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Systemic Final > Mouth and esophagus > Flashcards

Mouth and esophagus Flashcards

1
Q

What 3 layers make up the esophagus?

A

Mucosa, Submucosa and Esophageal muscle

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2
Q

What differentiates upper esophagus from lower?

A

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)

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3
Q

How are the muscle layers arranged in the esophagus?

A

Ring inner muscles [for peristalsing]

Longitudinal outer [to hold everything together]

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4
Q

What part of the esophagus does oropharyngeal dysphagia occur?

A

Upper esophagus by larynx.

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5
Q

What are symptoms of oropharyngeal dysphagia?

A 
Difficulty making bolus
Can't swallow
     Regurgitates/aspirates
     Coughs and chokes 
     More difficult if liquids
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6
Q

Causes of oropharyngeal dysphagia?

A

Neurologic (Parkinson’s, amyotrophic sclerosis, CVA)
Iatrogenic (Surgery)
Structural (Neoplasm, diverticula, crycopharyngeal bar)

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7
Q

How do you visualize oropharyngeal disorders?

A

Videofluoroscopic swallowing study (VFSS) food laced with barium and then take x-ray video of it.

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8
Q

What are symptoms of esophageal dysphagia?

A

Regurgitation and chest pain (GERD)
coughing/choking (unrelated to swalllowing)
Feeling as if something stuck in throat

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9
Q

What are some causes of esophageal dysphagia?

A

Abnormal peristalsis/swallowing
Poor function of Lower sphincter
Achalasia, Scleroderma, GERD

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10
Q

How would you visualize esophageal dysphagia?

A

Manometer (measures duration, strength and pattern peristalsis)
Chest x ray (will see bird beak sign)
Endoscopy to rule out other causes

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11
Q

Treatment for esophageal dysphagia?

A

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

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12
Q

Prognosis for esophageal dysphagia?

A

Depends on etiology

Main worry is aspiration pneumonia

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13
Q

What is achalasia?

A

Poor peristalsis and the continual constriction of lower esophageal sphincter

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14
Q

Symptoms of achalasia?

A

Regurgitation without acid reflux
“Something stuck in my throat”
Drink water to try to wash it down

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15
Q

Pathophysiology of achalasia?

A

Postganglionic inhibitory neurons fail - lower sphincter stays constricted
Usually idiopathic

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16
Q

How would you visualize achalasia?

A

Chest x ray: Birdbeak toward bottom of esophagus
Manometer: Poor contraction and poor LES relaxtion
Endoscopy: Rule out and check for cancer

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17
Q

Treatment for achalasia?

A

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)

18
Q

Prognosis for achalasia? What happens if you don’t treat it?

A

Good pronosis. Left untreated, will get lung problems and weight loss.

19
Q

How does scleroderma affect the esophagus?

A

Atrophy of esophageal smooth muscle (lower 2/3 esophagus)
Decrease secretions
Decrease LES muscle tone leading to GERD

20
Q

How common is scleroderma esophagus?

A

80% people with scleroderma will have esophageal problems

21
Q

Etiology of scleroderma?

A

Idiopathic and uncommon

22
Q

Gene markers of scleroderma?

A

ANA+

AntiSCL70, AntiCentromere Abs

23
Q

How do you treat scleroderma?

A

Not really a treatment

PPIs to relieve GERD

24
Q

How do you monitor scleroderma?

A

Videofluoroscopic swallow study (VFSS): Dilated esophagus
Manometry: poor peristalsis and LES contraction
Endoscopy to monitor for cancer

25
Q

What’s the most common upper GI dz in the US?

A

GERD

26
Q

What’re the 2 types of GERD?

A

Hypotensive LES

Transient LES relaxation

27
Q

What causes Transient LES relaxation?

A

Esophagus herniates from diaphragm. Diaphragm doesn’t help keep it closed any more

28
Q

What are some causes for GERD?

A

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

29
Q

Symptoms of GERD?

A

Regurgitation/acid reflux, heart burn, dysphagia

Symptoms of acid in throat/lungs: Eroded teeth, sore throat, aspiration pneumonia

30
Q

How do you monitor GERD?

A

ambulatory pH monitoring

Pt eats normal diet and decreases acid surpressing drugs one week before

31
Q

How do you test for GERD?

A

Manometry, barium swallow, Endoscopy for strictures, inflam and ulcers (make sure it’s not Barret’s)

32
Q

Treatment for GERD?

A 
Lose weight, don't recline when you eat, stop smoking
PPIs, Antacids, H2 blockers
Laproscopic fundoplication (wrap stomach around bottom of esophagus)
33
Q

Prognosis for GERD? What happens if you don’t treat it?

A

Good! If not treated, can become Barret’s esophagus (pre cancer) Remember, check by looking for ulcers, strictures and inflammation

34
Q

What’s the pathophysiology of Barret’s esophagus?

A

Metaplasia of esophageal cells. Go from squamous to columnar. Metaplasia = dysplasia = neoplasm

35
Q

Predilection of Barret’s esophagus?

A

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

36
Q

How do you diagnose Barret’s?

A

Endoscopy and biopsy

37
Q

What’re symptoms of Barret’s?

A

Same as GERD
Regurgitation/acid reflux, heart burn, dysphagia
Symptoms of acid in throat/lungs: Eroded teeth, sore throat, aspiration pneumonia

38
Q

How do you treat Barret’s?

A

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)

39
Q

Prognosis of Barret’s?

A

30% get cancer

40
Q

How can you try to prevent cancer in Barret’s?

A 
Endoscopic mucosal resection (EMR)
Ablation with lasers, radiowaves, heat and cold
Photodynamic therapy (PDT), Radiofrequency ablation, focal thermal ablation and cryablation

Systemic Final (8 decks)

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