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Flashcards in ICR: Dysphagia Deck (30)
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1

dysphagia

difficulty swallowing

2

odynophagia

act of swallowing that induces pain
secondary to mucosal injury/inflammation
-drooling for fear of swallowing saliva
can be infectious or noninfectious

3

GERD

gastroesophageal reflux; reflux of gastric contents up the esophagus; decreased LES pressure
transient relaxations
hiatal hernia
symptoms --> heartburn, chest pain, salivation, halitosis, dysphagia, asthma, chronic cough, hoarsness, aspiration pneumonia, sore throat
signs - dental enamel erosion, barium swallow, endoscopy, manometry (pressure), pH monitoring
responds to PPI --> have to take on empty stomach before you eat

4

upper 1/3 esophagus is...

striated muscle --> skeletal muscle disorders (als, ms, parkinsons, etc)

5

lower 2/3 esophagus is...

smooth muscle --> smooth muscle disorders (scleroderma)

6

UES

cricopharyngeal sphincter
error --> liquid through nose

7

LES

lower esophageal sphincter
high pressure zone that prevents gastric reflux

8

esophageal vs gastric mucosa

e - stratified squamous
g - non ciliated columnar w goblet cells
split by GE junction

9

to prevent aspiration ...

larynx moves upward and forward and bolus goes through piriform rescess

10

two dysphagia types

oropharyngeal and esophageal

11

oropharyngeal type of dysphagia

(transfer dysphagia)
swallowing mechanism --> problem is muscular or neurologic or neuromuscular, during or immediately after swallow
HARD to swallow liquids (and food)
-->liquid out nose, choking, coughing
localize above suprasternal notch
test = modified barium swallow
treat = thickened diet, excercises, feeding tube, speech pathology

12

esophageal type of dysphagia

(transit dysphagia)
difficulty swallowing after bolus is in esophagus
food gets stuck, can progress to liquid
2-7 sec before dysphagia sensation
hard to localize
discomfort/pain resolves with passing or regurgitation

13

important for history

food types?
intermittent, continuous, or progressive?
location?
timing?
onset?
other symptoms? -- heartburn, regurge, etc
associated symptoms? -- sore through, cough, etc
medical hx and risks? -- alc/tobacco/caustic ingestion, meds, surgeries, allergies

14

a) alcohol/tobacco use / weightloss-->
b) caustic ingestion -->
c) meds -->
d) surgeries -->
e) allergies -->

a esophageal cancer
b esophageal stricture
c caustic/burn injury
d tracheo-esophageal fistula repair --> stricture
e eosinophilic esophagitis

15

main infection of esophagus (ESOPHAGITIS)? -- dysphagia and odonyphagia

candida albicans
HSV
CMV
IMMUNOCOMPROMISED PPL

16

schatzki's ring

B ring
360 degree web like stricture at GE junction; chronic acid reflux
intermittent solid food dysphagia
related to chronic reflux --> treat w PPI

17

eosinophilic esophagitis (EOE)

intermittent solid food dysphagia
allergic history/young with atopic hx (asthma/exema/rhitis)
findings --> multiple rings(trachealization), linear furrows, narrow esophagus, esophageal strictures, 15 eosinophils per frame
NOT responsive to PPI
treat with elemental (restrictive) diets
or meds --> fluticasone

18

benign esophageal tumor

intermittent solid food disorder
leiomyoma

19

heart condition that can cause intermittent dysphagia?

vascular extrinsic compression on aorta

20

inflammatory condtion that can cause intermittent dysphagia?

sarcoid

21

two types of progressive food dysphagias

benign peptic strictures - secondary to GERD, progressive from reflux, >1yr

malignant esophageal strictures - progresses slowly to liquid dysphagia; weight loss

22

achalasia

HYPERTONIC LES; lack of or incomplete LES relaxation
loss of esophageal peristalsis; normal or increased LES pressure (normal is 10-25 mmHg)
ganglion cell destruction is the cause
"bird beak sign"
esophageal body dilation on barium swallow

23

diffuse esophageal spasm

increase of/longer duration of peristalsis/non-peristalsis contractions
severe chest pain
intensifies with fast eating and stress

24

scleroderma

HYPOTONIA LES; loss of LES pressure and absent peristalsis on lower smooth muscle due to prolonged gastric acid exposure
severe GERD
often strictures and Barretts are present; usually women

25

chagas disease

caused by trypanosoma cruzi --> invades ganglion cells
similar to achalasia (loss of LES relaxation)
travelers and immigrants (central/south america)
may have megacolon, CHF, or megaureters

26

infectious adynophagia

immunocompromised individuals
CMV, candida, and HSV

27

noninfectious odynophagia

pill induced --> tetracycline, aspirin, quinidine, vitamic C

caustic injury --> lye

idiopathic esophageal ulceration --> with HIV

28

meds for GERD

antacid
alginic acid
H2 receptor antagonists (cimetidine, ranitidine, famotidine)
PPIs (omeprazole, lansoprazole)

29

when to take PPI

for GERD, before eating to block the proton pumps

30

pseudo achalasia

use imaging to find extrinsic compression on esophagus
not lumenal