Esophageal disorders Flashcards Preview

GI > Esophageal disorders > Flashcards

Flashcards in Esophageal disorders Deck (33)
Loading flashcards...
1
Q

What type of tissue is found in the esophagus, rectum, and remained of the bowel?

A

esophagus & rectum = stratified squamous epithelium

REmainder of bowel is columnar or cubiodal epithelium

2
Q

Esophagus:

  • what are the layers?
  • what are the two types of movement?
  • total length?
A

Inner circular muscle (propulsion of food forward) & outer longitudinal muscle

NO serosa*** this makes it dangerous if there is an infection, for this reason it is known as an unforgiving organ. Cancer will spread very rapidly into the mediastinum.

What are the two types of movement:

  • peristaltic = moves food forward
  • segmental = mixing

18-24cm

3
Q

Etiologies of Dysphagia:

  • in the lumen
  • in the wall
  • outside the wall
  • neuromuscular
A

Lumen: tumor

In Wall:

  • achalsia* (stricture of esophagus & dilation above stricture)
  • tumor *
  • GERD*
  • Plummer Vinson Syndrome (Fe deficiency anemia)
  • Scleroderma (CT disorder)
  • chagas ( parasite, causes heart problems and esophageal dysphagia)

Outside of wall:

  • pressure of enlarged LN***
  • thoracic aortic aneurysm (runs behind and to the left of esophagus)
  • bronchial carcinoma
  • goiter (atopic thyroid tissue not in normal place)

Neuromuscular:

  • MS
  • Stroke
4
Q

Normal phases of swallowing :

  • voluntary
  • involuntary
  • between swallowing
A

Voluntary: oropharyngeal phase- bolus is moved into pharynx

involuntary: UES relaxation, persistalsis, LES relaxation

Between swallowing: UES prevents air entering the esophagus during inspiration and prevents esophagopharyngeal reflux.
-LES prevents gastroesophageal reflux.

5
Q

Sx of esophageal dysfunction

A

pain, obstruction (dysphagia), bleeding

6
Q

Upper Esophageal Motility Disorders:

  • sx
  • etiologies
A

Sx; oropharyngeal dysphagia, difficulty swallowing, tracheal aspiration

etiologies:
- stroke
- parkinsons
- poliomyelitis
- ALS
- MS
- DM
- Myasthenia Gravis
- dermatomyositis and polymyositis

7
Q

Achalasia

  • what is this?
  • etiologies
  • hx findings
  • PE findings
A

incomplete relaxation of LES during swallowing leading to functional obstruction and proximal dilation. Ganglion cells of myenteric plexus(longitudinal muscle) are diminished or absent.

Etiologies:
-may be d/t autoimmune or viral infection b/c on histology they see inflammation.

Hx findings suggestive of achalasia;

  • dysphagia*
  • regurgitation
  • chest pain (retrosternal)
  • heartburn
  • weight loss
  • PNA d/t aspiration

PE is NONCONTRIBUTORY

8
Q

Achalasia:

  • lab studies
  • imaging studies
  • Tx
A

labs:
- noncontributory

Imaging:

  • UGI (Upper GI series) : birds beak
  • EGD(esophagogastroduodenoscopy) : normal or dilated esophagus. normal mucosa color is white/tan
  • Monometry (measures the function of the LES) use pressure catheter
  • barium swallow* Exam of choice! (fluoroscopy)

-Tx:
goal is to relieve sx by eliminating the outflow resistance cause by the hypertensive and non-relaxing LES.

Medical Management;

  • btoulinum toxin
  • Ca2+ channel blocker/smooth muscle dilator (Nifedipine/Isosorbide dinitrate)

Surgical Management;

  • myomectomy
  • balloon dilation of LES.
9
Q

Achalasia:

-MC finding on barium swallow?

A

-Birds beak.

10
Q

Diffuse Esophageal Spasm

  • sx
  • often confused with what other disorder?
A

Sx:

  • chest pain
  • intermittent dysphagia
  • segmental non-peristaltic contractions
  • corkscrew esophagus
  • muscular hypertrophy of esophagus

-often confused with an MI, need to get EKG to differentiate.

11
Q

Nutcracker Esophagus

-what is this?

