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DEMS I > esophagus pathophysiology > Flashcards

esophagus pathophysiology Flashcards

1
Q
  1. Understand the anatomy and function of the oropharynx and its associated structures.
A

includes teeth, lips, mouth (mastication and saliva), tongue, pharynx (movement of bolus from mouth to upper esophagus). Protection of airway and nasal passages via clsoure of nasopharynx (soft palate elevation), elevation of posterior tongue and epiglottis/vocal cord closure

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2
Q

Phases of deglutition (swallowing)

A

oral phase: voluntary, chewing and moving bolus to back of tongue. Pharyngeal phase: involuntary, bolus on upper pharynx, pharynx changes shape and contracts while UES relaxes, bolus transits from oropharynx to esophagus

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3
Q

Oropharyngeal dysfunction symptoms

A

•Oropharyngeal (transfer) dysphagia = inability to initiate a swallow or transfer food bolus into esophagus. Nasal regurgitation, aspiration into airway/lungs (coughing, choking, stridor, wheezing, cyanosis), aspiration pneumonitis (SOB or hypoxia) or pneumonia

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4
Q

Causes of oropharyngeal dysphagia

A

obstruction or neuromuscular (motility disorder)

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5
Q

aspiration pneumonitis vs pneumonia

A

Aspiration pneumonitis = lung injury from acidic or lipophilic properties food. Pneumonia if bacterial colonization occurs

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6
Q

Conditions which cause oropharyngeal disease

A 
Neurologic:  Stroke, Amyotrophic lateral sclerosis (ALS), Parkinson’s disease, Multiple sclerosis, Polio.  Muscular:  Myasthenia gravis, muscular dystrophy
Muscle injury (surgery, radiation therapy).  Structural:  Zenkers diverticulum, crycopharyngeal bar, thyromegaly, fibrosis, head and neck cancersNeurologic:  Stroke, Amyotrophic lateral sclerosis (ALS), Parkinson’s disease, Multiple sclerosis, Polio.  Muscular:  Myasthenia gravis, muscular dystrophy
Muscle injury (surgery, radiation therapy).  Structural:  Zenkers diverticulum, crycopharyngeal bar, thyromegaly, fibrosis, head and neck cancersNeurologic:  Stroke, Amyotrophic lateral sclerosis (ALS), Parkinson’s disease, Multiple sclerosis, Polio.  Muscular:  Myasthenia gravis, muscular dystrophy
Muscle injury (surgery, radiation therapy).  Structural:  Zenkers diverticulum, crycopharyngeal bar, thyromegaly, fibrosis, head and neck cancers
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7
Q

What is Zenkers diverticulum

A

–– outpouching of esophagus leading to food regurgitation or bacterial colonization (halitosis)

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8
Q

Oropharyngeal dysfunction diagnosis

A

history and PE!!! Also, modified barium swallow using X ray video, or neuro consult

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9
Q

Symptoms of esophageal motility disorders

A

dysphagia to solids and liquids, chest pain

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10
Q

Etiology of esophageal motility disorders

A
  1. Achalasia: abnormal peristalsis, failure of LES relaxation. 2. Spastic Disorders of the Esophagus. 3. Weak Peristalsis. 4. Scleroderma
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11
Q

Diagnosis of esophageal motility disorders

A

Upper endoscopy or barium esophagram to exclude structural lesion, and esophageal manometry

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12
Q

Types of Achalasia and their manometry findings

A
  1. Type I (Classic): Swallowing - no significant change in esophageal pressurization. 2. Type II: Swallowing - simultaneous pressurization spanning entire esophagus length. 3. Type III (Spastic): Swallowing - abnormal, lumen obliterating contractions/spasms
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13
Q

treatment of achalasia

A

Type II: Botox injections, pneumatic dilation, surgical myotomy work best. Type III: Botox injections, pneumatic dilation, surgical myotomy have poor outcomes

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14
Q

Pathophysiology of achalasia

A

LES pressure & relaxation regulated by excitatory and inhibitory neurotransmitters. Loss of inhibitory neurons in myenteric plexus causes hypertensive, non-relaxed lower esophageal sphincter

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15
Q

What is pseudoachalasia

A

Type of secondary achalasia due to direct mechanical obstruction of LES. Caused by Infiltrative submucosal invasion (esophageal/gastric malignancy), paraneoplastic tumors express neuronal Ag so T cells and Abs attack neurons of myenteric plexus (small cell lung cancer, pancreatic, prostate), or Chagas disease

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16
Q

Achalasia treatment

A

Surgical myotomy, Botox injections at GE junction (inhibits Ach release from nerve), balloon dilation to tear LES muscle fibers, Per-oral endoscopic myotomy, medical if contraindication for others (nitrates, Ca channel blockers, sildenafil)

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17
Q

What is scleroderma/progressive systemic sclerosis?

