Mouth and esophagus Flashcards
What 3 layers make up the esophagus?
Mucosa, Submucosa and Esophageal muscle
What differentiates upper esophagus from lower?
Upper 1/3 esophagus is skeletal and sphincter is voluntary (burping, vomitting)
Lower 2/3 is smooth muscle and muscle is not voluntary (Stops acid reflux)
How are the muscle layers arranged in the esophagus?
Ring inner muscles [for peristalsing]
Longitudinal outer [to hold everything together]
What part of the esophagus does oropharyngeal dysphagia occur?
Upper esophagus by larynx.
What are symptoms of oropharyngeal dysphagia?
Difficulty making bolus
Can't swallow
Regurgitates/aspirates
Coughs and chokes
More difficult if liquidsCauses of oropharyngeal dysphagia?
Neurologic (Parkinson’s, amyotrophic sclerosis, CVA)
Iatrogenic (Surgery)
Structural (Neoplasm, diverticula, crycopharyngeal bar)
How do you visualize oropharyngeal disorders?
Videofluoroscopic swallowing study (VFSS) food laced with barium and then take x-ray video of it.
What are symptoms of esophageal dysphagia?
Regurgitation and chest pain (GERD)
coughing/choking (unrelated to swalllowing)
Feeling as if something stuck in throat
What are some causes of esophageal dysphagia?
Abnormal peristalsis/swallowing
Poor function of Lower sphincter
Achalasia, Scleroderma, GERD
How would you visualize esophageal dysphagia?
Manometer (measures duration, strength and pattern peristalsis)
Chest x ray (will see bird beak sign)
Endoscopy to rule out other causes
Treatment for esophageal dysphagia?
Depends on severity - dysphagia diet
Moderate to severe: Level 1 - Puddingy foods
Mild to moderate: Level 2 - Moist/soft food (mincemeat)
Almost normal: Level 3 - normal food in bite sizes
Make sure to eat upright, quietly and slowly
Make exaggerated swallowing motions with head and no food left in cheeks when done
Prognosis for esophageal dysphagia?
Depends on etiology
Main worry is aspiration pneumonia
What is achalasia?
Poor peristalsis and the continual constriction of lower esophageal sphincter
Symptoms of achalasia?
Regurgitation without acid reflux
“Something stuck in my throat”
Drink water to try to wash it down
Pathophysiology of achalasia?
Postganglionic inhibitory neurons fail - lower sphincter stays constricted
Usually idiopathic
How would you visualize achalasia?
Chest x ray: Birdbeak toward bottom of esophagus
Manometer: Poor contraction and poor LES relaxtion
Endoscopy: Rule out and check for cancer
Treatment for achalasia?
Nitroglycerine, Ca channel blocker, anticholinergic
Botox injection and phosphodiesterase inhibitor (Pharms not very effective)
Also pneumatic dilation (will cause GERD)
Heller myotomy (sew stomach onto slit in lower esophagus)
Prognosis for achalasia? What happens if you don’t treat it?
Good pronosis. Left untreated, will get lung problems and weight loss.
How does scleroderma affect the esophagus?
Atrophy of esophageal smooth muscle (lower 2/3 esophagus)
Decrease secretions
Decrease LES muscle tone leading to GERD
How common is scleroderma esophagus?
80% people with scleroderma will have esophageal problems
Etiology of scleroderma?
Idiopathic and uncommon
Gene markers of scleroderma?
ANA+
AntiSCL70, AntiCentromere Abs
How do you treat scleroderma?
Not really a treatment
PPIs to relieve GERD
How do you monitor scleroderma?
Videofluoroscopic swallow study (VFSS): Dilated esophagus
Manometry: poor peristalsis and LES contraction
Endoscopy to monitor for cancer
What’s the most common upper GI dz in the US?
GERD
What’re the 2 types of GERD?
Hypotensive LES
Transient LES relaxation
What causes Transient LES relaxation?
Esophagus herniates from diaphragm. Diaphragm doesn’t help keep it closed any more
What are some causes for GERD?
Specific foods: Caffeine, mint, chocolate, alcohol, tomatoey foods
Specific drugs: estrogen, Antidepressants, Anticholinergics
Mucosal damage caused by more drugs: aspirin, Iron salts, KCl tabs
Smoking reclining fatty
Symptoms of GERD?
Regurgitation/acid reflux, heart burn, dysphagia
Symptoms of acid in throat/lungs: Eroded teeth, sore throat, aspiration pneumonia
How do you monitor GERD?
ambulatory pH monitoring
Pt eats normal diet and decreases acid surpressing drugs one week before
How do you test for GERD?
Manometry, barium swallow, Endoscopy for strictures, inflam and ulcers (make sure it’s not Barret’s)
Treatment for GERD?
Lose weight, don't recline when you eat, stop smoking PPIs, Antacids, H2 blockers Laproscopic fundoplication (wrap stomach around bottom of esophagus)
Prognosis for GERD? What happens if you don’t treat it?
Good! If not treated, can become Barret’s esophagus (pre cancer) Remember, check by looking for ulcers, strictures and inflammation
What’s the pathophysiology of Barret’s esophagus?
Metaplasia of esophageal cells. Go from squamous to columnar. Metaplasia = dysplasia = neoplasm
Predilection of Barret’s esophagus?
Middle aged white guys with GERD and strictures
Also same risk factors as GERD
Specific foods: Caffeine, mint, chocolate, alcohol, tomatoey foods
Specific drugs: estrogen, Antidepressants, Anticholinergics
Mucosal damage caused by more drugs: aspirin, Iron salts, KCl tabs
Smoking reclining fatty
How do you diagnose Barret’s?
Endoscopy and biopsy
What’re symptoms of Barret’s?
Same as GERD
Regurgitation/acid reflux, heart burn, dysphagia
Symptoms of acid in throat/lungs: Eroded teeth, sore throat, aspiration pneumonia
How do you treat Barret’s?
Same as GERD
Lose weight, don’t recline when you eat, stop smoking
PPIs, Antacids, H2 blockers
Laproscopic fundoplication (wrap stomach around bottom of esophagus)
Prognosis of Barret’s?
30% get cancer
How can you try to prevent cancer in Barret’s?
Endoscopic mucosal resection (EMR) Ablation with lasers, radiowaves, heat and cold Photodynamic therapy (PDT), Radiofrequency ablation, focal thermal ablation and cryablation
