score used for in pH monitoring?

A

To quantify acid exposure and determine whether it is abnormal (scores of 14.72 or greater are considered abnormal).

33
Q

What are the components of the DeMeester score?

A
  1. Percent total time pH < 4
  2. Percent upright time pH < 4
  3. Percent supine time pH < 4
  4. Number of reflux episodes
  5. Number of reflux episodes ≥ 5 minutes
  6. Longest reflux episode (in minutes)
34
Q

What principle does impedance testing in esophageal studies rely on?

A

The principle of current resistance.

35
Q

How is the impedance catheter placed, and how long does the procedure last?

A

A long flexible catheter with 6 to 8 sensors is placed transnasally for 24 hours

36
Q

How does the impedance catheter detect a liquid and Air bolus?

A

-a rapid decrease in impedance (resistance)
-swallowed air boluses will be detected as increased impedance

37
Q

What type of movement can impedance testing assess based on the direction of impedance change?

A

Both antegrade movement (normal peristalsis) and retrograde movement (gastroesophageal reflux).

A1-G Surg Note Esophagus (15 decks)

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