Week 7 (Esophagus and Eosinophilic GI Diseases) Flashcards
1
Q
What is the primary function of the esophagus?
A
Transport food bolus from mouth to stomach and prevent retrograde flow of GI contents
Includes protecting the host from macronutrients until they are broken down
2
Q
What does LES stand for?
A
Lower Esophageal Sphincter
3
Q
What does UES stand for?
A
Upper Esophageal Sphincter
4
Q
What is the length and width of the esophagus?
A
18-26 cm long and 2-3 cm wide
5
Q
Where does the esophagus originate and terminate?
A
Originates at cricoid cartilage and terminates below the hiatus in the right crura of the diaphragm
6
Q
What type of muscle predominates in the upper esophagus?
A
Skeletal muscle
7
Q
What type of muscle predominates in the distal esophagus?
A
Smooth muscle
8
Q
What are the two layers of esophageal tissue?
A
Circular and longitudinal muscle layers
9
Q
What is the thickness of the circular muscle layer at the diaphragmatic hiatus?
A
2-4 cm
10
Q
What is the role of the vagus nerve in esophageal function?
A
Regulates peristalsis via the parasympathetic pathway
11
Q
What type of nervous system controls esophageal function?
A
Parasympathetic and sympathetic
12
Q
What is the mechanism and control of esophageal function described as?
A
Complex due to intricate neural coordination
13
Q
What are the objectives of studying esophageal function?
A
Structure/Function, Normal Physiology of Swallowing, Esophageal Dysfunction, Testing, Diseases and Management
14
Q
What are the phases of swallowing?
A
Preparatory phase, Transfer phase, Deglutition reflex, Esophageal phase
15
Q
What is primary peristalsis?
A
The initial wave of muscle contractions that moves food down the esophagus
16
Q
What is degultitive inhibition?
A
Inhibition of peristalsis during swallowing
17
Q
Which cranial nerves are involved in swallowing?
A
V, VII, IX, X, XII
18
Q
What occurs in the oral/pharyngeal phase of swallowing?
A
All activities occur within oral cavity
This phase includes preparatory and transfer phases.
19
Q
What is the role of the Upper Esophageal Sphincter (UES)?
A
Juncture of hypopharynx and cervical esophagus
UES opening allows orthograde/antegrade (swallowing) movement.
20
Q
What type of movement occurs when the UES opens?
A
Orthograde/antegrade movement
This refers to the swallowing process.
21
Q
What is primary peristalsis?
A
Movement of food bolus down the esophagus
It is a reflexive action initiated during swallowing.
22
Q
What inhibits a progressing peristaltic wave during swallowing?
A
Deglutitive inhibition
This occurs when another swallow is initiated.
23
Q
What precedes peristaltic contractions?
A
Inhibition
Peristaltic contractions are always preceded by inhibition.
24
Q
What is the role of central mechanisms in swallowing?
A
Involves sequential activation of excitatory activity of lower motor neurons in the vagal nucleus ambiguus
This is crucial for swallowing activity.
25
What type of muscle is involved in esophageal peristalsis?
Esophageal smooth muscle
## Footnote
This involves patterned activation of preganglionic neurons.
26
What is the composition of the esophagogastric junction (EGJ) high pressure zone?
Lower esophageal sphincter, crural diaphragm, proximal gastric cardia
## Footnote
This zone is important for preventing reflux.
27
What must progressing peristaltic waves do at the EGJ?
Advance the food bolus into the stomach
## Footnote
This is crucial for successful swallowing.
28
What helps prevent reflux of gastric contents into the esophagus?
Normal resting LES tone
## Footnote
LES refers to the lower esophageal sphincter.
29
What is dysphagia?
Difficulty swallowing
## Footnote
It is one of the common esophageal symptoms.
30
What is regurgitation?
Effortless appearance of gastroesophageal contents into mouth
## Footnote
This symptom can indicate esophageal issues.
31
What is odynophagia?
Pain with swallowing
## Footnote
This condition is often alarming and requires attention.
32
What does heartburn refer to?
Burning retrosternal discomfort
## Footnote
It is a common symptom of esophageal dysfunction.
33
What is globus?
Lump in throat sensation
## Footnote
It can be a symptom of esophageal issues.
34
What are warning signs that necessitate prompt endoscopy?
Dysphagia, odynophagia, GI bleeding/melena, weight loss
## Footnote
These symptoms may indicate serious underlying conditions.
35
What is esophageal motility disorder?
When the normal neuromuscular coordination is disrupted causing symptoms such as dysphagia, chest pain, reflux, regurgitation, or heartburn.
