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DEMS 1 > Oropharynx & Eso Pathophys > Flashcards

Oropharynx & Eso Pathophys Flashcards

1
Q

BENIGN STRUCTURAL
Zenker’s Diverticulum
(Info/Cause)

A

Outpouching of lower oropharynx due form muscle wall defect

ANY AGE

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2
Q

BENIGN STRUCTURAL
Zenker’s Diverticulum
(Pres/Diagnx/Treat)

A

Dysphagia, Halitosis
Detect with EGD
Surgical diverticulotomy

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3
Q

BENIGN STRUCTURAL
Cervical Osteophytes
(Info/Cause)

A

Osteophytes narrow oropharynx

RARE

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4
Q

BENIGN STRUCTURAL
Cervical Osteophytes
(Pres/Diagnx/Treat)

A

Often Hx of arthritis or neck surgery
Detect with EGD
Not treatment discussed

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5
Q

BENIGN STRUCTURAL
Cricopharyngeal Ring and HTN
(Info/Cause)

A

Cricopharyngeal muscle displaced or fails to relax –> UES compression

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6
Q

BENIGN STRUCTURAL
Cricopharyngeal Ring and HTN
(Pres/Diagnx/Treat)

A

Dysphagia
Detect with EGD
Treat with Cricopharyngeal myotomy

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7
Q

NEUROMUSCULAR
ALS, Parkinson’s, Muscular Dystrophy etc.
(Pres/Diagnx/Treat)

A

Dysphagia
Diagnx with H&P, neuro exam
Treat - underlying cause, - speech/swallow tx, - PEG tube (eventually)

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8
Q

GERD

info/risks/causes

A

Reflux of gastric juice into eso
Risk: Obesity, high fat diet, caffeine, EtOH, tobacco
Cause: HCl&raquo_space; enyzmes
Impaired eso peristalsis, hiatal hernias, dysmotility, obstruction, scleroderma
INAPPROPRIATE LES RELAXATION

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9
Q

GERD

presentation

A

HEARTBURN (substernal or epigastric, rises in chest)
Often after meals, large/fatty, may be worse lying down, acid taste
Rare: wheezing, stridor, hoarseness

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10
Q

GERD

Labs/Diagnx

A 
GOLD STANDARD: 24 hr pH study
Barium swallow (10-20% abormal)
EGD
LES relaxation on manometry
INCREASED EOSINOPHILS in DISTAL ESOPHAGUS
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11
Q

GERD

Treatment

A

Antacids
PPIs, H2 blockers
Change behavior
(5-10% may progress to Barrett’s - risk of cancer)

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12
Q

Achalasia

Info/cause

A

“No relaxation”
HYPERTONIC LES (vagal input to LES impaired [lack of ganglion cells], secondary to diabetic autonomic neuropath or malignancy)
Age 30-60, progressive, both genders, increased risk of squamous cell carc

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13
Q

Achalasia

Pres

A

SOLID AND LIQUID dysphagia
Feels like food stuck
Chest pain, regurg, weight loss
Halitosis

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14
Q

Achalasia

Diagnx

A

Gold Standard: Esophageal Manometry (LES does not relax, no linear peristalsis)
BIRDS BEAK on esophagram (dilated eso, narrow LES)
EGD/CT to rule out cancer
Absence of ganglia in distal eso and LES

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15
Q

Achalasia

Treatment

A

Dilate LES with BALLOON (1-2% perforation rate)
Surgical myotomy
Oral nitrates, CCBs, Botox into LES

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16
Q

Diffuse Esophageal Spasm (Info/Pres)

A

Uncoordinated contraction of esophagus body - dysphagia
May be post-prandial, related to swallowing, med side effect
CAN MIMIC ANGINA

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17
Q

Diffuse Esophageal Spasm (Diagnx/treat)

A

Manometry

Give nitrates/anticholinegics

18
Q

Nutcracker Esophagus

A

Unknown cause: high pressure, peristaltic contraction in esophageal body
Intermittent chest pain and dysphagia
Diagnx with manometry

19
Q

Scleroderma (info/pres)

A

Multisystem, FIBROSIS OF MANY ORGANS

High incidence of stricture, GERD, dysphagia due to wek peristalsis, heartburn Extra-GI symptoms

20
Q

Scleroderma (Diagnx/Treat)

A

Manometry
PRINCIPAL PATH is SM atrophy and gut wall FIBROSIS
Treat with PPIs

21
Q

Chemical Injury

A

Corrosive, PILL ESOPHAGITIS ( pill stuck –> inlf, NSAIDs, K supplements), reflux esophagitis
Pres: ODYNOPHAGIA, +/- dysphagia
Diagnx: H&P, +/- endoscopy
Treat: discontinue offending agent (underlying cause)

22
Q

INFX

Herpes

A 
Usually immunocompromised
Pres: PAIN WITH SWALLOWING (odynophagia), dysphagia, GI bleen
Diagnx: endoscopy: PUNCHED OUT ULCERS
Hist: INTRANUCLEAR VIRAL INCLUSION
Treat: Antivirals
23
Q

