2. Disorders Of The Esophagus Flashcards
What are important questions to ask during a clinical history when evaluating esophageal disorders?
Weight gain or loss Gastro bleeding Dietary habits including the timing of meals Smoking Alcohol consumption History of vomiting History of eating disorders
Sx of esophageal disease.
Heartburn. Regurgitation. Chest pain. Dysphagia. Odynophagia. Globus sensation. Water brash.
What is the most useful test for evaluation of the proximal GI tract?
Upper Endoscopy (EGD)
What can an EGD be used to detect?
Mucosal lesions. Detection of abnormalities id’d by color.
(Can also get biopsy and dilate strictures).
This test provides an assessment of esophageal function and morphology that may be undetected on endoscopy. (Also great or strictures, hernias, diverticula, and abnormal al motility.)
Barium radiography.
A pressure-sensing catheter w/in the esophagus that assesses the MOTILITY and FUNCTIONALITY of swallowing.
Esophageal Manometry
Combines an endoscope with an ultrasound transducer to create a trans mural image of the tissue (through the wall) surrounding the endoscope tip.
Endoscopic ultrasound
Demonstrates excessive esophageal exposure to refluxed gastric juice using a pH-sensitive transmitter or a transnasally positioned wire electrode.
Ambulatory Reflux Testing
The most common congenital esophageal abnormality.
Esophageal atresia
What parts of the esophagus are not communicating in esophageal atresia?
Proximal and Distal portions
Infants with this condition commonly have pneumonia and atelectasis
Tracheoesophageal fistula
What is “gastric type epithelium in the proximal cervical esophagus”?
Heterotopic gastric mucosa
The most common type of hiatal hernia.
Type I-sliding (95%)
Herniation of the gastric cardia and fundus.
Type II-paraesophageal hernia
Hernia including the colon.
Type IV
Distal esophageal B ring where the lumen is <13mm.
Schatki’s ring. “Steakhouse syndrome”. Tx-dilation.
Where are esophageal webs generally found?
Proximal esophagus.
Symptoms of Plummer-Vinson syndrome.
Iron-deficiency anemia in middle-aged women.
Esophageal diverticula just about the diaphragm.
Ephiphrenic
Diverticula often caused by TB.
Midesophageal
Herniation of the mucosa and submucosa through the esophageal muscle (upper esophageal sphincter).
Hypopharyngeal (Zenker’s)
Dilation of the submucosal esophageal glands.
Intramural esophageal pseudodiverticulosis
Complete rupture at the lower thoracic esophagus.
Boerhaave’s syndrome.
Incomplete tear that only affects mucosa and submucosa, may extend to the distal esophagus.
Mallory-Weiss Syndrome
A patient presents with pleuritic retrosternal pain, HX shows recent endoscopy.
Perforation from instrumentation.
Diagnostic test for Boerhaave’s syndrome.
CT of chest. Esophageal perforation.
Tx for Boerhaave’s Syndrome.
Nasogastric suction and IV broad-spectrum antibiotics with prompt surgical drainage and repair in non-contained leaks.
Conservative therapy-NPS and antibiotics.
Clipping or stent.
A child drank cleaning fluid, what should you be concerned about?
Corrosive esophagitis
Drugs that can cause radiation esophagitis.
Doxorubicin, bleomycin, cyclophosphamide , and cisplatin.
What can happen years after radiation therapy (in terms of esophagus)?
Submucosal fibrosis and strictures.
Pills that can cause pill esophagitis.
Bisphosphonates. NSAIDS. Ferrous.
You see localized inflammation and shallow ulceration, in the mid-esophagus. Pt. has sudden chest pain.
Pill esophagitis.
A common cause of hematemesis.
Mallory-Weiss Tears
What can you use to treat uncontrolled bleeding in Mallory-Weiss tears?
Local epinephrine. Cauterization therapy, endoscopic clipping, or angiographic embolization.
Most common esophageal cancer worldwide.
SCC
Major risk factor for adenocarcinoma.
GERD and Barrett’s Esophagus.
Major risk factor for SCC.
Tobacco and alcohol.
SCC is usually found….
Cervical and thoracic portions of esophagus.
Esophageal adenocarcinoma is usually found as…..
Dysplastic columnar epithelial cells in the distal esophagus.
When healthy esophageal epithelium is replaced with meta plastic columnar and goblet cells.
Barrett’s Esophagus
Result of damage from prolonged exposure of the esophagus to the gastric acid.
Barrett’s Esophagus.
This test allows for visualization and ID of tumor.
Esophagoscopy.
This test is used to assess spread of tumor and any associated lymph nodes.
Endoscopic Ultrasonography
This test can assess the extent of tumor spread to the mediastinum and para-aortic lymph nodes.
CT scan of the chest and abdomen.
This test is useful in assessing the presence of distant metastatic diseas.
PET
Complications of esophageal carcinoma.
Metastasis to adjacent and supraclavicular lymph nodes, liver, lungs, pleura, and bone.
Tracheoesophageal fistula may develop.
Hypercalcemia may develop as a paraneoplastic response.
Tx for high grade dysphasia, carcinoma in situ, and T1a.
Endoscopic mucosal resection and/or ablation.
