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Esophagus Flashcards

1
Q

Describe the musculature of the esophagus

A
  1. Top half is striated and circular

2. Bottom half is smooth and longitudinal

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2
Q

What provides intrinsic innervation to the esophagus?

A

The enteric nervous system

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3
Q

How does sensory information travel from the esophagus to the brain?

A

Through the vagus nerve to the NTS

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4
Q

What are the red flag symptoms of dysphagia?

A

weight loss, anemia, melena, hematemesis

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5
Q

What is transfer dysphagia? What are the symptoms?

A

Difficulty initiating a swallow

  • -Neuromuscular mechanism
  • -food “sticks in throat” with nasal regurgitation and coughing
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6
Q

What is transport dysphagia of the esophagus? what are the symptoms?

A

Intralumenal obstruction caused by an esophageal ring, or extrinsic compression, or stricture. Could also be spasm/motor failure
–“Food sticks in chest”

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7
Q

What are examples of structural abnormalities of the exophagus?

A

Aencker’s diverticulum

Cricopharyngeal web

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8
Q

What are available studies for assessing esophageal function?

A
  1. Barium swallow
  2. Upper endoscopy
  3. Manometry
  4. pH studies
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9
Q

At what point does the UES/LES relax?

A

At the beginning of the swallow

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10
Q

What three muscles make up the UES?

A

Cricopharyngeus
Inferior constrictor
Prox esophagus

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11
Q

What are some causes of a hypercontractile esophagus?

A

Achalasia

Diffuse esophageal spasm

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12
Q

What are some causes of a hypocontractile state?

A

Achalasia
Scleroderma/CREST
Transient LES Relaxations

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13
Q

What is the incidence of achalasia?

A

.5-1/100K

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14
Q

What is the pathophysiology of Achalasia?

A

Injury to the ganglion cells in the myenteric plexus with inflammation and death. We are not 100% sure. The degeneration of the vagal fibers results in constricture of the LES.

–>Loss of the normal balance between acetylcholine and nitric oxide

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15
Q

What do you see on chest x ray of someone with achalasia?

A

dilated esophagus

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16
Q

What do you see on barium swallow of someone with achalasia?

A

bird’s beak

17
Q

What is the gold standard for diagnosis of achalasia?

A

Manometry

18
Q

What would you see on manometry of someone with achalasia?

A
  1. incomplete relaxation of the LES
  2. Elevated resting pressure
  3. Aperistalsis with simultaneous instead of staggered contractions
  4. Vigorous achalasia (high amplitude, vigorous achalasia
19
Q

Why would you perform an upper endoscopy on a suspected achalasia?

A

To rule out pseudoachalasia (a tumor at the GEJ). Will see a pinpoint opening of the LES

20
Q

What are available treatments for achalasia?

A
  1. drugs
  2. pneumatic dilation
  3. myotomy
  4. POEM (endoscopic surgery)
21
Q

What are the symptoms of a diffuse esophageal spasm?

A

chest pain and dysphagia.

22
Q

How do you diagnose and treat diffuse esophageal spasm?

A

Diagnose thru esophageal manometry. Treat using medications

23
Q

What does diffuse esophageal spasm look like on barium swallow?

A

Corkscrew appearance

24
Q

What do you see in the esophagus of someone with scleroderma?

A
  1. Weak LES
  2. Poor esophageal contractility
  3. Delayed gastric emptying
    - ->smooth muscle is weakened
25
Q

What are the complications of the esophagus in scleroderma?

A

Peptic stricture and ulcer

26
Q

What are common causes of extrinsic compression of the esophagus?

A
  1. vascular compression (aortica, lusoria=subclavian mass)
  2. mediastinal mass
  3. Esophageal rings
  4. Esoinophilic dsophagitis
  5. malignant tumors
27
Q

What is the difference between an esophageal web and ring?

A

Web: protrusion of the mucosa
Ring: Protrusion of the muscular layer of the esophagus
A ring: muscular, above the GEJ
B ring: ring at the GEJ

28
Q

What does an eosinophilic esophagitis look like?

A

Ringed esophagus

or “feline esophagus”

29
Q

If you see a shelf pattern on barium swallow…

A

Think of a cancer pushing on the esophagus

30
Q

What’s the prognosis for esophageal cancer?

A

poor. cure rates are low. Can stent for comfort, also surgery, chemo, and radiation

31
Q

What are the most common causes of esophageal symptoms in AIDS?

A
  1. Candida, HSV, CMV.

- ->Candida shows a spiculated appearance on barium

32
Q

What is the major complication of GERD?

A

Barrett’s esophagus leading to adenocarcinoma

33
Q

What are the atypical manifestations of GERD?

A
  1. Asthma
  2. Cough
  3. Laryngitis
  4. Chest pain
  5. Globus
  6. Dental erosion
34
Q

What are the aggravating factors in GERD?

A
  1. Obesity
  2. alcohol
  3. tobacco
  4. preggers
  5. hiatal hernia
  6. fat, caffeine, chocolate, juices
35
Q

What additional test might be helpful in diagnosing GERD?

A

Bravo pH capsule

36
Q

What are treatment options for GERD?

A
  1. Histamine 2 receptor antagonists: cimetidine etc.
  2. Prokinetics: limited effectiveness
  3. PPIs
  4. surgery (Nissen fundiplication, now can also do endoscopic ablation or suction)
  5. Antacids and life style changes

–>note that acid suppression does not stop reflux…it only reduces the acidity of that reflux

37
Q

What treatment would you use for TLESRs?

A

Baclofen: a GABA receptor agonist

38
Q

What are some concerns surrounding PPIs?

A
  1. hospital acquired pneumonia
  2. Enteric infections like C difficile
  3. Decreased B12 absorption, Ca, Mg
  4. Hip fractures more likely…although controversial b/c bone density is stable
39
Q

What is the defining feature of achalasia?

A

Lack of motility, aperistalsis. With or without the bird beak phenomenon

GI (27 decks)

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