10.1 - Pathophysiological Conditions of the Esophagus

Question 1

Esophageal Strictures

Answer 1

Chronic inflammation or injury to esophagus

Cause
1) GERD - causes inflammation and scarring
2) Ingesting chemicals - that cause burns and scarring
3) Esophageal Surgery - causes tissues injury = fibrosis

Patho
1) Inflammation
- injury triggers immune response = tissue damage

2) Fibrosis
- fibroblasts activate and form scars

3) Narrowing
- collagen deposition thickens walls = narrowing = hard to swallow

Changes
- fibrosis
- scarring
- narrowed esophagus

S&S
- difficulty swallowing = dysphagia
- aspiration (inhale food into lungs)
- food bolus can lodge in esophagus

Treatment
- esophageal dilation

Question 2

Esophageal Varices

Answer 2

Dilated veins due to increased pressure in portal system (portal hypertension)

Cause
- Liver disease
- Portal vein thrombosis (clot in vein can obstruct blood flow)

Patho
1) Portal Hypertension: resistance of blood flow through liver = ↑ pressure in portal vein

2) blood reroutes through collateral vessels (esophageal veins)

3) veins dilate and distended (due to ↑ blood flow) = rupture

Changes
- vein dilation

S&S
- Melena: dark, tarry stools of digested blood in GI tract
- Hematemesis: vomiting blood
- Anemia - chronic bleeding from rupture
- hypovolemic shock - large blood loss can cause fast breathing and low BP

Question 3

Barrets Esophagus

Answer 3

Epithelial lining of esophagus is replaced by columnar epithelial cells

Cause
- GERD: exposure to acid can lead to changes in epithelial cells

Patho
- acid damages epithelium = metaplasia = epithelial cells become columnar cells (resistant to acid, ↑ cancer)

Changes
- metaplasia of endothelial to columnar cells
- salmon pink colour (normal = pearly white)

S&S
- ↑ cancer risk: can progress to adenocarcinoma
- Symptoms management: treat GERD (heartburn, chest pain)

Question 4

Esophageal Cancer

Answer 4

Cause - 2 Types
1) Adenocarcinoma - GERD, Barretts
2) Squamous Cell - smoking, alcohol use

Patho
1)GERD, alcohol, smoking cause chronic irritation = cell damage
2) Dysplasia - genetic mutations = abnormal cells (precancerous)
3) Abnormal cells can metastasize and invade layers of esophagus

Changes
- abnormal cell growth = masses = narrowed esophagus
- cancer can invade nearby tissue

S&S
- dysphagia (which leads to malnutrition and weight loss)

Treatment
- esophagectomy
- radiation and chemo

Question 5

Gastroesopheageal Reflux Disease

Answer 5

Stomach acid enters esophagus due to lower esophageal sphincter dysfunction

Cause
- obesity and pregnancy (due to ↑ intrabdominal pressure)
- hernia: stomach pushes through diaphragm and weakens sphincter
- diet: fatty food, acohol smoking

Patho
- sphincter relaxes (opens) and allows stomach acid into esophagus = inflamed mucosal lining
- delayed gastric emptying = ↑ pressure = worsened reflux

Changes
1) Esophagitis: inflamed/eroded mucous lining

2) Barretts Esophagus: persistent injury causes metaplasia

S&S
- heartburn
- epigastric chest pain
- regurgitation

Complications
- esophagitis
- strictures
- barrets esophagus =cancer

Question 6

Esophagitis

Answer 6

inflammation affecting esophagus

Cause
1) GERD - acid reflux damages esophagus
2) Eosinophilic Esophagitis: associated w allergic response (causes inflammation)
- medications
- infxns
- chemical injury

Patho
1) GERD - acid exposure causes inflammation
2) Eosinophilic Esophagitis: eosinophils infiltrate mucosa and cause inflammation
3) Meds: can directly damage mucosa
4) Infections: pathogens invade mucosa = inflammation
5) Chemicals: substances can cause cell injury = necrosis

Changes
- edema and erythema (redness)
- chronic: ulcers, fibrosis, metaplasia

S&S
- dysphagia
- odonophagia (painful swallow)
- epigastric chest pain

Complications
- esophageal strictures
- barretts esophagus = cancer