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GI/Liver > Lec 1 Esophagus > Flashcards

Lec 1 Esophagus Flashcards

1
Q

What two muscles compose the upper esophageal sphincter?

A
  • cricopharyngeus

- inferior pharyngeal constrictor

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2
Q

What kind of muscle is the UES?

A

skeletal muscle

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3
Q

When is UES relaxed? contracted?

A
  • tonically closed at rest

- relaxed during swallowing

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4
Q

WHat is normal amplitude of peristaltic wave in esophagus?

A

60-100 mmHg

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5
Q

What is purpose of primary, secondary, tertiary peristalsis?

A

primary = clears the bolus

secondary = sweepers; wipe up any refuxed food also propulsive

tertiary = non propulsive, spontaneous not triggered by bolus

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6
Q

What causes relaxation of LES?

A

NO = inhibitory neurotransmitter

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7
Q

Why can you have negative pressure in the esophagus?

A

b/c thoracic cavity under negative pressure

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8
Q

What are some neural factors that decrease lower esophageal sphincter pressure

A
  • cholinergic antagonists
  • alpha adrenergic blockers
  • beta adrenergic agonists
  • nitric oxide
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9
Q

What are 4 hormones that decrease lower esophageal sphincter pressure?

A
  • secretin
  • CCK
  • somatostatin
  • progesterone [pregnancy]
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10
Q

What are 4 foods that decrease lower esophageal sphincter pressure?

A
  • fats
  • chocolate
  • ethanol
  • peppermint
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11
Q

What are some drugs that decrease lower esophageal sphincter pressure?

A
  • theophylline
  • Ca channel blockers
  • morphine
  • diazepam
  • serotonin
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12
Q

What are symptoms of esophageal disorder?

A
  • dysphagia
  • heartburn
  • odynophagia
  • chest pain
  • regurgitation
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13
Q

What is dysphagia?

A

sense of impaired transport of bolus through esophagus?

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14
Q

What causes heartburn? What makes it better/worse?

A

due to reflux fo gastric contents into esophagus

worse after meals, with bending
relieved by antacids

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15
Q

What is odynophagia?

A

pain on swallowing

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16
Q

What are some atypical symptoms of esophageal disorder?

A
  • hoarseness
  • cough
  • wheeze
  • sore throat
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17
Q

What are x diagnostic tests for esophageal disorders?

A
  • barium esophagram
  • endoscopy w/ biopsy
  • endoscopic ultrasound
  • esophageal manometry
  • acid reflux [pH] studies
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18
Q

What does a barium esophagram [barium swallow] tell you?

A

evaluates structural lesions [strictures, web, hiatal hernia]

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19
Q

What does endoscopy tell you?

A

directly visualizes esophageal mucosa

allows you to do biopsy for tissue diagnosis

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20
Q

What does endoscopic ultrasound [EUS] tell you?

A

useful for imaging lesions in esophageal wall or immediately adjacent to esophagus

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21
Q

What does esophageal manometry tell you?

A
  • measures pressure, contractile activity, and sphincter function
  • useful for motility disorders
  • can demonstrate tendency for GE reflux
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22
Q

What does acid reflux study tell you?

A
  • measures esophageal pH

- have 24 hrs pH probe can quantify amount and duration of reflux and correlate w/ symptoms

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23
Q

What is gastroesophageal reflux disease?

A
  • reflux of gastric contents into esophagus
  • commonly presents as heartburn and regurgitation w/ lying down
  • due to decrease in LES tone
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24
Q

What are symptoms of GERD?

A
  • heartburn [worse w/ food, lying, better w/ antacids]
  • chest pain
  • dysphagia
  • nocturnal cough/dyspnea
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25
Q

What is diagnostic test for GERD?

A
  • 24 pH monitoring to demonstrate reflux

- endoscopy to looks for erythema, linear ulcers that suggest effects of reflux

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26
Q

What are physiologic defensive factors that prevent GERD?

A
  • LES = anti-reflux barrier

- esophageal acid clearance via gastric emptying, esophageal peristalsis, saliva

27
Q

How does a hiatal hernia effect GERD?

A

increase in transient LES relaxations
have acid pocket in proximal stomach and no longer have diaphragm “pinching” at the GE junction

== increases risk for GERD

28
Q

What are the 2 types of hiatal hernia?

A
  • sliding = GE junction just slides up

- para esophageal = GE junction in normal place but there is a true hernial sac that goes up above the diaphragm

29
Q

What is a hiatal hernia?

A

part of top of stomach herniates above the diaphgram

30
Q

What are some possible complications of GERD?

A
  • ulceration/esophagitis
  • stricture
  • barrett’s esophagus
31
Q

What role does saliva play in protecting from GERD?