A

What: high pressure peristaltic contractions. extremely painful b/c there is spasm,… ischemiaessentially of the esophageal muscle, claudication of the esophagus.

12
Q

Esophageal atresia:

  • what is this?
  • why is this dangerous?
  • how can you confirm this?
  • tx
A

what: congenital abnormality in which the mid portion of the esophagus is absent.

Dangerous b/c upper portion comes to a blind end, undigested food being vomitted back up.
Lower portion connects to the distal portion of the trachea, stomach secretions into trachea.

-on plain xray, NG tube will not reach the stomach. There is also absence of gas in the abdomen.

Tx: surgical repair

13
Q

GERD

  • definition
  • Pathophys
  • what are the 4 major physiologic mechanisms protecting against esophageal acid injury?
A

definition: mucosal damage produced by the abnormal reflux of gastric contents into the esophagus.

Patho:
-LES and diaphragm barrier are disrupted and acid is able to leak from the stomach to the esophagus.

4 mechanism:

  • clearance mechanisms
  • mucosal integrity
  • LES competence
  • Gastric emptying
14
Q

GERD

  • sx
  • Extra-esophageal sx
A

Sx:

  • heart burn (pyrosis): substernal burning discomfort
  • regurgitation: bitter, acidic fluid in the mouth when lying down or bending over.

extraesophageal manifestations:

  • Pulmonary: asthma, aspiration pneumonia, chronic bronchitis, pulmonary fibrosis
  • ENT: hoarseness, laryngitis, pharyngitis, chronic cough, globus sensation(feels like something stuck in throat), dysphonia, sinusitis, subglottic stenosis, laryngeal cancer
  • other: chest pain, dental erosion
15
Q

Oral laryngopharyngeal signs assigned with GERD.

A
  • edema and hyperemia of larynx
  • vocal cord erythema, polyps, granulomas, ulcers
  • hyperemia and lymphoid hyperplasia of posterior pharynx
  • interarytenyoid changes
  • dental erosion
  • subglottic stenosis
  • laryngeal cancer
16
Q

Causes of GERD

A
  • hiatal hernia
  • incompetent LES
  • decreased esophagus clearance
  • decreased gastric emptying
  • medications
17
Q

Hiatal Hernia

  • what is it?
  • what are the types?
  • causes
A

What: herniation of a portion of the stomach adjacent to the esophagus through an opening in the diaphragm. (stomach which has slipped above the diaphragm)

Types:

  • sliding; the stomach portion immediately proximal to the LES goes through orifice in the diaphragm
  • paraesophageal/rolling: portion of the stomach “rolls” up through the opening of the diaphragm. Gastroesophageal junction remains fixed.

causes: d/t increases in intra-abdominal pressure
- structural changes
- obesity
- pregnancy
- heavy lifting

18
Q

Hiatal Hernia:

  • how does this cause GERD?
  • complications
  • sx
A

-food lodges in pouch; inflammation of mucosa, reflux of food up to the esophagus. Often incompetent gastro-esophageal sphincter d/t a change in the normal pressure differences of the esophagus and the stomach.

Complications:

  • GERD
  • hemorrhage
  • stenosis of the esophagus
  • ulcerations
  • strangulation of hernia
  • regurgitation
  • increased risk for resp dz.

Sx:

  • asymptomatic
  • heartburn
  • dysphagia
  • reflux with lying down
  • pain, burning when bending over
19
Q

Gerd:

-Tx Lifestyle changes

A

Lifestyle modifications:

  • avoid large meals
  • avoid acidic foods; alcohol, caffeine, chocolate (at night), onion, garlic, peppermint
  • decrease fat intake
  • avoid lying down 3-4hrs after a meal
  • elevated HOB 4-8 inches
  • avoid medications that potentiate GERD (alpha antagonists, theophylline, sedatives, NSAIDS)
  • avoid tight clothing
  • lose weight
  • stop smoking.
20
Q

GERD:

-Medication Tx

A

Antacids

H2 Receptor Antagonists:

  • cimetidine
  • ranitidine (zantac)* safe for pregos
  • Famotidine (Pepcid)
  • Nizatidine

Proton Pump Inhibitors:

  • omeprazole (prevacid)
  • rabeprazole (Aciphex)
  • pantoprazole (Protonix)
  • esomeprazole (Nexium)

Antireflux Surgery

  • reduce hiatal hernia
  • repair diaphragm
  • strengthen GE junction
  • stengthen antireflux barrier via gastric wrap
21
Q

GERD:

-complications; describe each.