INFX

Candida

A

Most frequent, also immunocompromised
Pres: Odynophagia, +/- dysphagia, or asymptomatic
Diagnx: endoscopy: WHITE PLAQUES, fibrinopurulent exudate
Hist: PSEUDOHYPHAE, budding yeast in tissue (special stains GMS, PAS)
Treat: Antifungals

24
Q

INFX

CMV

A

Immunocomprimised, usu in combo with candida
Pres: Odynoophagia, +/- dysphagia, GI bleeding
Diagnx: endoscopy: punched out ulcers in distal eso
Hist: CYTO and NUCLEOMEGALY, intraCYTOPLASMIC inclusions
Treat: antiviral

25
Q

Eosinophilic Esophagitis (cause/info/pres)

A

Caused by eosinophilic infiltrate, diffuse narrowing of esophagus, MALES,

26
Q

Eosinophilic Esophagitis (diagnx/treat)

A

Endoscopy: concentric rings, burrows, nodular plaques and exudates
Biopsy: diffuse sheet of eosinophils, frequent degranulated forms (dust, microabscesses), MID-ESOPHAGUS
Treat: TOPICAL STEROIDS (oral spray), dilation may be necessary, endoscopic removal of bolus, no response to anti-reflux tx

27
Q

Barrett’s Esophagus (cause/risks/pres)

A

consequence of GERD (F, decreased LES resting pressure, smoking obesity
Increasing in prevalence
Pres: USUALLY ASYMPTOMATIC OR HEARTBURN

28
Q

Barrett’s Esophagus (Diagnx/treat)

A

METAPLASIA (squamous–>glandular containing columnar (goblet) epithelium) this is an effort of the esophagus to protect itself rorm acid
Salmon colored patch on endoscopy
Alcian BLUE stain highlights GOBLET cells (no goblet cells in stomach)
Treat: GERD treatment, also increase screening

29
Q

Benign Strictures

A

Minority of pts with reflux eso get peptic stricture of distal eso (due to fibrosis from relfux)
PRES: SOLID FOOD DYSPHAGIA
Diagnx: EGD (biopsy to rule out cancer and tx dilation)
Treat: GERD treatment, also with EGD dilation

30
Q

Mucosal (“Schatzki”) Rings

A

congenital esophageal rings –> narrow lumen and cause infl (similar to benign stricture)
Pres: dysphagia
Diagnx: EGD
Treat: EGD dilation

31
Q

Esophageal Perforation

A

after profound retching/vomiting, esp EtOH or malnourished, can be complication of surgery procedure
Pres: upper GI bleed, high morbidity/mortality
Diagnx: EGD
Treat: urgent stent/surgical intervention

32
Q

Mallory-Weiss Tear

A

linear superficial tear esp in alcoholics

33
Q

Esophageal Cancer

A

4% of cancer deaths in men (not top 10 in women)

Pres: dysphagia, weight loss, no symptoms until advanced dz, rarer: bloody vomit, chest pain, anemia

34
Q

Adenocarcinoma

A

Risk with GERD/Barretts, more than half of all eso cancers, more common in elderly, Caucasian, mean
Pres: solid food dysphagia, weight loss
Diagnx: EGD, DISTAL eso, big bulky tumor with GLANDS
Treat: RESECTION if early, also CHEMO/radiation and metal STENT placement

35
Q

Squamous Cell Carcinoma

A

Risks: smoking, EtOH, casutic injury (hot tea), hx of head & neck cancer, mean age 65, poor oral health/poverty
Pres: eso stricture–> dysphagia, weight loss
Diagnx: UPPER/MID eso (50-60%), more ulcerative tumor, NO glands
Treat: RESECTION if early, also CHEMO/radiation and metal STENT placement

36
Q

Other cancers

A

Malignant: neuroendocrine (carcinoud), GISTS, lymphomas, metastases
Benign: leiomyomas, hemangiomas, lymphangiomas

37
Q

Oropharynx (involved in …/phases …)

A 
Swallowing (deglutition)
Normal = 600x /day
Oral phase (voluntary): biting,licking, chewing, initiation of swallow
Pharyngeal phase (involuntary): once bolus gets to posterior 1/3 of tongue, pharnyx contracts and changes shape (hyoid/larynx up and anterior), UES relaxes, soft palate elevates to close nasopharynx and protect airway
38
Q

Esophagus (upper & lower)

A

Upper 1/3 is skeletal muscle, lower 1/3 is smooth (middle is mixed)
BUT ENTIRE ACTION OF ESOPHAGUS IS INVOLUNTARY

39
Q

Work Up Protocol

Dysphagia

A

coughing, aspiration, sitting up food
suspect neuromuscular dz, benign obstruction or neoplasia
BARIUM SWALLOW

40
Q

Work Up Protocol

Esophageal Motility Dysfunction

A

pain and/or dysphagia
suspect GERD, achalasia, diffuse esophageal spasm, nutcracker esophagus
MANOMETRY (and pH study for GERD)

41
Q

Work Up Protocol

Benign Structural Disorder

A

painless +/- solid food dysphagia
suspect strictures, eosinophilic esophagitis, prior trauma
ENDOSCOPY (EGD)

42
Q

Work Up Protocol

Neoplasia

A

Painless +/- solid food dysphagia + cancer sx
suspect esophageal cancer
ENDOSCOPY and BIOPSY

DEMS 1 (16 decks)

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