A

rich in bicarbonate, acts as endogenous antacid

32
Q

What are 2 tests that indicate potential for reflux?

A
  • barium swallow

- lower esophageal sphincter pressure tracings

33
Q

What is an esophageal stricture?

A
  • tapered concentric narrowing of esophagus due to inflammation and fibrosis

associated w/ lye ingestion and acid reflux

34
Q

What is barrett’s esophagus?

A

columnar metaplasia of lower esophagus [replaces normal squamous epithelium]

due to prolonged gastroesophagela reflux

35
Q

What does dysphagia of solid foods only vs dysphagia of solids + liquids tell you?

A

solid foods only = structural problem

solids + liquids = motility problem

36
Q

What does progressive solid food only dysphagia suggest?

A

tumor [carcinoma] or peptic stricture

tumor will have more rapid onset

37
Q

What does progressive solid + liquid dysphagia with heartburn suggest?

A

scleroderma

38
Q

What does progressive solid + liquid dysphagia w/out heartburn suggest?

A

achalasia

39
Q

What does intermittent solid+liquid dysphagia with chest pain suggest?

A

esophageal spasm

40
Q

What is a potential complication of barrett’s esophagus?

A

increases risk of adenocarcionoma within the barrett’s epithelium [lower esophagus]

41
Q

What tests can tell you if there is increased acid exposure in the esophagus?

A
  • sometimes endoscopy

- 24 hr pH

42
Q

What test[s] can tell you if there is correlation with symptoms in GE reflux?

A

24 hr pH

43
Q

What test[s] can tell you mechanisms of reflux in GE reflux?

A
  • esophagram

- manometry

44
Q

What is initial treatment for GERD?

A
  • lifestyle changes [weight loss, dietary modification, stay upright after meals]
  • remove harmful medications
  • give antacids
45
Q

What is most effective treatment for GERD?

A

proton pump inhibitors

46
Q

What are some medical treatments for GERD?

A
  • proton pump inhibitors
  • H2 receptor antagonists
  • prokinetics
  • sucralfate
47
Q

What is achalasia?

A

failure of relaxation of LES due to loss of myenteric [auerbach] plexus

LES remains tonically contracted

48
Q

What do you see on barium swallow with achalasia?

A

dilated esophagus w/ an area of distal stenosis

“birds beak”

49
Q

What are symptoms of achalasia?

A
  • dysphagia
  • regurgitation
  • weight loss
  • chest pain
50
Q

What do you see on manometry with achalasia?

A
  • high pressure LES
  • impaired LES relaxation
  • aperistalsis of body of esophagus [see air fluid level]
51
Q

What are 3 treatments for achalasia?

A
  • botulinum toxin
  • pneumatic [balloon] dilation
  • heller myotomy = surgically divide LES muscle fibers
52
Q

What are 2 secondary causes that mimic achalasia [“pseudo-achalasia”]?

A
  • chagas disease [trypanosoma cruzii]

- cancer of GE junction –> more rapid progression, older [>50], more weight loss [> 15 lb]

53
Q

What is action of botox in achalasia?

A

blocks ACh transmission at the LES

54
Q

What is diffuse esophageal spasm?

A

disorder of chest pain and dysphagis w/ no organic lesion that are intermittent

may be precipitated by meals or emotional stress

55
Q

What do you see on xray in diffuse esophageal spasm?

A

corkscrew esophagus during spasm; may appear normal otherwise

56
Q

What happens to esophagus in scleroderma?

A

loss of smooth muscle –> decrease LES pressure and dysmotility –> reflux –> replacement of smooth muscle w/ fibrosis = stricture

have loss of LES function and poor peristalsis –> leading to GE reflux

57
Q

What is treatment for diffuse esophageal spasm?

A

muscle relaxants, Ca blockers, nitrates

58
Q

What do you see on manometry with diffuse esophageal spasm?

A

simultaneous prolonged contractions throughout esophagus [rather than phasic]

  • repetitive contrations even w/ a smile
  • LES usually normal
59
Q

What is nutracker esophagsu?

A

disorder of high amplitude peristaltic contractions

60
Q

What do you see on manometry w/ nutcracker esophagus?

A
  • high amplitude contractions (> 180 mmHg)

- normal peristalsis and LES

61
Q

How do the manometric findings of scleroderma differ from achalasia?)

A

scleroderma = low pressure in LES

achalasia = high pressure in LES

62
Q

How is esophagus effected in pregnancy?

A
  • decreased LES pressure in pregnancy; reverts to normal after delivery
63
Q

What are 3 bugs that cause infectious esophagitis?

A
  • HSV –> infects squamous epithelium = punched out ulcers
  • CMV –> infects endothelial [usually immune suppressed] = linear ulcers
  • candida albicans = white

GI/Liver (36 decks)

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