Dysphagia Overview and Classification

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Questions and Answers

What is the role of parietal cells in the stomach?

They produce bile to assist in digestion.

They protect the stomach lining from toxins.

They help in the absorption of nutrients.

They secrete intrinsic factor and gastric acid. (correct)

What is a consequence of chronic gastritis related to glandular changes?

The glands begin to secrete increased amounts of intrinsic factor.

Epithelial cells undergo hyperplasia leading to cyst formation.

Glands become hypertrophic and produce excess acid.

The epithelium undergoes metaplasia to acquire a more intestinal type. (correct)

Which factor is most associated with the long-term malignancy potential in gastritis?

Infection with H. Pylori and its associated toxins. (correct)

Exposure to nonsteroidal anti-inflammatory drugs (NSAIDs).

Excessive alcohol consumption.

Increased production of gastrin from the antrum.

How does the CagA complex of H. Pylori affect gastric epithelial cells?

It induces apoptosis and promotes interleukin 8 production. Signup and view all the answers

Which of the following is NOT a known cause of increased gastrin production in gastric inflammation?

Development of metaplasia. Signup and view all the answers

What condition is characterized by progressive dysphagia with no heartburn in elderly patients?

Carcinoma Signup and view all the answers

Which condition is characterized by a significant reduction in intrinsic factor leading to B12 deficiency?

Gastritis Signup and view all the answers

What is a key diagnostic tool used to identify esophageal motility disorders?

Manometry Signup and view all the answers

Which of the following conditions can cause intermittent dysphagia associated with chest pain?

Diffuse Esophageal Spasm Signup and view all the answers

Which category of esophagitis is primarily caused by acid reflux?

GERD Signup and view all the answers

Which condition is most commonly associated with the presence of anti-Sci70 antibodies?

Scleroderma Signup and view all the answers

What is the primary management approach for severe cases of esophageal spasms?

Botulinum injections Signup and view all the answers

What is the most common infectious cause of gastritis?

Helicobacter Pylori Signup and view all the answers

Which of the following is a treatment option for eosinophilic esophagitis?

PPI and topical or systemic steroid Signup and view all the answers

Which type of esophageal cancer is primarily linked to Barrett’s metaplasia?

Adenocarcinoma Signup and view all the answers

Which symptom is NOT typically associated with achalasia?

Acid reflux Signup and view all the answers

What is a major complication associated with esophagitis?

Esophageal stricture Signup and view all the answers

What is a common consequence of untreated peptic ulcer disease?

Iron deficiency anemia Signup and view all the answers

In which demographic does eosinophilic esophagitis most commonly occur?

Young white men Signup and view all the answers

Which neurological condition is associated with oropharyngeal dysphagia?

Diabetic Neuropathy Signup and view all the answers

Which of the following is a classic presenting symptom of esophageal carcinoma?

Odynophagia Signup and view all the answers

Which of the following statements about Boerhaave’s syndrome is correct?

It always requires surgical intervention. Signup and view all the answers

What are the main risk factors for esophageal carcinoma?

Chronic gastroesophageal reflux and smoking Signup and view all the answers

What is a significant risk factor for gastric ulcers?

Long-term use of NSAIDs Signup and view all the answers

Which condition is characterized by a small tumor that produces excessive gastrin?

Zollinger-Ellison Syndrome Signup and view all the answers

Which demographic is more likely to develop gastric cancer?

Men after the 7th decade of life Signup and view all the answers

What symptom is commonly associated with gastric ulcers following a meal?

Epigastric pain that occurs 2-5 hours after eating Signup and view all the answers

Which substance is associated with increased risk of gastric cancer?

Nitrosamines Signup and view all the answers

What role does mucous bicarbonate play in the stomach?

Serves as a defense mechanism against mucosal injury Signup and view all the answers

What factor does NOT contribute to the risk of gastric ulcers?

Physical exercise Signup and view all the answers

Which type of gastric cancer is indicated by a thick wall and infiltrative nature, commonly identified as 'leather bottle' appearance?

Diffuse Linitis Plastica Signup and view all the answers

Study Notes

Dysphagia

Dysphagia categorized into solid food only and solids and liquids.
Solid food only:
- Intermittent: Esophageal ring causes.
- Progressive:
  - With heartburn: Peptic stricture.
  - Without heartburn: Linked to old age or carcinoma.
Solids and liquids:
- Intermittent: Chest pain associated with Diffuse Esophageal Spasm (DES).
- Progressive:
  - With heartburn: Scleroderma.
  - Without heartburn: Nocturnal symptoms indicate achalasia, a condition of lack of relaxation.
Mechanical causes of dysphagia include benign/malignant strictures, esophageal webs/rings, diverticula, hernias, and inflammatory conditions.
Functional causes include achalasia, scleroderma, and DES.
Oropharyngeal dysphagia often results from neurological deficits (e.g., ALS, diabetic neuropathy, MS).