36
What are the two types of esophageal dysfunction?
* Structurally blocking
* Functionally (motor) blocking
37
What determines the direction and vigor of esophageal contractions?
Regional differences in the density of the inhibitory and excitatory neurons.
38
What can modulate the pathogenesis of esophageal motor disorders?
Variable smooth muscle response to the same quantum of neurotransmitter.
39
List some structural oropharyngeal disorders.
* Malignancy
* Spinal osteophytes
* Zenker’s diverticulum
* Proximal strictures, rings, or webs
* Radiation injury
* Oropharynx infection
* Thyroid enlargement
40
What are some neuromuscular (systemic) disorders that can affect esophageal function?
* Cerebral vascular accident
* Multiple sclerosis
* Parkinson’s disease
* Myasthenia gravis
* Amyotrophic lateral sclerosis
* Muscular dystrophy
* Dermatomyositis
* Thyroid disorders
41
What is oropharyngeal dysphagia?
Dysphagia that occurs pre/intra-gulp.
42
List some structural esophageal disorders.
* Eosinophilic esophagitis
* Esophageal (Schatzki) ring or webs
* Peptic stricture
* Malignancy
* Radiation or medication induced strictures
* Foreign body
* Vascular compression (dysphagia lusoria)
* Mediastinal mass / external compression
43
What are some motility esophageal disorders?
* Achalasia and EGJ outflow obstruction
* Absent contractility
* Distal esophageal spasm
* Hypercontractile esophagus
* Minor disorders of peristalsis
* Scleroderma
* Gastroesophageal reflux disease
* Chaga’s disease
44
What are the objectives of studying esophageal dysfunction?
* Structure / Function
* Normal Physiology of Swallowing
* Esophageal Dysfunction – symptoms and causes
* Testing (EGD, Barium, Manometry)
* Diseases and Management
45
What tests are used in the evaluation of esophageal symptoms?
* Radiologic
* Cookie swallow / modified Ba swallow
* Barium swallow / esophagram
* Endoscopy
* Esophageal Manometry
* Ambulatory pH
* Impedance testing
* EndoFLIP
* Modified Barium (Cookie) Swallow
46
What are common dysfunction symptoms?
* Inability to initiate
* Aspiration
* Nasal regurgitation
* Pharyngeal residue
47
What is the purpose of a barium esophagram?
To evaluate both structural and motor function.
48
True or False: Esophageal manometry is used to evaluate only the structural aspect of the esophagus.
False.
49
Fill in the blank: _______ is a condition characterized by difficulty swallowing due to structural or functional issues.
Dysphagia
50
What is Barium used for in medical imaging?
Barium is used as a contrast agent in various imaging studies, particularly in esophagrams.
51
What does an Esophagram assess?
An Esophagram assesses the structure and function of the esophagus.
52
What does 'Normal' indicate in medical imaging results?
Normal indicates that no abnormalities were found in the imaging study.
53
What is a Hiatal Hernia?
A Hiatal Hernia is a condition where part of the stomach pushes through the diaphragm into the chest cavity.
54
What is Zenker’s Diverticulum?
Zenker’s Diverticulum is a pharyngeal diverticulum that occurs above the upper esophageal sphincter.
55
What does EGD stand for?
EGD stands for Esophagogastroduodenoscopy.
56
What is the purpose of Diagnostic procedures?
Diagnostic procedures are used to identify and evaluate medical conditions.
57
What are mucosal biopsies?
Mucosal biopsies are tissue samples taken from the mucous membrane for examination.
58
What does it mean to Resect in a medical context?
Resect means to surgically remove a portion of tissue or an organ.
59
What is Cytology?
Cytology is the study of cells, often used to diagnose diseases.
60
What is the role of Imaging in medicine?
Imaging provides visual representations of the interior of a body for diagnostic purposes.
61
What does Therapeutic refer to?
Therapeutic refers to treatments aimed at curing or alleviating symptoms of a disease.
62
What does Dilation involve?
Dilation involves widening an anatomical structure, often used in procedures to treat strictures.
63
What is Injection in a medical procedure?
Injection is the act of administering a substance into the body using a syringe.
64
What is a Stent?
A stent is a tube inserted into a vessel or duct to keep it open.
65
What does Ultrathin refer to in medical instruments?
Ultrathin refers to instruments that are exceptionally thin, often used in delicate procedures.
66
What is meant by Pediatric in a medical context?
Pediatric refers to the branch of medicine that deals with the medical care of infants, children, and adolescents.
