Term
|
Definition
| Neuromuscular response with voluntary (oral phase) and involuntary (pharyngeal phase) components |
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Term
|
Definition
1. Closure of nasopharynx w/ contraction of soft palate
2. Anterosuperior displacement of larynx to prevent food aspiration
3. Closure of larynx by epiglottis
4. Relaxation of UES
5. Pharyngeal contraction to move bolus into esophagus |
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Term
| Innervation of the Esophagus |
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Definition
1. Upper esophageal peristalsis - vegal innervation
2. Lower esophageal (smooth muscle mediated) peristalsis - enteric nerve plexus
3. Secondary peristalsis is initiated by esophageal distention and requires vagal innervation |
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Term
|
Definition
1. Occurs following esophageal peristalsis
2. Allows passage of food into stomach
3. Vagally mediated
Neurotransmitters: VIP, NO |
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Term
| Causes of Dysphagia due to Oropharygneal Dysfunctions |
|
Definition
1. CNS disease
- Cerebrovascular infarcts
- Poliomyelitis
- ALS
- Parkinson's disease
2. Muscular disorders
- Muscular dystrophy
- Myasthenia gravis
3. Xerostomia (dry mouth) |
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Term
| Esophageal Dysfunction Disorders |
|
Definition
- Achalasia
- Diffuse esophageal spasms
- Scleroderma
- LES dysfunction |
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Term
|
Definition
1. Most common
2. Incomplete relaxation of LES
3. Decreased esophageal motility
4. Loss of enteric nerves in distal esoph (and elevated anti-neural antibody)
5. Sx - regurgitation, chest discomfort, Wt loss |
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Term
|
Definition
1. Medications: Ca++ blocking agents and nitrates that reduce LES pressure
2. Balloon dilation of the LES
3. Surgical cutting of the LES smooth muscle to allow food passage
4. Botulinum toxin injections |
|
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Term
|
Definition
1. Loss of inhibitory neural input to body of esophagus and LES
2. Chest pain is major symptom--caused by uncoordinated contractions at multiple sites along esoph. body
3. May be assoc. w/ solid and/or liquid dysphagia |
|
|
Term
| Diffuse Esophageal Spasm - Treatment |
|
Definition
| Calcium channel blockers or Nitrates (reduce symptoms) |
|
|
Term
|
Definition
1. Rare collagen vascular disease affecting skin and internal organs
2. Can lead to:
- Progressive loss of esophageal and LES smooth muscle and replacement w/ dense fibrous tissue
- Progressive loss of esophageal body peristalsis
- Markedly decreased LES pressure |
|
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Term
|
Definition
1. Can lead to dysphagia and gastroesophageal acid reflux (heartburn)
2. Acid-related damage is ~universal and includes:
- Stricture formation
- Replacement of esophagal squamous epith. by metaplastic columnar epith. of intestinal type (Barrett's)
- Adenocarcinoma of the esophagus |
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|
Term
| Obstructive disorders in the absence of heartburn |
|
Definition
| Might indicate congenital obstructions or cancer |
|
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Term
| Obstructive disorders with longstanding heartburn |
|
Definition
| Might indicate reflux stricture or reflux-induced adenocarcinoma secondary to Barrett's esophagus |
|
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Term
| Factors that compromise the LES as a barrier |
|
Definition
- Reduced LES pressure
- Increased nonswallow-induced LES relaxation
- Hiatal hernia |
|
|
Term
| Aggravating factors in GERD |
|
Definition
1. Malfunctioning LES
2. Obesity
3. Bending down or supine posture
4. Large meals
5. Slow stomach emptying
6. Weak muscular contractions in the esophagus
7. Exercise
8. Pregnancy
9. Factors that directly inhibit LES contraction (smoking, certain hormones, certain foods)
