ICR: Dysphagia

Question 1

dysphagia

Answer 1

difficulty swallowing

Question 2

odynophagia

Answer 2

act of swallowing that induces pain
secondary to mucosal injury/inflammation
-drooling for fear of swallowing saliva
can be infectious or noninfectious

Question 3

GERD

Answer 3

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

Question 4

upper 1/3 esophagus is…

Answer 4

striated muscle –> skeletal muscle disorders (als, ms, parkinsons, etc)

Question 5

lower 2/3 esophagus is…

Answer 5

smooth muscle –> smooth muscle disorders (scleroderma)

Question 6

UES

Answer 6

cricopharyngeal sphincter

error –> liquid through nose

Question 7

LES

Answer 7

lower esophageal sphincter

high pressure zone that prevents gastric reflux

Question 8

esophageal vs gastric mucosa

Answer 8

e - stratified squamous
g - non ciliated columnar w goblet cells
split by GE junction

Question 9

to prevent aspiration …

Answer 9

larynx moves upward and forward and bolus goes through piriform rescess

Question 10

two dysphagia types

Answer 10

oropharyngeal and esophageal

Question 11

oropharyngeal type of dysphagia

Answer 11

(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

Question 12

esophageal type of dysphagia

Answer 12

(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

Question 13

important for history

Answer 13

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

Question 14

a) alcohol/tobacco use / weightloss–>
b) caustic ingestion –>
c) meds –>
d) surgeries –>
e) allergies –>

Answer 14

a esophageal cancer
b esophageal stricture
c caustic/burn injury
d tracheo-esophageal fistula repair --> stricture
e eosinophilic esophagitis

Question 15

main infection of esophagus (ESOPHAGITIS)? – dysphagia and odonyphagia

Answer 15

candida albicans
HSV
CMV
IMMUNOCOMPROMISED PPL

Question 16

schatzki’s ring

Answer 16

B ring
360 degree web like stricture at GE junction; chronic acid reflux
intermittent solid food dysphagia
related to chronic reflux –> treat w PPI

Question 17

eosinophilic esophagitis (EOE)

Answer 17

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

Question 18

benign esophageal tumor

Answer 18

intermittent solid food disorder

leiomyoma

Question 19

heart condition that can cause intermittent dysphagia?

Answer 19

vascular extrinsic compression on aorta

Question 20

inflammatory condtion that can cause intermittent dysphagia?

Answer 20

sarcoid

Question 21

two types of progressive food dysphagias

Answer 21

benign peptic strictures - secondary to GERD, progressive from reflux, >1yr

malignant esophageal strictures - progresses slowly to liquid dysphagia; weight loss

Question 22

achalasia

Answer 22

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

Question 23

diffuse esophageal spasm

Answer 23

increase of/longer duration of peristalsis/non-peristalsis contractions
severe chest pain
intensifies with fast eating and stress

Question 24

scleroderma

Answer 24

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

Question 25

chagas disease

Answer 25

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

Question 26

infectious adynophagia

Answer 26

immunocompromised individuals

CMV, candida, and HSV

Question 27

noninfectious odynophagia

Answer 27

pill induced –> tetracycline, aspirin, quinidine, vitamic C

caustic injury –> lye

idiopathic esophageal ulceration –> with HIV

Question 28

meds for GERD

Answer 28

antacid
alginic acid
H2 receptor antagonists (cimetidine, ranitidine, famotidine)
PPIs (omeprazole, lansoprazole)

Question 29

when to take PPI

Answer 29

for GERD, before eating to block the proton pumps

Question 30

pseudo achalasia

Answer 30

use imaging to find extrinsic compression on esophagus

not lumenal