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GINME > Week 2: Dysphagia > Flashcards

Week 2: Dysphagia Flashcards

1
Q

Types of dysphagia

3 listed

A
  • Mechanical
  • dysmotility
  • or both
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2
Q

How long is the esophagus?

A

20-22 cm long muscular tube

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3
Q

Which muscular layer is most superficial?

A

outer longitudinal layer

Inner circular layer

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4
Q

Categories of causes of oropharyngeal dysphagia

A

Neuromuscular or Structural causes

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5
Q

Neuromuscular causes of oropharyngeal dysphagia

8 listed

A
  • CVA/stroke
  • ALS
  • Brain tumor
  • Poliomyelitis
  • Myasthenia gravis
  • Muscular dystrophies
  • Polymyositis and dermatomyositis
  • UES dysfunction
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6
Q

Structural causes of oropharyngeal dysphagia

A
  • Pharyngitis
  • Radiation injury
  • Cervical osteophyte
  • Head and Neck cancer
  • Thyromegaly/Goiter
  • Zencker’s diverticulum
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7
Q

What is dysphagia?

A

Symptoms that result from the slowing or cessation of a food or liquid bolus passing through the esophagus

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8
Q

nervous structure of the esophagus

A

Myenteric plexus

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9
Q

Oropharyngeal dysphagia presentation

8 listed

A
  • Difficulty initiating swallow
  • Double swallowing
  • Drooling
  • Cough, choking sensation “Can’t breathe”
  • Nasal regurgitation
  • Aspiration -> Pneumonia
  • Dysarthria and voice changes/weakness
  • Localization in throat or high neck
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10
Q

Categories of causes of Esophageal dysphagia

A

Structural

motility

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11
Q

Structural causes of Esophageal dysphagia

7 listed

A

Benign stricture

GERD

Eosinophilic esophagitis

Infectious esophagitis

Foreign bodies

Extrinsic compression

Esophageal CA

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12
Q

Motility causes of Esophageal dysphagia

5 listed

A
  • Achalasia disorders
  • Scleroderma
  • Esophageal spastic disorders
  • Chagas disease
  • Non-relaxing lower esophageal sphincter
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13
Q

Presentation of Esophageal dysphagia

4 listed

A
  • Food sticking retrosternally
  • Regurgitation or vomiting
  • Chest pain
  • Localization at sternal notch or below
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14
Q

Associated symptoms of dysphagia

6 listed

A
  • Slow eating
  • careful eating
  • Sips of beverage with solid food bolus
  • Walking around while eating
  • Avoiding restaurants and social meals
  • Restricted diet
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15
Q

Causes of sudden mechanical Dysphagia

A
  • Foreign body
  • Eosinophilic esophagitis
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16
Q

Causes of intermittent mechanical Dysphagia

A
  • Schatzki’s ring (reflux driven obstruction)
  • Webs (fibrous strands)
  • Ext. Compression (Mass or vascular structure)
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17
Q

Causes of progressive mechanical Dysphagia < 50 years old

A
  • Heartburn
  • GERD Stricture
  • Caustic, med-induced, radiation
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18
Q

Causes of progressive mechanical Dysphagia > 50 years old

A

Carcinoma

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19
Q

Overview of historical causes of mechanical obstruction dysphagia

A
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20
Q

Causes of recent neuromuscular or infectious dysphagia

A
  • Immunosuppression
  • Antibiotics
  • HIV infection
  • Candida
  • CMV
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21
Q

Causes of intermittent neuromuscular or infectious dysphagia

A

Chest pain?

Motility disorder

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22
Q

Causes of progressive neuromuscular or infectious dysphagia

A
  • Achalasia
  • Scleroderma
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23
Q

Overview of historical causes of neuromuscular or infectious dysphagia

A
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24
Q

Physical exam for dysphagia

A
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25
Q

Types of tests for dysphagia

A
  • Barium swallow
  • Endoscopy
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26
Q

Barium swallow capabilities for dysphagia

A
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27
Q

Endoscopy capabilities for dysphagia

A
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28
Q

Describe diffuse esophageal spasm via barium swallow

A

spastic “Corkscrew appearance”

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29
Q

Describe eosinophilc esophagitis via barium swallow

A

corrugated appearance from furrows that form from the scarring from eosinophilic infiltration

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30
Q

What is depicted by barium swallow?

