Mouth and esophagus Flashcards by Jeanine Duong

What 3 layers make up the esophagus?

Mucosa, Submucosa and Esophageal muscle

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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)

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How are the muscle layers arranged in the esophagus?

Ring inner muscles [for peristalsing]

Longitudinal outer [to hold everything together]

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What part of the esophagus does oropharyngeal dysphagia occur?

Upper esophagus by larynx.

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What are symptoms of oropharyngeal dysphagia?

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

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Causes of oropharyngeal dysphagia?

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

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How do you visualize oropharyngeal disorders?

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

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What are symptoms of esophageal dysphagia?

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

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What are some causes of esophageal dysphagia?

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

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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

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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

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Prognosis for esophageal dysphagia?

Depends on etiology

Main worry is aspiration pneumonia

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What is achalasia?

Poor peristalsis and the continual constriction of lower esophageal sphincter

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Symptoms of achalasia?

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

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Pathophysiology of achalasia?

Postganglionic inhibitory neurons fail - lower sphincter stays constricted
Usually idiopathic

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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

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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 ```