Dysphagia

Front 1

Define dysphagia and odynophagia

Back 1

Dysphagia= diff or inability to swallow foods and liquids
Odynophagia = painful swallowing

Front 2

Discriminate between oropharyngeal and esophageal dysphagia symptoms

Back 2

Oropharyngeal Dysphagia can cause

Front 3

Describe the diagnostic approach to a patient who presents with dysphagia

Back 3

-If dysphagia, determine whether oropharyngeal (ENT symptoms, aspiration, nasal regurgitation) or esophageal (chest, food impaction)
--If ORO, structural (zenker's, neoplasm) or propulsive (cerebrovascular, parkinson's ALS)
--If ESO, structural (pill or infectious esophagitis, neoplasm, schatkzi ring) or propulsive (GERD, Achalasia)

Front 4

Recognize Plummer-Vinson syndrome

Back 4

*Triad of dysphagia (due to esophageal web), glossitis, Fe deficiency anemia

Front 5

Define reflux and identify causes of gastroesophageal reflux disease (GERD).

Back 5

--abnormal relaxation of LES and/or delayed gastric emptying --> gastric reflux, esophageal damage and inflammation
--heartburn, acidic taste in mouth, dysphagia, hoarseness, globus sensation, chronic cough (esp at night), regurge
--histo triad: eosinophils, basal zone hyperplasia, elongation of lamina propria papillae
--treat with diet changes, H2-blockers, antacids or PPIs if advanced
--long-standing leads to barrett's (metaplasia from squamous cell to columnar containing GOBLET cells!!)

Front 6

Describe the pathophysiology, signs and symptoms, complications, diagnosis and treatment of GERD

Back 6

-Normal motility and LES

Front 7

Differentiate between the two major types of esophageal cancer

Back 7

--Adenocarcinoma, malignant proliferation of glands, usually lower 1/3 (Barett's - risk factor)
--Squamous cell, malignant prolif of squamous cells, upper or middle (alcohol, tobacco, very hot tea, HPV - risk factors)-presents with dysphagia and wt loss

Front 8

Zenker Diverticulum

Back 8

-Often associated with a restrictive defect or cricopharyngeal bar
-- posterior herniation of mucosa and submucosa through an area of relative weakness proximal to the crico muscle
-presents with halitosis, dysphagia, obstruction

Front 9

Esophageal motor disorders

Back 9

--Achalasia(failure to relax LES)
--Scleroderma (absent motility, weak LES)
--Diffuse Esophageal Spasm, DES (non-peristaltic, disordered contractions)

Front 10

Achalasia

Back 10

--failure of LES to relax -- unknown etiology -- symptoms are dysphagia, regurgitation, wt loss, chest pain -- night cough and aspirations
*Secondary causes: pseudoachalasia from neoplasm, mechanical obstruction, autoantibodies to myenteric neurons (e.g. small cell lung cancer), Chagas Disease (parasite T.Cruz, central and south america, may take years to manifest)
*TX: reduce LES pressure by: Ca channel antagonist, nitrates, endoscopic botox, endoscopic pneumatic dilation, surgical myotomy
*If untreated, can progress to esophageal cancer (sqaumous>adenoc)