GI: general terms + exams Flashcards
esophagus connects ___ to ____?
hypopharynx to stomach
where is esophagus located
posterior mediastinum
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
key functional impairment disorders are? (2)
swallowing disorders
and
excessive gastroesophageal reflux
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.
pyrosis
heartburn
another term for heartburn
pyrosis
what is the MC esophageal symp
pyrosis—heartburn
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
is regurgiation the same as heartburn?
NO
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
rumination
when recently swallowed food is regurgitated and then reswallowed repetitively up to one hour
explain esophageal CP
- sensation?
- radiation?
pressure type of sensation in mid chest
radiates to mid-back, arms, jaws
why is cardiac and esoph CP similar?
they share a nerve plexus +
nerve endings in esophageal wall have poor ability to discriminate different stimuli
MCC of esophageal CP?
GERD
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
Dysphagia with liquids AND solids suggest?
motility disorder
EX: achalasia
dysphagia with only solid food suggestive of? (3)
stricture
ring
tumor
define odynophagia
pain either caused by or exacerbated by swallowing
odynophagia is more common with?
pill or infectious esophagitis
rather than reflux esophagitis
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?
- oral/preparatory–chewing, making food bolus
- pharyngeal phase
- 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?
- XR — still
- 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
- increased sensitivity for detection of mucosal lesions
- increased sensitivity for detection of abnormalities like Barretts esophagus or vascular lesions
- ability to obtain biopsies
- ability to dilate strictures DURING exam
DISADV
- expensive
- low sensitivity for detection of non-focal esophageal strictures
- 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
