Week 5 - Esophageal Disorders Flashcards
list 3 types of esophageal disorders
- gastroesophageal reflux disease (GERD)
- hiatal hernia
- esophageal cancer
what is GERD
- a condition where gastric contents move into the esophagus, creating the sensation of heartburn and/or esophagitis
what kind of cells line the esophagus? what does this allow?
- stratified squamous
- protects against friction
what kind of epithelial cells line the stomach?
- simple columnar epithelium
what is the lower esophageal sphincter
- bundle of muscles at the lower end of the esophagus, where it meets the stomach
what is the function of the lower esophageal sphincter
- opens to allow food & drink to pass into the stomach from the mouth
- then closes to keep those contents inside the stomach for digestion
what happens if the LES is damaged
- it becomes weak & relaxes = stomach acids & its contents flow back into the esophagus
what are the 2 parts of the lower external sphincter? what kind of muscle makes up each?
- internal = smooth muscle
- external = skeletal muscle
what is important about the external & internal LES
- must line up so they can work together and create enough pressure to close the esophagus
list 6 causes of GERD
- weak or incompetent LES
- hiatal hernia
- decreased esophageal peristalsis
- decreased saliva function
- increased gastric acid production
- delayed stomach emptying
what pressure should the LES normally exert? at what point does the pressure become not enough to keep it closed?
- normal = 10-30
- <10 = too weak
how does decreased esophageal peristalsis cause GERD
- it wont push stuff down
how does decreased saliva function cause GERD
- get decreased flushing effect of the salivia = won’t push down what comes up
how does increased gastric acid production or delayed stomach emptying cause GERD
= overwhelms LES
what are the 2 categories of symptoms that occurs with GERD
- heartburn
2. respiratory symptoms
what is heart burn? where can it radiate to?
- retrosternal or epigastric pain that can radiate to the throat, shoulder, or back
what is heartburn often confused w
- angina
what makes heartburn worse (3)
- occurs 30-60 min after eating
- worse w bending at the waist
- recumbency
why does recumbency and bending at the waist make heart burn worse?
- no longer get the help of gravity to push the contents down
what respiratory symptoms occur with heartburn (4)
- aspiration of gastric contents =
- coughing, wheezing, and hoarseness
what respiratory symptoms occur with heartburn (4)
- aspiration of gastric contents =
- coughing, wheezing, and hoarseness
list 4 chronic complications of GERD
- esophageal stricture
- barrett’s esophagus
- hiatal hernia
- hemorrhage and ulcerations
what is esophageal stricture
- narrowing of the esophagus
what causes esophageal stricture
- scar tissue formation
- spasm
- edema
what does esophageal stricture lead to (4)
- futher reflux (bc scar tissue prevents it from fully closing)
- dysphagia (bc difficult to swallow)
- obstruction
- perforation
what % of people w esophagitis develop stricture?
10
what is barrett’s esophagus
- replacement of esophageal stratified squamous epithelium with simple columnar epithelium so it resembles the stomach and intestine
what causes barrett’s esophagus
- the acid kills the stratified squamous epithelium
what % of patients with Barrett’s develop esophageal cancer
10
what is the hiatus
- the opening of the diaphragm
- basically it is the hole that the esophagus passes thru
what is the hiatus normally like? what is it like during a hiatal hernia
- normally v tight, so that contents of the stomach cannot go up
- during a hiatal hernia, the hiatus dilates
what is a hiatal hernia
- herniation of a portion of the stomach into the esophagus thru the hiatus (opening of the diaphragm)
what does a hiatal hernia cause
- GERD
what are 2 types of hiatal hernias
- sliding
2. rolling
what is the gastro-esophageal junction
- point where the esophagus ends and the stomach begins
what is a sliding hiatal hernia
- where the gastro-esophageal junction slides above the hiatus of the diaphragm & part of the stomach slides into the hiatal opening
what is a rolling hiatal hernia
- the fundus (top) of the stomach rolls up thru the hiatus, but the gastro-esophageal junction remains in place
describe the treatment for GERD (7)
- avoid large meals
- avoid foods that relax LES
- sitting upright
- drink fluids
- antacids
- inhibit gastric acid production
- surgery
list 4 foods that relax LES
- alcohol
- caffeine
- nicotine
- fat
why is sitting upright a treatment for GERD
- get help from gravity to push the stomach contents down
why is drinking fluids a treatment for GERD
- flushes the esophagus clean
when might surgery be done for GERD (2)
- if severe or unresponsive cases