A

Complications:
-erosive esophagitis; (erosion d/t acid reflux)

  • stricture (may result from healing esophagus, may require dilation)
  • Barretts esophagus; acid damages lining of esophagus and causes chronic esophagitis, damaged area heals in a metaplastic process and abnormal cells replace the old ones, can progress to dysplasia and adenocarcinoma. (precancerous erosion of mucosa and squamous cells)
22
Q

When to perform diagnostic tests for GERD?

A
  • uncertain of dx
  • atypical sx
  • symptoms associated with complications
  • inadequate response to therapy
  • recurrent sx
23
Q

what are the diagnostic Tests for GERD ? Describe each.

A
  • Barium Swallow : useful 1st test for pts with dysphagia, stricture, mass, birds beak, hiatal hernia
  • Endoscopy:
  • Ambulatory 24hr pH monitoring: NG placed and pH measured for 24hrs.
  • Esophageal manometry: assess LES pressure, location and relaxation
24
Q

Infection-induced esophagitis:

  • etiology
  • whhat is this?
A

Etiology:

  • fungal: candida
  • viruses: herpes and CMV

WHat: inflammation of esophagus k

25
Q

Eosinophilic Esophagitis

  • what is this?
  • tx
A

What: many intraepithelial eosinophils associated with food allergies.

Tx:

  • oral steroid (Fluticasone)
  • 220mcg two puffs a day
26
Q

Esophageal Bleeding, Mallory Weiss Tear:

  • caused from?
  • what is this?
  • sx
  • tx
A

Caused from sever retching and vomiting

WHat: longitudinal tears at the gastroesophageal junction, commonly seen in chronic alcoholics after bout of severe vomiting.

Sx: pain, bleeding, superimposed infection, 75% have hiatal hernia

Tx: most often bleeding stops w/o intervention, though life-threatening hematemesis may occur.

27
Q

Esophageal Bleeding, Esophageal Varices:

  • what is this?
  • cause
  • sx
  • prognosis
A

What: tortuous dilated veins in the submucosa of distal esophagus

Cause:

  • portal HTN 2ndry to liver cirrhosis
  • anything that increases pressure (i.e. coughing can start massive bleed)

Sx:
-asymptomatic until they rupture leading to massive hemorrhage.

Prognosis:
-20-30% die during the first episode, rebleeding occurs in 70% of cases within one year.

28
Q

Esophageal Diverticula

  • what is this?
  • types? andd their sx
  • Tx
A

What: saclike outpouching of one or more layers of the esophagus.

Types:

  • zenkers diverticulum; MC of the esophageal diverticula.
  • -Located above UES
  • -sx: dysphagia, weight loss, regurgitation(lie down it comes back up), chronic cough, aspiration

-Epiphrenic diverticulum:
arises in the distal esophagus just above the diaphragm.

Tx:

  • empty esophagus by applying chest pressure
  • limit foods (blenderize)
  • endoscopic surgery
29
Q

Scleroderma:

-what is this?

A

what: impaired motility of the distal 2/3 smooth muscle, patulous GE junction.

30
Q

Esophageal Perforation:

  • causes
  • prognosis
A

Cause:

  • 75% iatrogenic; endoscopy #1 cause!
  • Boerhaave Syndrome: full thickness rupture of the distal esophagus; ETOH & emesis.
  • repeated forceful vomiting

prognosis: mortality is high, dx is commonly missed/delayed.

31
Q

Esophageal perforation:

-expulsion of the esophageal contents leads to?

A
  • necrotizing mediastinitis and polymicrobial infection leading to shock.
  • pleural/peritoneal space; rapidly progressive infection/shock
  • empyema; pus in chest between pleural space andd lung.
32
Q

Swallowed Foreign Body

-tx

A

Tx: most pass spontaneously, some require intervention; 1% surgical

*know the Heimlich maneuver.

33
Q

if someone has ingested Lye or acid do you need to call 911?

A

yes. risk for perforation.