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Dysphagia: Structure and Neuromuscular Issues 2-21

Terms in this set (22)

define and describe esophageal atresia. what clinical manifestations are associated with it?
often seen with fistulas (tracheoesophageal is most common)
symptoms:
vomiting, regurgitation, or aspiration pneumonia
define and describe Webs. what clinical manifestations are associated with it?
shelf-like protrusions of mucosa into lumen
uncommon
(occur in upper esophagus; not circumferential)
Plummer-Vinsom syndrome (triad of iron deficiency anemia, glossitis, cheilosis [Female > Male, > 40 y/o])
Long-standing GERD
symptoms:
dysphagia
define and describe Rings (Schatzki rings). what clinical manifestations are associated with it?
circumerential and thicker, may include hypertrophied muscularis
occurs in lower esophagus & gastroesophageal junction
symptoms:
dysphagia
define and describe pseudo-diverticula. what clinical manifestations are associated with it?
(lack all wall layers)
increased eophageal wall stress: high amp contractions with poor peristaltic movement (spasms)
can cause mucosal outpouchings (rare)
symptoms:
heartburn, dysphagia
define and describe true diverticula. what clinical manifestations are associated with it?
3 types:
Zenker - paraesophageal, just above upper esophageal sphincter (may be large, store residual food bolus -> regurgitation; mass effect)
Traction - mid esophagus
Epiphrenic; just above the lower esophageal sphincter
symptoms:
heartburn, dysphagia
define and describe Inlet patch. what clinical manifestations are associated with it?
congenital "islands" of ectopic gastric mucosa
most often in cervical esophagus
may resemble intestinal epithelium
Not Barrett's esophagus (unlikely to undergo neoplastic progression)
symptoms:
GERD-like
define and describe Pancreatic heterotopia. what clinical manifestations are associated with it?
pancreatic acinar tissue growing ectopically at the distal esophagus (GE junction)
~16% pediatric endoscopies
define and describe Stenosis. what clinical manifestations are associated with it?
narrowing of the lumen (usually involving fibrosis)
due to radiation, persistent GERD, chemical or thermal injury
symptoms:
resembles an obstruction
define and describe Achalasia. what clinical manifestations are associated with it?
impaired smooth muscle relaxation of lower esophageal sphincter (LES)
(triad: incomplete LES relaxation, increased LES tone, aperistalsis [imbalance/failure of inhibitory neurons])
primary = idiopathic
secondary =
Chagas disease (destroys enteric ganglion cells)
infiltrative disorder (amyloidosis, malignancy, sarcoidosis)
diabetic autonomic neuropathy
polio
treatment:
dilation (balloon), myotomy, Botox
define and describe Sliding hernia. what clinical manifestations are associated with it?
portion of gastric cardia ascends and pushes lower esophagus upward → bell-shaped dilatation
symptoms:
rarely symptomatic - heartburn, regurgitation (medically managed)
define and describe Paraesophageal hernia. what clinical manifestations are associated with it?
less common, more symptomatic
Herniation of portion of gastric fundus alongside esophagus; progressively enlarges
Symptoms:
heartburn, regurgitation (requires surgery)
define and describe the diff causes of esophagitis
several diff mechanisms:
GERD
Eosinophillic/Allergic
Chemical (pill-induced)
Thermal injury
GVHD
Infectious (Candida, CMV, HSV)
Lichen planus
Bullous Dz (pemphigus vulgaris)
Stevens-Johnson syndrome (drug-induced)
define and describe Pill-induced Esophagitis. what clinical manifestations are associated with it?
dysphagia, odynophagia; taken pill just before with little or no fluid and aware of a sensation of the pill being "stuck in the chest."
produces inflammation (with subsequent ulceration and stricture) from the physical contact of drug with mucosa for prolonged periods causing irritation of the mucosa

chemotherapy agents (e.g., Taxol) can cause pronounced mitotic arrest and can result in necrosis and ulceration of mucosa (taxol more pronounced in the esophagus; colchicine more pronounced in the small bowel)
define and describe Eosinophilic Esophagitis. what clinical manifestations are associated with it?
common to all types of esophagitis
true EE is restricted to esophagus, but may be due to systemic eosinophilic process
-epithelial infiltration by lots of eosinophils (esp proximal & mid-esophagus, may or may not have blood eosinophilia)
Rx:
corticosteroids, allergen avoidance
DDx:
GERD (eosinophils only in distal esophagus)
Fungal or parasitic infection
systemic allergic or collagen vascular Dz
define and describe Infectious Esophagitis. what clinical manifestations are associated with it?
usually occurs in immunocompromised pt's (HIV, Chemo, transplant)
Virus or fungi most common
define and describe Herpes Esophagitis. what clinical manifestations are associated with it?
caused by HSV 1, HSV 2 or varicella-zoster virus
Herpetic ulcers may serve as portal of entry for other pathogens (can lead to pneumonitis)
symptoms:
chest pain, odynophagia, upper GI bleeding
define and describe Viral (CMV) Esophagitis. what clinical manifestations are associated with it?
caused by CMV
common in HIV-AIDS pts
multiple, well-circumscribed ulcers (CMV virus seen in nuclei of endothelial cells & fibroblasts, NOT epithelial cells (unlike HSV))
accurate diagnosis important for appropriate viral therapy
(Acyclovir ineffective against CMV)
define and describe Candida Esophagitis. what clinical manifestations are associated with it?
more commonly occurs in HIV-AIDS, transplant, immune-suppressive disorder, or diabetes pt's
(~1/3 HIV pts have candidiasis esophagitis)
Candida organims are part of normal flora of GI tract
Dx: presence of psuedohyphae w/in tissue
Symptoms:
dysphagia, odynophagia (possible asymptomatic)
endoscopy will reveal small white mucosal plaques
Rx:
antifungals
describe how the CD4 counts for AIDS pt's correlates to etiologic agents for esophagitis
>200 HSV, VZV
100-200 Candida, HSV
<100 Candida, CMV, HSV
<50 idiopathic esophageal ulceration
define and describe GERD Esophagitis. what clinical manifestations are associated with it?
most common cause of esophagitis
-caused by reflux of gastric contents into distal esophagus due to decreased competence of Lower Esophageal Sphincter, delayed gastric emptying.
chronic exposure to gastric juices impairs natural reparative capacity of mucosa
etiologic agents:
alcohol, tobacco, CNS depressants, hypothyroidism, pregnancy, hiatal hernia, systemic sclerosis
symptoms:
heartburn, regurgitation, chest pain (may involve bronchospasm/asthma)
how is GERD esophagitis diagnosed and treated?
endoscopy & histology (hyperemic mucosa, erosions, ulceration, inflammatory cells)
emperic treatment (provides relief)
intraesophageal pH monitoring (standard)
Rx:
pharm - H2 receptor antagonists, promote motility, PPI (antacids)
surgical - reduce hiatal hernia, interrupt gastric vagal innervation
define and describe Barrett Esophagus. what clinical manifestations are associated with it?
sequelae of chronic GERD
intestinal goblet cell metaplasia within distal esophageal mucosa (Metaplastic change in response to chronic irritation; may be irreversible)
-requires correlation between endoscopic findings & histologic finding of intestinal goblet cell metaplasia
-risk factor for esophageal adenocarcinoma (30-125x more likely)
-occurs mostly in pt ~60 y/0 (M > F)
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