define heartburn arises from? radiates? MC felt when? relieved with?

- discomfort or burning sensation behind the sternum - arises from epigastrum - can radiate toward neck - MC experienced after eating, during exercise and/or lying recumbent (lying down) - relieved with drinking water or antacid

GI: general terms + exams Flashcards by Caroline Bouillon

esophagus connects ___ to ____?

hypopharynx to stomach

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where is esophagus located

posterior mediastinum

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esophageal pain can be caused by? (4)

inflam
infection
dysmotility–condition in which muscles of the digestive system do not work as they should
neoplasm

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key functional impairment disorders are? (2)

swallowing disorders
and
excessive gastroesophageal reflux

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list some important hx findings indicative of esophageal disease

***what are the major ones

wt gain or loss 
gastrointestinal bleeding 
dietary habits: timing of meals, smoking, etoh 
MAJOR s/s are: 
1. heartburn 
2. regurgiation 
3. CP 
4. dysphagia 
5. odynophagia 
6. globus sensation--is a persistent sensation of a lump in the throat.

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pyrosis

heartburn

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another term for heartburn

pyrosis

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what is the MC esophageal symp

pyrosis—heartburn

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define heartburn

arises from?
radiates?
MC felt when?
relieved with?

discomfort or burning sensation behind the sternum
arises from epigastrum
can radiate toward neck
MC experienced after eating, during exercise and/or lying recumbent (lying down)
relieved with drinking water or antacid

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is regurgiation the same as heartburn?

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define regurgitation

*what can provoke it?

effortless return of food or fluid into the pharynx w/o N/V

PT reports sour or burning fluid in throat or mouth
increasing intrabdom pressure provokes it: bending, belching, etc

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rumination

when recently swallowed food is regurgitated and then reswallowed repetitively up to one hour

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explain esophageal CP

sensation?
radiation?

pressure type of sensation in mid chest

radiates to mid-back, arms, jaws

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why is cardiac and esoph CP similar?

they share a nerve plexus +

nerve endings in esophageal wall have poor ability to discriminate different stimuli

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MCC of esophageal CP?

GERD

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esophageal dysphagia

described as?
imp to distinguish?

desc as food sticking or lodging in chest

-imp to distinguish dysphagia with solids vs liquids, episodic vs constant and progressive vs static

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Dysphagia with liquids AND solids suggest?

motility disorder

EX: achalasia

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dysphagia with only solid food suggestive of? (3)

stricture
ring
tumor

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define odynophagia

pain either caused by or exacerbated by swallowing

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odynophagia is more common with?

pill or infectious esophagitis

rather than reflux esophagitis

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odynophagia + GERD suggestive of? (2)

esoph ulcer
or
extensive erosions

globus sensation

define
relieved with?

perception of a lump or fullness in throat

felt regardless of swallowing
often relieved with swallowing

globus sensation often assoc with?

GERD

water brash

vagal reflex triggers excessive salivation

*acidification of esophogus triggers the vagal reflex

odynophagia suggestive of? (3)

defect in mucosal lintegrity inflammation infection

aphagia - define - sugg of?

inability to swallow | sugg of acute obstruction

dysphagia arises from disorders in what three anatomic phases of swallowing?

1. oral/preparatory--chewing, making food bolus 2. pharyngeal phase 3. Esophageal phase

pharyngeal phase of swallowing involved with which anatomical structures

oropharynx larynx Upper esophageal sphincter (UES)

esophageal phase of swallowing involved with with anatomical structures?

esophageal body lower esophageal sphincter (LES) gastroesophageal junction (GEJ)

what is the hallmark symptom of motility disorder

dysphagia

define peristalsis

muscles behind food bolus contract-- squeezes bolus forward--muscles ahead of the food bolus relax--allowing bolus to advance w/o resistance

what makes lower esophageal sphincter relax and open?

arrival of food bolus towards end of esophagus increases pressure--- signals muscles on sphincter to relax------ food enters stomach

three ways to "test" esophagus

upper endoscopy esophagram esophageal manometry

upper endoscopy - another name? - proceudre - what is seen? - good for? - not helpful for ??

aka esophagogastroduodenoscopy (EGD) * put fiberoptic camera down into esophagus to visualize problem * SEE: high quality color imaging of esoph, gastric and duodenal LUMENS * can also do biopsies, injection catheters for delivery of drugs, balloon dilators or hemostatic devices GOOD FOR: mucosal lesions, biopsies or interventional procedures are required (dilation, banding) minimally invasive******** NOT GOOD FOR: looking at motion.. aka mobility disorders

Esophagram * name the two types - what is needed with these tests? - Good for? - cons? - high sensitivtiy for?

1. XR --- still 2. Fluoroscopy---real time/moving XR *contrast PO is needed so it illuminates inside esophagus "BARIUM SWALLOW" GOOD FOR: function and morphology: strictures, compression and altered anatomy: reflux, hiatal hernias, mucosal granulairty, erosions, ulcerations, strictures high sensitiity for detecting strictures vs endoscopy CON: -not good for looking at mucosa -not fully diagnostic and PT will eventually need endoscopy---even if the esophagram study is negative ...why???? because next step would be to obtain biopsies, provide tx, or clarify any abnormal findings in case of + exam OR to add certainty to a - exam

two types of contrast used for esophagrams

barium | gastrografin

what is the most useful test for evaluation of proximal gasotrintestinal tract

endoscopy

list advantages of endoscopy vs barium esophgram | list the disadvantages

ADV 1. increased sensitivity for detection of mucosal lesions 2. increased sensitivity for detection of abnormalities like Barretts esophagus or vascular lesions 3. ability to obtain biopsies 4. ability to dilate strictures DURING exam DISADV 1. expensive 2. low sensitivity for detection of non-focal esophageal strictures 3. sedatives or anesthetics are req

esophageal manometry - aka? - what are high pressure zones? - where do u see peristaltic conractions - indications

aka motility testing * pressure-sensing catheter put in esophagus--- contractility seen following test swallows * *UES and LES are high pressure zones----- they relax on swallowing * *Intersphincteric esophagus exhibits peristaltic contractions INDS: diagnose motility disorders: achalasia, diffuse esophageal spasm, and assess peristaltic integrity prior to surgery for GERD

oral phase dysphagia more problematic with fluids or solid?

fluids

manifests as chewing problems, oral stasis of food, inability to form bolus, and coughing, choking or aspirational pneumonia *which phase of dysphagia

oral phase

explain oral phase dysphagia

manifests as chewing problems, oral stasis of food, inability to form bolus, and coughing, choking or aspirational pneumonia *which phase of dysphagia

oropharyngeal phase dysphagia localized to?

throat

many attempts to clear throat of food or saliva is associated with which phase dysphagia

oropharyngeal phase dysphagia

common s/s for oropharyngeal phase dysphagia

dysarthria | dysphonia

define dysarthria

is a motor speech disorder in which the muscles that are used to produce speech are damaged, paralyzed, or weakened. The person with dysarthria cannot control their tongue or voice box and may slur words. There are strategies to improve communication

define dysphonia

diff in speaking due to difficulty in speaking due to a physical disorder of the mouth, tongue, throat, or vocal cords.

how are the different dysphagias usually diagnosed?

esophogram--fluroro exam--- real time imaging

strokes and other neuro disorders can cause what kind of dysphagia

oropharyngeal phase dysphagia

what muscle is located at the junction of the pharynx (throat) and esophagus

cricopharyngeus muscle aka UES

what muscle is the major muscular component of the UES

cricopharyngeus muscle