A

Diffuse Esophageal Spasm

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31
Q

What is depicted by barium swallow?

A

Eosinophilic Esophagitis

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32
Q

Describe esophagitis via endoscopy

A

breaks in mucosa (represents esophageal injury

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33
Q

What is depicted via endoscopy?

A

Achalasia

34
Q

What is depicted via endoscopy?

A

Adeno Carcinoma

35
Q

What is depicted via endoscopy?

A

Candida

36
Q

What is depicted via endoscopy?

A

Esophagitis

37
Q

What is depicted via endoscopy?

A

Schatzki ring

38
Q

What is depicted via endoscopy?

A

Peptic stricture

39
Q

What is depicted via endoscopy?

A

Diffuse Esophageal spasm

40
Q

What is depicted via endoscopy?

A

Eosinophilic Esophagitis

41
Q

Describe peptic stricture via endoscopy

A

scarred down

needs to be dilated or stretched out

42
Q

Describe Schatzski ring via endoscopy

A

doesnt expand any further

can be broken up by biopsy cuts to open it up

43
Q

Describe adenocarcinoma via endoscopy

A

lumen is narrowed by neoplasm

44
Q

Describe Candida via endoscopy

A

growth of fungus

45
Q

Describe eosinophilic esophagitis via endoscopy

A

corrugated rings or could be linear corrugation

46
Q

Describe achalasia via endoscopy

A

the sphincter is super tight

47
Q

Describe Diffuse eosphageal spasm via endoscopy

A

“corkscrew” spasming

48
Q

Approach to dysphagia

A
49
Q

What is a high-resolution manometry catheter?

A

basically an EKG of esophagus

50
Q

High-resolution manometry catheter data

A
51
Q

Normal swallow under High-resolution manometry catheter

A
52
Q

Describe Achalasia by barium swallow

A
53
Q

HRM AKA

A

High-resolution manometry catheter

54
Q

HRM of type II Achalasia

A

Failure of LES to relax

55
Q

Subtypes of achalasia

A
56
Q

Upper endoscopy of Achalasia

A
57
Q

Describe Type I Achalasia HRM

A

Absent peristalsis

No peristaltic waves, no movement

58
Q

Describe Type II Achalasia HRM

A

Panesophageal pressurizations occur after a swallow but could keep going

59
Q

Describe Type III Achalasia HRM

A

Hypercontraction but not a productive peristaltic spasm

food still gets trapped and patient still feels bolus stuck

60
Q

Why does achalasia occur?

A
  • Loss of myenteric neurons such as by immune-mediated neuronal death
  • Imbalance between excitatory and inhibitory forces
61
Q

Describe achalasia by loss of myenteric neurons

A
62
Q

Describe achalasia by excitatory/inhibitory imbalance

A
63
Q

Achalasia type I causation

A

loss of myenteric nerves

64
Q

Achalasia type II causation

A

Loss of myenteric neurons

65
Q

Achalasia type III causation

A

Excitatory/inhibitory force imbalance

66
Q

Pharmacological therapy of Achalasia

A

(botox is kind of the go to)

67
Q

Surgical interventions of achalasia

A
  • Pneumatic dilation (balloon)
  • Heller Myotomy (cut the circular muscle fibers)
68
Q

Response rates of achalasia treatments

A
69
Q

POEM for achalasia

A
70
Q

POEM outcomes

A
71
Q

Achalasia means?

A

“Failure to relax”

72
Q

The predominant feature of achalasia

A

poorly relaxing LES

73
Q

Symptoms of Achalasia

A
  • Dysphagia
  • Regurgitation
  • Heatburn
  • CP
  • Cough
  • Choking
  • Aspiration pneumonia
  • Weight loss
74
Q

Achalasia Manometric abnormalities

A
  • Abnormal LES residual pressure
  • No normal peristalsis
75
Q

Is achalasia ever cured?

What treatments are there?

A

Never cured and treatment is aimed at reducing the pressure across the LES

  • Pneumatic dilation
  • Heller Myotomy
  • POEM
  • Botox, CCB, nitrates
76
Q

What is pseudoachalasia?

A
77
Q

Dysphagia workup pathway

A
78
Q

What is the patient’s diagnosis?

A

Pseudoachalasia

79
Q

Is this achalasia

A
80
Q

EGD pseudoachalasia

A

GINME (63 decks)

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