Esophagitis

Inflammation of the esophageal mucosa categorized as:
- GERD: Acid-related damage.
- Medication-associated: Certain antibiotics and NSAIDs.
- Infectious: Cytomegalovirus, herpes, candidiasis.
- Eosinophilic: Antigen sensitivity, notably in young white males.
Symptoms include painful swallowing (odynophagia), dysphagia, heartburn, and retrosternal pain.
Diagnosis confirmed via endoscopy.
Management tactics vary based on cause including:
- GERD: Reflux treatments.
- Medication: Adjustments.
- Infectious: Antimicrobial therapy.
- Eosinophilic: PPIs, steroids.
Major complications include recurrence leading to esophageal stricture.

Gastritis

Inflammation of gastric mucosa, often infectious; Helicobacter Pylori is the most common cause.
Autoimmune gastritis more prevalent in women; other less common causes include Crohn's, IBS, and ischemic conditions.
Primarily affects the antrum of the stomach, notably impacting mucus cells.
Causes encompass:
- Increased gastrin production.
- Epithelial cell injury.
- NSAIDs, alcohol, autoimmune diseases.
- H. pylori can create toxins leading to cell injury.
Acute gastritis characterized by inflammation and increased acid secretion.
Chronic gastritis leads to gland atrophy and metaplasia, decreasing acid and intrinsic factor production, increasing risk for cancer and MALT lymphoma.
Symptoms include heartburn, iron deficiency, and cognitive decline.
Diagnosis aided by CBC, stool tests, endoscopy, and breath tests.
Treatment involves avoiding irritants, PPIs, and antibiotics as needed.

Esophageal Motility Disorders

Disorders like diffuse spasm, scleroderma, and achalasia cause esophageal dysphagia.
Spasms characterized by hyperdynamic, non-propulsive contractions due to various factors like decreased nitric oxide and inflammation.
Presentation can vary from asymptomatic to intermittent dysphagia or chest pain, exacerbated by temperature changes.
Diagnosis through manometry showing increased pressure contractions and barium swallow displaying corkscrew patterns.
Management options include peppermint oil, calcium channel blockers, PPIs, and localized botulinum injections for severe cases.

Scleroderma

An autoimmune disorder causing esophageal atrophy, scarring, and decreased lower esophageal tone.
Characterized by diminished peristalsis and massive reflux.
Diagnosed with AntiSci70 test, where 95% of CREST patients test positive.
Includes features like calcinosis, Raynaud's, esophageal dysmotility, sclerodactyly, and telangiectasia.
Treatment involves immunosuppression, PPIs, endoscopic dilation for strictures, and surgical fundoplication if necessary.

Achalasia

Characterized by degeneration of ganglion cells, leading to esophageal dysfunction and diminished peristalsis.
Lower esophageal sphincter fails to relax, leading to megacolon and regurgitation of undigested food.
Diagnosed via barium swallow showing "bird beak sign."
Management includes muscle fiber stretching techniques like balloon dilation, botulinum toxin, oral nitrates, and calcium blockers.

Esophageal Carcinoma

Eighth most prevalent cancer; sixth leading cause of cancer death, more common in males.
Two primary types:
- Squamous cell carcinoma: prevalent globally, linked to diet.
- Adenocarcinoma: more common in the U.S., associated with Barrett’s esophagus.
Symptoms: bleeding, dysphagia, significant weight loss, iron deficiency, and pain (odynophagia).
Diagnosis involves barium swallow, endoscopy, and biopsy.
Treatment focuses on early detection for surgical resection, chemotherapy, and palliative care options.

Gastroesophageal Reflux Disease (GERD)

Symptoms: esophagitis, chest pain, heartburn, regurgitation, cough, dysphagia.
Water brash due to hypersalivation from gastric contents reflux.
Diagnostic methods include symptom evaluations and potential endoscopy if treatment fails.
24-hour pH monitoring can indicate acid reflux.

Esophageal Tears and Perforations

Includes Mallory-Weiss Syndrome and Boerhaave’s Syndrome; more common in males.
Often linked to alcohol use; tears account for 10-15% of upper GI bleeds.
Symptoms can range from asymptomatic to chest/epigastric pain, often post-vomiting.
Diagnosis often confirmed through symptoms and endoscopy.
Management involves fluids, transfusion, and specialized tubes for pressure.

Peptic Ulcer Disease

Most ulcers occur in the duodenum; major cause is H. pylori infection.
Other factors: NSAIDs, corticosteroids, smoking, and chronic diseases.
Gastric ulcers occur primarily in the lesser curvature of the stomach, while duodenal ulcers are more common.
Symptoms include epigastric pain, nausea, and possible occult bleeding.
Diagnosis through EGD can reveal ulcers; treatment includes lifestyle modifications, PPIs, and antibiotics.

Gastric Cancer

Third most common cancer death, particularly prevalent in Eastern Asia and Eastern Europe.
Associated risk factors: nitrosamines, genetics, H. pylori, longstanding gastritis.
Intestinal gastric carcinoma presents as nodular; diffuse is infiltrative with poor prognosis.
Presentation includes epigastric discomfort, nausea, weight loss, and potential hematemesis.

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Description

This quiz covers the different categories of dysphagia related to both solid food and liquids. It explores causes ranging from esophageal rings to conditions like achalasia and scleroderma. Understanding these classifications is crucial for diagnosing and managing dysphagia effectively.