10.3 Esophagus Flashcards
Tracheoesophageal Fistula
Congenital defect that connects the esophagus and the trachea
What is found with the proximal esophagus in TE fistula?
Esophageal atresia - blind pouch
What are the 4 clinical features of TE fistula?
- Vomiting
- Polyhydramnios
- Abdominal Distension
- Aspiration
Esophageal Web
Thin protrusion of esophageal mucosa in the upper esophagus that presents with dysphagia for poorly chewed food
What is esophageal web associated with?
SCC of the esophagus
Plummer-Vinson Syndrome
Manifestation of esophageal web with iron deficiency anemia, and beefy red tongue due to atrophic glossitis
Zenker Diverticulum
Outpouching of the pharyngeal mucosa through an acquired defect in the muscular wall
Where does Zenker diverticulum generally occur at?
Above the UES
How can Zenker diverticulum present?
Dysphagia, obstruction and halitosis
Mallory-Weiss Syndrome
Longitudinal laceration of the mucosa at the gastroesophageal junction due to severe vomiting (alcohol, bulimia)
Boerhaave Syndrome
Rupture of esophagus leading to air in mediastinum and is a transmural tear - EMERGENCY
How does Mallory-Weiss syndrome present?
Painful hematemesis
What is the main cause of esophageal varices?
Portal HTN
Esophageal Varices
Dilated submucosal veins in lower esophagus
What are the clinical signs of esophageal varices?
Asymptomatic with risk of rupture with painless hematemesis
What is the most common cause of death in cirrhosis?
Esophageal Varices
Achalasia
Disordered esophageal motility due to inability to relax LES
What is there dysphagia for in achalasia?
Solids AND liquids
What is the cause of achalasia?
Damaged ganglion cells in the myenteric plexus - can be idiopathic or secondary to something like Chagas Disease
What are the clinical features of achalasia?
- Dysphagia
- Putrid breath
- High LES pressure
- Bird beak sign with barium swallow
What are patients with achalasia at increased risk of?
Esophageal SCC
Gastroesophageal Disease (GERD)
Reflux of acid from the stomach due to reduced LES tone
What are risk factors of GERD?
- Alcohol
- Smoking
- Obesity
- Caffeine
What happens to the esophageal cells in GERD?
Metaplasia from non-keratinized stratified squamous cells to non-ciliated columnar cells with goblet cells
Sliding Hiatal Hernia
Cardia of the stomach slides up into the area of the esophagus - associated with GERD
Paraesophageal Hernia
Stomach rolls up next to the esophagus - bowel sounds in the lung
What are the clinical features of GERD?
- Heartburn
- Adult onset asthma
- Damage to enamel of teeth
- Ulceration of mucosa and submucosa
What are the main complications of GERD?
- Strictures
- Barrett’s Esophagus
What is the most common esophageal carcinoma in the West?
Adenocarcinoma
Barrett Esophagus
Metaplasia of the lower esophageal mucosa from stratified squamous to non-ciliated columnar with goblet cells
What is the main complication of Barrett Esophagus?
Adenocarcinoma
Esophageal Squamous Cell Carcinoma
Malignant proliferation of squamous cells and is the most common esophageal cancer worldwide
What are the risk factors for esophageal SCC?
IRRITATION
- Alcohol and tobacco
- Hot tea
- Achalasia
- Esophageal web
What is the prognosis of esophageal SCC?
Poor prognosis as they tend to present late
Why would esophageal SCC present with hoarse voice?
Affects the recurrent laryngeal nerve
