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GI 2 > Ch 17 Esophagus > Flashcards

Ch 17 Esophagus Flashcards

1
Q

Describe Nutcracker Esophagus?

A

High amplitude contractons of distal esophagus caused by loss of normal coordination of inner circular layer and outer longitudinal layer of smooth muscle

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2
Q

What is a diffuse esophageal spasm?

A

repetitive simultaneous contractions of distal esophageal smooth muscle

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3
Q

When/where do Zenker diverticula occur commonly?

A

develop after 50 and occur immediately above upper esophageal sphincter

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4
Q

How do mechanical obstructions present generally and what are examples?

A

Caused by strictures or cancers and present as progressive dysphagia beginning with inability to swallow solids progressing to liquids

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5
Q

What causes benign esophageal stenosis?

A

Fibrous thickening of submucosa and assoc. with atrophy of muscularis propria & secondary epithelial destruction

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6
Q

What usually causes stenosis?

A

inflammation and scarring caused by chronic GERD irradiation or caustic injury

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7
Q

With benign esophageal stenosis do patients lose weight?

A

No, they maintain weight and keep their appetite unlike with malignant strictures

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8
Q

when, and in who, do esophageal mucosal webs occur? Associations?

A

Women older than 40 Associated with GERD, Chronic GVHD, or blistering skin diseases

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9
Q

What are signs of Plummer Vinson syndrome?

A

Iron deficiency anemia Glossitis Cheilosis Esophageal webs in upper esophagus

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10
Q

What is the main symptom of esophageal webs?

A

Non progressive dysphagia associated with incompletely chewed food

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11
Q

What are Schatzki rings? Difference between A and B rings?

A

similar to webs except that are circumferential, thicker, and include mucosa submucosa and sometimes hypertrophic muscularis propria. A rings when they are above gastroesophgeal junction covered by squamous mucosa B rings when located at squamocolumnar junction of LES

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12
Q

What is the triad that describes Achalasia?

A
  1. incomplete relaxation of LES 2. Increased LES tone 3. Aperistalsis of esophagaus
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13
Q

What causes primary achalasia?

A

Result of distal esophageal inhibitory ganglion cell degeneration, leading to inability to relax LES, increased tone and aperistalsis. May also see degenerative changes in vagus nerve or dorsal motor nucleus of vagus

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14
Q

What causes Secondary Achalasia?

A

Chagas disease in which Trypanosoma cruzi destroys the myenteric plexus causing failure of peristalsis and esophageal dilation. Also assoc. with HSV1 infection and Sjogren syndrome or other autoimmune diseases

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15
Q

How do you treat achalasia?

A

Laparoscopic myotomy and pneumatic balloon dilation Botox to inhibit LES cholinergic neurons

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16
Q

What causes Mallory-Weiss tears (aka longitudinal mucosal tears)?

A

Forceful retching or vomiting secondary to acute alcohol intoxication

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17
Q

Treatment for Mallory Weiss syndrome?

A

Do not require surgical intervention and healing is usually rapid and complete

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18
Q

What syndrome is similar to mallory weiss but much more serious and less common?

A

Boerhaave syndrome, characterized by transmural tearing and rupture of distal esophagus

19
Q

Treatment for Borehaave syndrome?

A

has catastrophic effects leading to severe mediastinitis and requires surgical intervention

20
Q

What is associated with Borehaave syndrome? What can this be mistaken for?

A

severe chest pain, tachypnea, shock, Initial DDx can be a MI

21
Q

Esophageal infections in healthy people are uncommon, and most often due to ____. In contrast to those who are immunosuppressed in which the infection is caused by ___, ___, or ___.

A

Esophageal infections in healthy people are uncommon, and most often due to HSV. In contrast to those who are immunosuppressed in which the infection is caused by CMV, Fungal, or HSV.

22
Q

What type of esophageal ulcers will HSV cause?

A

Punched out ulcers and biopsy will show nuclear viral inclusions with a rim of degenerating epithelial cells at the margins

23
Q

What type of esophageal ulcer will CMV cause? Histology?

A
  • shallow ulcerations
  • characteristic nuclear and cytoplasmic incusions
24
Q

What iss the most common cause of GERD?

A
  • transient lower esophageal sphincter
25
Q

What are complications of GERD?

A
  • Ulceration
  • Hematemesis
  • Melena
  • Strictue development
  • Barret’s esophagus
26
Q

What is a hiatal hernia? What are its sx similar to?

A
  • separation of the diaphragmatic cura and protrusion of the stomach into the thorax through the gap
  • Can cause symptoms similar to GERD such as heart burn and regurgitation of gastric juices
27
Q

You are looking at a histology slide from somewhere in the GI tract, and see large numbers of intraepithelial eosionphils particularly superficially. You’re told this patient was suffering from food impaction and dysphagia. Their PMH includes atopic dermititis and asthma. What could this possibly be?

A

EOE

28
Q

Do PPI’s relieve EOE?

A

No because acid isn’t the issue

29
Q

What conditions are esophageal varicies most associated with?

A
  • Alcoholic liver disease (#1)
  • Hepatic schistosomiasis (#2)
30
Q

Prognosis of esophageal variceal hemorrhage?

A
  • Despite interventions such as splanchinic vasoconstriciton, balloon tamponade or variceal ligation 30% of these patients die due to:
    • Hypovolemic shock
    • Hepatic coma
  • 50% of patients who survive this are likely to have a recurrent bleed w/n 1 year and this has ~30% mortality as well
31
Q

Who is barret esophgus most common in?

A
  • white men between 40 and 60 yo
32
Q

What cancer is associated with barrets esophagus?

A

Esophageal adenocarcinoma

Majority of patiets with barrets do NOT end up developing this though

33
Q

Intestinal type metaplasia replacing the squamous cells with goblet cells is seen in what esophageal disorder?

A

Barrets

34
Q

What is the only way Barret esophagus can be identified?

A

Endoscopy and biopsy usually prompted by GERD sx

35
Q

What is the most common type of esophageal cancer in the world?

A

SCC

36
Q

Some serotypes of H. pylori are assoc with a ___ risk of esophageal adenocarcinioa bc they cause gastric atrophy which ____ acid production.

A

Some serotypes of H. pylori are assoc with a decreased** risk of esophageal adenocarcinioa bc they cause gastric atrophy which **decreases acid production.

37
Q

Adenocarcinoma occurs more frequently in who?

A

White males and occasionally hispanic men and white women in the US

38
Q

In the early stage of Barrets progression to dysplasia and invasive carcinoma, what is the mutation seen? Late stage?

A
  • Early: p53 and down reg of CDKN2A aka p16/INK4a
  • Later: EGFR, ERBB2, MET, Cyclin D1, Cyclin E
39
Q

How do esophageal adenocarcinomas present clinically?

A
  • Pain/difficulty swallowing
  • Progressive weight loss
  • Hematemesis
  • Chest pain
  • Vomiting

Usually when sx appear the tumor has spread to submucosal lymh vessels and has a

40
Q

Who does esophageal SCC impact most?

A

African American Males (4:1) older than 45

41
Q

SCC of the esophagus is linked to what in the US?

A
  • Alcohol and tobacco which synergize to increase the risk even more
  • Also HPV
42
Q

What are the mutations involved in SCC of the esophagus?

A
  • over expression of Cyclin D1
  • Loss of function p53, E-cadherin, and NONTCH1
43
Q

Where do half of SCC in the esophagus occur?

A

Middle third

GI 2 (19 decks)

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