ICR: Dysphagia Flashcards
dysphagia
difficulty swallowing
odynophagia
act of swallowing that induces pain
secondary to mucosal injury/inflammation
-drooling for fear of swallowing saliva
can be infectious or noninfectious
GERD
gastroesophageal reflux; reflux of gastric contents up the esophagus; decreased LES pressure
transient relaxations
hiatal hernia
symptoms –> heartburn, chest pain, salivation, halitosis, dysphagia, asthma, chronic cough, hoarsness, aspiration pneumonia, sore throat
signs - dental enamel erosion, barium swallow, endoscopy, manometry (pressure), pH monitoring
responds to PPI –> have to take on empty stomach before you eat
upper 1/3 esophagus is…
striated muscle –> skeletal muscle disorders (als, ms, parkinsons, etc)
lower 2/3 esophagus is…
smooth muscle –> smooth muscle disorders (scleroderma)
UES
cricopharyngeal sphincter
error –> liquid through nose
LES
lower esophageal sphincter
high pressure zone that prevents gastric reflux
esophageal vs gastric mucosa
e - stratified squamous
g - non ciliated columnar w goblet cells
split by GE junction
to prevent aspiration …
larynx moves upward and forward and bolus goes through piriform rescess
two dysphagia types
oropharyngeal and esophageal
oropharyngeal type of dysphagia
(transfer dysphagia)
swallowing mechanism –> problem is muscular or neurologic or neuromuscular, during or immediately after swallow
HARD to swallow liquids (and food)
–>liquid out nose, choking, coughing
localize above suprasternal notch
test = modified barium swallow
treat = thickened diet, excercises, feeding tube, speech pathology
esophageal type of dysphagia
(transit dysphagia)
difficulty swallowing after bolus is in esophagus
food gets stuck, can progress to liquid
2-7 sec before dysphagia sensation
hard to localize
discomfort/pain resolves with passing or regurgitation
important for history
food types?
intermittent, continuous, or progressive?
location?
timing?
onset?
other symptoms? – heartburn, regurge, etc
associated symptoms? – sore through, cough, etc
medical hx and risks? – alc/tobacco/caustic ingestion, meds, surgeries, allergies
a) alcohol/tobacco use / weightloss–>
b) caustic ingestion –>
c) meds –>
d) surgeries –>
e) allergies –>
a esophageal cancer b esophageal stricture c caustic/burn injury d tracheo-esophageal fistula repair --> stricture e eosinophilic esophagitis
main infection of esophagus (ESOPHAGITIS)? – dysphagia and odonyphagia
candida albicans
HSV
CMV
IMMUNOCOMPROMISED PPL
schatzki’s ring
B ring
360 degree web like stricture at GE junction; chronic acid reflux
intermittent solid food dysphagia
related to chronic reflux –> treat w PPI
eosinophilic esophagitis (EOE)
intermittent solid food dysphagia
allergic history/young with atopic hx (asthma/exema/rhitis)
findings –> multiple rings(trachealization), linear furrows, narrow esophagus, esophageal strictures, 15 eosinophils per frame
NOT responsive to PPI
treat with elemental (restrictive) diets
or meds –> fluticasone
benign esophageal tumor
intermittent solid food disorder
leiomyoma
heart condition that can cause intermittent dysphagia?
vascular extrinsic compression on aorta
inflammatory condtion that can cause intermittent dysphagia?
sarcoid
two types of progressive food dysphagias
benign peptic strictures - secondary to GERD, progressive from reflux, >1yr
malignant esophageal strictures - progresses slowly to liquid dysphagia; weight loss
achalasia
HYPERTONIC LES; lack of or incomplete LES relaxation
loss of esophageal peristalsis; normal or increased LES pressure (normal is 10-25 mmHg)
ganglion cell destruction is the cause
“bird beak sign”
esophageal body dilation on barium swallow
diffuse esophageal spasm
increase of/longer duration of peristalsis/non-peristalsis contractions
severe chest pain
intensifies with fast eating and stress
scleroderma
HYPOTONIA LES; loss of LES pressure and absent peristalsis on lower smooth muscle due to prolonged gastric acid exposure
severe GERD
often strictures and Barretts are present; usually women
chagas disease
caused by trypanosoma cruzi –> invades ganglion cells
similar to achalasia (loss of LES relaxation)
travelers and immigrants (central/south america)
may have megacolon, CHF, or megaureters
infectious adynophagia
immunocompromised individuals
CMV, candida, and HSV
noninfectious odynophagia
pill induced –> tetracycline, aspirin, quinidine, vitamic C
caustic injury –> lye
idiopathic esophageal ulceration –> with HIV
meds for GERD
antacid
alginic acid
H2 receptor antagonists (cimetidine, ranitidine, famotidine)
PPIs (omeprazole, lansoprazole)
when to take PPI
for GERD, before eating to block the proton pumps
pseudo achalasia
use imaging to find extrinsic compression on esophagus
not lumenal