10. Meds |
|
|
Term
| Foods that inhibit LES contractions |
|
Definition
- Fatty foods
- Chocolate
- Caffeine
- Onions
- Spicy foods
- Mint
- Alcohol |
|
|
Term
| Medications that inhibit LES contraction |
|
Definition
- Benzodiazepine
- Calcium channel blockers
- Nitrates |
|
|
Term
|
Definition
1. Clinical syndrome
2. Endoscopic exam (inspect lining for ulcers/inflamm, biopsy to test for Barrett's or esoph. ca., hiatal hernia)
3. X-ray exam of stomach to confirm hiatal hernia
4. 24-hr pH monitoring of lower esophagus
5. Esophageal manometry |
|
|
Term
|
Definition
- Antacids
- Reduced smoking and EtOH consumption
- Dietary modifications
- Smaller more frequent meals
- H2-receptor blockers (cimetidine, famotidine, etc.) to reduce gastric acid secretion
- Proton pump inhibitors (omeprazole, etc.) to prevent gastric acid secretion
- Surgery: Fundoplication |
|
|
Term
|
Definition
1. Upper part of stomach is wrapped around the LES to strengthen the sphincter and repair hiatal hernia
2. Surgical treatment of GERD |
|
|
Term
| Severe Consequences of Vomiting |
|
Definition
| Aspiration pneumonia, Volume and electrolyte depletion, Acid-base imbalance, Malnutrition |
|
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Term
|
Definition
1. Reverse peristalsis in jejunum and duodenum
2. Inhibition of gastric peristalsis
3. Relaxation of longitudinal esophageal body wall muscle
4. Spasmodic, repeated inspiratory efforts against closed glottis (contraction of ab muscles, diaphragm, intercostal muscles)
5. Moves the contents of the duodenum and stomach into the lower esophagus |
|
|
Term
|
Definition
Expels contents of the lower esophagus by:
- Contraction of the pylorus
- Contraction of abdominal muscles
- Relaxation of diaphragm
- Relaxation of UES |
|
|
Term
| Regions in the medulla that initiate nausea and vomiting |
|
Definition
1. Vomiting Center
2. Chemoreceptor Trigger Zone (CTZ) |
|
|
Term
|
Definition
Stimulated by afferent vagal or sympathetic fibers arising from the gut, vestibular apparatus, coronary arteries, gallbladder, and peritoneum
(Explains why nausea freq. accompanies vertigo, MI, biliary colic, peritonitis, and intracranial HTN) |
|
|
Term
| Chemoreceptor Trigger Zone (CTZ) |
|
Definition
1. Responds to stimulation of muscarinic ACh receptors, histamine H1 receptors, dopamine D2 receptors, serotonin 5HT3 receptors
2. Broad range of drugs & metab disorders activate nausea and vomiting via CTZ |
|
|
Term
| Drugs assoc. w/ Nausea and Vomiting |
|
Definition
| Chemotherapeutic agents, Dopaminergic agents, Digoxin, Opiates, Ipecac, Salicylates, Ethanol, Many others |
|
|
Term
| Metabolic disorders assoc. w/ Nausea & Vomiting |
|
Definition
| Diabetic ketoacidosis, Uremia, Hypoxia, Thyrotoxicosis, Radiation sickness, Morning sickness during pregnancy |
|
|
Term
| Conditions resulting in Gastroparesis, Nausea, Vomiting |
|
Definition
| Surgical disruption of vagus, Diabetes mellitus, Gastric smooth muscle dysfunction (e.g. scleroderma), Surgical procedures (e.g. antrectomy), Disturbances of gastric slow wave activity, Drugs (e.g.opiates, antidepressants), Metabolic abnormalities (DKA), CNS disorders (e.g. brain tumor), Infections (e.g. viral gastroenteritis) |
|
|
Term
| Drugs that reduce Nausea and Vomiting |
|
Definition
- Anticholinergics
- Histamine H1 receptor antagonists
- Neuroleptic agents that are antihistaminic, anticholinergic, block dompamine D2 receptor in CTZ, and reduce afferent signals to the vomiting center (Prochlorperazine)
- Prokinetic agents that are D2 receptor antagonists (Metochlopramide) |
|
|
Term
| Chronic Vomiting can cause: |
|
Definition
| Dental erosino and caries, Damage to stomach & esophagus, Malnutrition, Hypokalemia, Hyponatremia, Metabolic alkalosis, Dehydration |
|
|
Term
| Delayed Rebound Effect of Antacid Therapy |
|
Definition
| Antacids may contain calcium that directly stimulates parietal cells, leading to a rebound increase in acid secretion |
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