67
What is an EGD with pH monitoring (BRAVO) placement?
pH testing via 24hour nasoesophageal catheter
Also measures impedance; help look at acid reflux
68
What does high resolution esophageal manometry measure?
Esophageal pressures and contractions along the length of a flexible catheter
69
How is pressure data presented in high resolution esophageal manometry?
In the context of esophageal pressure topography
70
What is EndoFLIP® used for?
Measures impedance planimetry (the distensibility of esophagus)
71
In which patient population is manometry particularly difficult?
Pediatrics
72
What are the common symptoms of esophageal dysfunction?
Dysphagia, heartburn, food impactions
73
What is eosinophilic esophagitis (EoE)?
A chronic, likely food antigen-mediated allergic disease of the esophagus
74
What histological feature characterizes eosinophilic esophagitis?
Presence of esophageal eosinophils
75
In a normal esophagus, what is the status of eosinophils?
Absent
76
What environmental factors are mentioned to impact eosinophilic esophagitis?
Host genetics
77
What is the efficacy of omeprazole in treating eosinophilic esophagitis?
~30-50% effective
78
What is the effectiveness of topical steroids for eosinophilic esophagitis?
~70%+ effective
79
How soon can improvement be seen with topical steroids in eosinophilic esophagitis?
As early as 2 weeks
80
What is the typical recurrence time for eosinophilic esophagitis symptoms off therapy?
Usually by 3 months
81
What percentage of patients experience improvement from elimination diets?
40-70% effective
82
What are the most common dietary triggers for eosinophilic esophagitis?
* Dairy
* Wheat/gluten
83
What is the mechanism of action of Dupilumab?
Blocks IL-4 and IL-13
84
What other allergic diseases is Dupilumab important for?
* Asthma
* Atopic dermatitis
* Seasonal allergies
85
What is the proposed pathophysiology of eosinophilic esophagitis according to Amiko Uchida, MD?
Involves eosinophils, Type 2 cytokines, and inflammation
86
What is a common issue noted in follow-up for eosinophilic esophagitis patients?
Large numbers lost to close follow-up (50+%)
87
Fill in the blank: Eosinophilic esophagitis is characterized clinically by _______.
dysphagia, heartburn, and food impactions
88
True or False: Eosinophils are present in a normal esophagus.
False
89
What are dilations in EoE often characterized as?
Planar
## Footnote
EoE stands for eosinophilic esophagitis.
90
In the management of EoE, what should be controlled concomitantly with dilations?
Inflammation
91
What is a Zenker’s diverticulum?
Outpouching of the posterior hypopharyngeal wall
92
What symptoms are associated with a Zenker’s diverticulum?
* Dysphagia
* Regurgitation
* Halitosis
93
What surgical interventions are associated with Zenker’s diverticulum?
* Myotomy
* Diverticulectomy
94
Name some causes of esophagitis.
* Reflux
* Alcohol
* Toxins
95
What is the annual incidence of achalasia worldwide?
~1/100,000
96
What is the estimated prevalence of achalasia?
~9-10/100,000
97
What significant association does achalasia have?
Increased association with eosinophilic esophagitis
98
What is the primary goal in the management of achalasia?
Early diagnosis to prevent late complications
99
What is the pathophysiology of achalasia?
Unopposed cholinergic stimulation resulting in impaired LES relaxation
100
What are the types of achalasia?
* Type I
* Type II
* Type III
101
What is the primary treatment for achalasia?
Myotomy
102
What are the surgical options for treating achalasia?
* Laparoscopic Heller
* Endoscopic myotomy
103
What technique is used in Per Oral Endoscopic Myotomy (POEM)?
Access to submucosal space and myotomy with a needle knife
104
What exacerbating factors can affect gastroesophageal reflux?
* Increased abdominal pressure
* Fatty foods
* Alcohol
* Smoking
* Large meals
105
What lifestyle changes can help manage gastroesophageal reflux?
* Weight loss
* HOB 30 degrees
* Avoid trigger foods
106
What acid reduction therapies are associated with gastroesophageal reflux management?
* PPI
* H2 blockers
* PCAB
107
What findings were noted in patient JG's EGD?
* Edema
* Rings
* Exudates
* Furrows
* Stricture
108
What is the overarching conclusion about the esophagus from the summary?
Esophagus is more than a conduit
109
What are key diagnostic tools for esophageal dysfunction?
* Endoscopy
* Imaging
110
True or False: Individualized approaches are needed for the management of EoE and achalasia.
True
