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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
What is diagnostic test for GERD?
- 24 pH monitoring to demonstrate reflux | - endoscopy to looks for erythema, linear ulcers that suggest effects of reflux
26
What are physiologic defensive factors that prevent GERD?
- LES = anti-reflux barrier | - esophageal acid clearance via gastric emptying, esophageal peristalsis, saliva
27
How does a hiatal hernia effect GERD?
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
What are the 2 types of hiatal hernia?
- 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
What is a hiatal hernia?
part of top of stomach herniates above the diaphgram
30
What are some possible complications of GERD?
- ulceration/esophagitis - stricture - barrett's esophagus
31
What role does saliva play in protecting from GERD?
rich in bicarbonate, acts as endogenous antacid
32
What are 2 tests that indicate potential for reflux?
- barium swallow | - lower esophageal sphincter pressure tracings
33
What is an esophageal stricture?
- tapered concentric narrowing of esophagus due to inflammation and fibrosis associated w/ lye ingestion and acid reflux
34
What is barrett's esophagus?
columnar metaplasia of lower esophagus [replaces normal squamous epithelium] due to prolonged gastroesophagela reflux
35
What does dysphagia of solid foods only vs dysphagia of solids + liquids tell you?
solid foods only = structural problem solids + liquids = motility problem
36
What does progressive solid food only dysphagia suggest?
tumor [carcinoma] or peptic stricture tumor will have more rapid onset
37
What does progressive solid + liquid dysphagia with heartburn suggest?
scleroderma
38
What does progressive solid + liquid dysphagia w/out heartburn suggest?
achalasia
39
What does intermittent solid+liquid dysphagia with chest pain suggest?
esophageal spasm
40
What is a potential complication of barrett's esophagus?
increases risk of adenocarcionoma within the barrett's epithelium [lower esophagus]
41
What tests can tell you if there is increased acid exposure in the esophagus?
- sometimes endoscopy | - 24 hr pH
42
What test[s] can tell you if there is correlation with symptoms in GE reflux?
24 hr pH
43
What test[s] can tell you mechanisms of reflux in GE reflux?
- esophagram | - manometry
44
What is initial treatment for GERD?
- lifestyle changes [weight loss, dietary modification, stay upright after meals] - remove harmful medications - give antacids
45
What is most effective treatment for GERD?
proton pump inhibitors
46
What are some medical treatments for GERD?
- proton pump inhibitors - H2 receptor antagonists - prokinetics - sucralfate
47
What is achalasia?
failure of relaxation of LES due to loss of myenteric [auerbach] plexus LES remains tonically contracted
48
What do you see on barium swallow with achalasia?
dilated esophagus w/ an area of distal stenosis "birds beak"
49
What are symptoms of achalasia?
- dysphagia - regurgitation - weight loss - chest pain
50
What do you see on manometry with achalasia?
- high pressure LES - impaired LES relaxation - aperistalsis of body of esophagus [see air fluid level]
51
What are 3 treatments for achalasia?
- botulinum toxin - pneumatic [balloon] dilation - heller myotomy = surgically divide LES muscle fibers
52
What are 2 secondary causes that mimic achalasia ["pseudo-achalasia"]?
- chagas disease [trypanosoma cruzii] | - cancer of GE junction --> more rapid progression, older [>50], more weight loss [> 15 lb]
53
What is action of botox in achalasia?
blocks ACh transmission at the LES
54
What is diffuse esophageal spasm?
disorder of chest pain and dysphagis w/ no organic lesion that are intermittent may be precipitated by meals or emotional stress
55
What do you see on xray in diffuse esophageal spasm?
corkscrew esophagus during spasm; may appear normal otherwise
56
What happens to esophagus in scleroderma?
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
What is treatment for diffuse esophageal spasm?
muscle relaxants, Ca blockers, nitrates
58
What do you see on manometry with diffuse esophageal spasm?
simultaneous prolonged contractions throughout esophagus [rather than phasic] - repetitive contrations even w/ a smile - LES usually normal
59
What is nutracker esophagsu?
disorder of high amplitude peristaltic contractions
60
What do you see on manometry w/ nutcracker esophagus?
- high amplitude contractions (> 180 mmHg) | - normal peristalsis and LES
61
How do the manometric findings of scleroderma differ from achalasia?)
scleroderma = low pressure in LES achalasia = high pressure in LES
62
How is esophagus effected in pregnancy?
- decreased LES pressure in pregnancy; reverts to normal after delivery
63
What are 3 bugs that cause infectious esophagitis?
- 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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