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44 Cards in this Set
- Front
- Back
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What are the 2 main types of hiatal hernia?
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-Sliding
-Paraesophageal |
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What is a sliding hiatal hernia?
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When the GE junction and part of the stomach go above the diaphragm but the stomach's orientation is unchanged
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What is a paraesophageal hiatal hernia?
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The GE junction stays put, but the fundus/greater curve of stomach slide up so the stomach rotates counter clockwise; can all end up in the chest!
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What is the clinical significance of a sliding hiatal hernia?
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The rubbing of the stomach on the diaphragm during respiration can cause an ulcer
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What is an ulcer caused by sliding hiatal hernia called?
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Cameron's ulcer
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What are 3 adverse clinical outcomes that make a paraesophageal hiatal hernia worrisome?
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-Delayed gastric emptying
-Gastric stasis -Gastric volvulus can develop |
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What are 3 signs of reflux esophagitis in infants?
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-Recurrent emesis
-Failure to thrive -Apnea syndrome |
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What are risk factors for reflux esophagitis?
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-Foods that lower LES pressure
-Foods that irritate esophagus -Hiatal hernia -Smoking/Drinking alcohol/Coffee -Medications, indwelling NG tube |
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What foods lower LES pressure?
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-Onions
-Peppermint -Chocolate -High fat |
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What meds lower LES pressure?
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-Theophylline
-Anticholinergics -Progesterone -CCBs -alpha adrenergics -Diazepam -Meperidine |
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What are 4 risk factors that lead to reflux esophagitis in Children?
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-Downs syndrome
-Mental retardation -Cerebral palsy -Tracheoesophag fistula repair |
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What are esophageal diverticula?
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Epithelium-lined pouches that protrude from the esophageal lumen
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What are the 3 most common locations of esophageal diverticula?
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-Pharyngoesophageal
-Parabronchial (midesophageal) -Epiphrenic (supradiaphragmatic) |
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Where is a Pharyngesophageal diverticulum?
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At the junction of the Pharynx and esophagus
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Where is a parabronchial diverticula?
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Near the tracheal bifurcation
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Where is an epiphrenic diverticulum?
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Within 10cm of the distal esophagus
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What is the difference between a true and false diverticulum?
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True - has all 3 layers; mucosa, submucosa, and muscle
False - only mucosa/submucosa |
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What are the other more commonly used terms for false and true diverticula of the esophaus?
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False - Pulsion
True - Traction |
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What is a Pulsion esophageal diverticula caused by?
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Increased intraluminal pressure causing herniation of the mucosa and submucosa THRU the esophageal muscle layer
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What is a Traction esophageal diverticula caused by?
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Inflammation in mediastinal lymph nodes, PULLING on the esophagus so that all 3 layers protrude
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Which types of esophageal diverticula tend to develop at which of the 3 common sites?
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Pulsion - pharyngoesophageal and epiphrenic
Traction - parabronchial |
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Which is the most COMMON type of esophageal diverticulum? At what age do these tend to develop?
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Pharyngoesophageal - 30-50 yrs old
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Where do Pharyngoesphageal diverticulum tend to arise from?
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Inferior pharyngeal constrictor, btwn oblique thyropharyngeus mm and horizontal cricopharyngeus mm
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What does the area including the Inferior pharyngeal constrictor, btwn oblique thyropharyngeus mm and horizontal cricopharyngeus mm constitute?
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The upper esophageal sphincter - UES
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What is the UES also known as?
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Killian's triangle
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Why do pulsion diverticula tend to form at Killian's triangle?
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There is a potential weakness at that point
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What causes the pulsion diverticula to develop at Killian's triangle?
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Increased intraluminal pressure combined with the potentially weak point
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What does a paraesophageal diverticulum have the potential to do with time?
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Drop into the prevertebral space and down into the mediastinum!
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What is most typically seen with Traction diverticula at the parabronchial location?
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Chronic mediastinal granulomatous diseases - TB or Histoplasmosis
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How are parabronchial diverticula typically found?
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Incidently on barium esophagrograms
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So which sort of esophageal diverticulum tends to be most symptomatic?
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Pharyngoesophageal - more dysphagia, regurgitation, aspiration, etc..
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Dysphagia
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Difficulty swallowing
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Odynophagia
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Pain with swallowing
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Pyrosis
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heartburn
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Globus hystericus
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lump in throat
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Achalasia
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failure to relax
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What is the cardinal feature of achalasia?
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Failure of LES relaxation
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What 2 functional components of the esophagus are dysfunctional in achalasia?
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-Neural
-Muscle |
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What is presumed to be the most important pathophysiologic defect in achalasia?
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Low # of NANC inhibitor ganglion cells in the intramural esophageal nerve plexus
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What effect does the loss of predominantly inhibitory neurons have?
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-Increased basal pressure
-Poor relaxation of LES |
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What other nerve dysfunction could lead to achalasia?
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Vagal nerve dysfunction
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What sex/age is typically affected by achalasia?
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-Equal sexes
-30-50s |
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What is the predominant symptom of achalasia?
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Dysphagia
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What are 5 other common symptoms of achalasia?
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-Weight loss
-Postural changes to help emptying -Chest pain -Regurgitation -Resp sx dt aspiration |