A

Multisystem disorder characterized by: Obliterative small vessel vasculitis and Connective tissue proliferation with fibrosis of multiple organs. GI manifestations in 80-90%: smooth muscle atrophy and gut wall fibrosis

18
Q

Symptoms of scleroderma/PSS

A

dysphagia (weak peristalsis), GERD (weak LES), stricture (unrepentant GERD)

19
Q

Spastic disorders of esophagus

A

peristalsis is preserved, but chest pain and dysphagia possibly due to overactivity of excitatory nerves or smooth muscle response

20
Q

List structural esophageal disorders

A

strictures (GERD, radiation, caustic causes), Schatzkis ring, eosinophilic esophagitis (benign), compression, cancer, metastasis

21
Q

Esophageal strictures cardinal symptom

A

dysphagia to solids

22
Q

Esophageal strictures cardinal treatment

A

endoscopic dilation using balloons or dilator

23
Q

What is eosinophilic esophagitis

A

•Chronic immune/antigen-mediated esophageal disease. Symptoms of esophageal dysfunction. Eosinophilic infiltrate in the esophagus. Absence of other potential causes of esophageal eosinophilia

24
Q

eosinophilic esophagitis endoscopic features

A

fixed esophageal rings, narrow caliber esophagus, longitudinal furrows running parallel to axis, white plaques/exudates, crepe paper mucosa that tears easily

25
Q

eosinophilic esophagitis treatment

A

Drugs (topical steroids via asthma preparations), diet (allergen free effective in children or 6-food elimination milk, eggs, wheat, soy, seafood, nuts), dilation

26
Q
  1. Understand the pathophysiology, symptoms, and treatment for gastroesophageal reflux disease (GERD).
A

•Pathologic reflux of gastric juice Acid into esophagus. Symptoms: heartburn (postprandial), regurgitation with acid taste, cough, throat clearing, rarely wheezing, stridor/ treatment: antacids or anti-secretory

27
Q

Causes of GERD

A

LES relaxation, hiatal hernia (righ crus catches on fundus causing obstruction), gastric/esophageal surgery, dysmotility, obstruction, rare: Zollinger-Ellison, Sjogrens, Scleroderma

28
Q

GERD risk factors

A

obesity, tobacco, meds, pregnancy

29
Q

Complications of GERD

A

erosion, Barrett’s esophagitis,

30
Q

GERD diagnosis

A

symptoms (heartburn +/- regurg), response to acid suppressive therapy, endoscopy for refractory symptoms, transnasal catheter or wireless capsule pH testing in esophagus,

31
Q

Barretts esophagus risk factors

A

male, white, central adiposity, advanced age, chronic gerd

32
Q

Barretts treatment

A

esophagectomy if high grade dysplasia or cancer, ablation of Barretts tissue or endoscopic resection of visible lesions

33
Q

What is Barretts a precursor to?

A

adenocarcinoma of esophagus

34
Q

2 Main types of esophageal cancer ypes

A

squamous cell and adenocarcinoma

35
Q

risk Factors for squamous cell carcinoma and location

A

age, alcohol/tobacco, caustic injuries. Anywhere is esophagus

36
Q

risk factors for adenocarcinoma and locations

A

age, smoking, obesity, GERD, BARRETTS esophagus. Usually in distal esophagus or gastric cardia

37
Q

List symptoms, examples and diagnosis of oropharyngeal obstructions

A

Sx: choking, cough, nasal regurg, aspiration. Dz: head and neck cancer, zenkers diverticulum, radiation therapy. Diagnosis: barium swallow

38
Q

List symptoms, examples and diagnosis of oropharyngeal propulsion/motility issues

A

sx: Transfer Dysphagia, Cough, Nasal regurgitation, Aspiration. Dz: neuro conditions (stroke, ALS, MS, parkinsons), myasthenia gravis, muscular dystrophy. Diagnosis: barium swallow

39
Q

List symptoms, examples and diagnosis of esophageal obstructions

A

Sx: Dysphagia to solids, Food impaction (EoE), Weight loss, Vomiting, Regurgitation. Dz: esophageal strictures, esophageal rings, EoE, extrinsic compression. Diagnosis: EGD, esophagram

40
Q

List symptoms, examples and diagnosis of esophageal propulsion/motility issues

A

sx: solid and liquid dysphagia, chest pain. Dz: achalasia, esophageal spasm, scleroderma, esophageal cancer. Diagnosis: esophagram, EGD, esophageal manometry

DEMS I (28 decks)

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