icr: dysphagia Flashcards
dysphagia
difficulty swallowing
odynophagia
act of swallowing that induces painsecondary to mucosal injury/inflammation-drooling for fear of swallowing salivacan be infectious or noninfectious
GERD
gastroesophageal reflux; reflux of gastric contents up the esophagus; decreased LES pressuretransient relaxationshiatal herniasymptoms –> heartburn, chest pain, salivation, halitosis, dysphagia, asthma, chronic cough, hoarsness, aspiration pneumonia, sore throatsigns - dental enamel erosion, barium swallow, endoscopy, manometry (pressure), pH monitoringresponds 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 sphinctererror –> liquid through nose
LES
lower esophageal sphincterhigh pressure zone that prevents gastric reflux
esophageal vs gastric mucosa
e - stratified squamousg - non ciliated columnar w goblet cellssplit 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 swallowHARD to swallow liquids (and food)–>liquid out nose, choking, coughinglocalize above suprasternal notchtest = modified barium swallowtreat = thickened diet, excercises, feeding tube, speech pathology
esophageal type of dysphagia
(transit dysphagia)difficulty swallowing after bolus is in esophagusfood gets stuck, can progress to liquid2-7 sec before dysphagia sensationhard to localizediscomfort/pain resolves with passing or regurgitation
important for history
food types?intermittent, continuous, or progressive?location?timing?onset?other symptoms? – heartburn, regurge, etcassociated symptoms? – sore through, cough, etcmedical 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 cancerb esophageal stricturec caustic/burn injuryd tracheo-esophageal fistula repair –> stricturee eosinophilic esophagitis
main infection of esophagus (ESOPHAGITIS)? – dysphagia and odonyphagia
candida albicansHSVCMVIMMUNOCOMPROMISED PPL
schatzki’s ring
B ring360 degree web like stricture at GE junction; chronic acid refluxintermittent solid food dysphagiarelated to chronic reflux –> treat w PPI
eosinophilic esophagitis (EOE)
intermittent solid food dysphagiaallergic history/young with atopic hx (asthma/exema/rhitis)findings –> multiple rings(trachealization), linear furrows, narrow esophagus, esophageal strictures, 15 eosinophils per frameNOT responsive to PPItreat with elemental (restrictive) dietsor meds –> fluticasone
benign esophageal tumor
intermittent solid food disorderleiomyoma
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, >1yrmalignant esophageal strictures - progresses slowly to liquid dysphagia; weight loss
achalasia
HYPERTONIC LES; lack of or incomplete LES relaxationloss 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 contractionssevere chest painintensifies with fast eating and stress
scleroderma
HYPOTONIA LES; loss of LES pressure and absent peristalsis on lower smooth muscle due to prolonged gastric acid exposuresevere GERD often strictures and Barretts are present; usually women
