Chapter 13: Intro and Esophogus Flashcards
This is usually associated with polyhydraminos
The most common esophageal anomaly is..
Complication?
Esophageal atresia
Tracheoesophageal fistula combined with some form of esophageal atresia (VATER syndrome (vertebral defect, anal atresia, tracheso fistula, renal dysplasia))…frequently associated with CONGENITAL HEART DISEASE
Most common form has esophagus end in blind pouch and lower esophagus connects with trachea
Leads to aspiration pneumonia
Thin mucosal membrane projects into esophagus with fibrovascular core. Can cause anemia and dysphagia. Most common in upper esophagus but can be anywhere.
What about an lower esophageal narrowing and rare intermittent dysphagia
Esophageal Web
Pathoma says: increase risk of esophageal SCC
Schatzki Ring
Severe iron deficiency anemia, esophageal web, and atrophic glossitis leading to beefy-red tongue. Dysphagia associated with aspiration of swallowed food is most common clinical sign
Plummer-Vinson Syndrome
Bad breath (halitosis), regurgitation of undigested food (obstruction), and dysphagia with voice change. Found an out pouching through pharyngeal mucosa in muscle wall on imaging that was near esophageal/pharynx junction
Name a subtype that occurs in the middle of the esophagus and attaches to mediastinal lymph nodes
What about one immediately above the diaphragm
Zenker Diverticulum
Traction diverticula
Epiphrenic diverticula
Dysphagia vs odynophagia
Difficulty swallowing (usually due to motor disorder/disruption) vs painful swallowing
Can arise from dysfunction of striated muscles (in upper esophagus), a systemic disease of skeletal muscle, or neuro/neuropathy disorders
Failure of the lower esophageal sphincter to function is known as. What else does it cause?
Pathophys? Underlying infection with what can cause secondary form?
Complication?
Achalasia (cardiospasm)
Loss or absence of myenteric ganglion cells–>chronic inflammation may ensue
Secondary: ganglion cells destroyed by protozoan T. cruzi in Chagas
Can develop squamous cell carcinoma in long standing cases
“Bird-beak” sign on barium swallow
Causes fibrosis of esophageal wall leading to dysphasia. Hint: anti-SCL-70 +
Scleroderma
Fibrosis of arterioles common and play role in fibrosis pathogenesis
X-ray shows retrocardiac gas-filled structure with symptoms of heartburn and regurg.
Name the two types and which needs correction/will be most symtomatic
Hiatal Hernia; Sliding and Paraesophageal
Should correct paraesophageal
Symptoms due to incompetence of lower esophageal sphincter
Risk of volvulus or gastric dilation in thoracic cavity
Tell me about GERD/ reflux esophagitis Risk factors? Clinical features? Cells present? Complications?
Reflux of acid from stomach due to reduced lower esophageal sphincter tone. Results in basal hyperlasia, papillae, and squamous hyperplasia
Risk: alcohol, chocolate, fatty foods, CIGARETTES, CNS depressants, pregnancy, estrogen, NG tubes, and HIATAL HERNIA
Features: heartburn, dysphagia, asthma/cough, TEETH DAMAGE
Cells: lymphocytes/neutrophils/eosinophils
Rx: proton pump inhibit
Complications: Ulceration with stricture and Barrett esophagus
Long term result of chronic GERD most commonly in the lower esophagus. SALMON COLORED Describe the changes that occur. Risk of advancing to what? Who has twice the risk factor?
Barrett Esophagus
Replacement of esophageal squamous epithelium by columnar epithelium (GLANDULAR EPITHELIUM) with well-formed goblet cells interspersed (Paneth cells/absorptive cells occasionally)
Risk of adenocarcinoma which correlates to length of esophagus involved
SMOKER RISK!
Patient complains of a sensation that food is sticking. Find mild eosinophilia
Eosinophilic esophagitis: ALLERGIES!
Infective esophagitis:
- Immunocompromised or diabetic patient with white mucosal plaques
- Associated with lymphoma and leukemia, small erosions or plaques may coalesce into larger lesions, have inclusions
- Reflects systemic viral disease in severely immunosuppressed patient, inclusion bodies in endothelial cells and granulation tissue fibroblasts
- Candidia
- Herpetic (herpetic inclusions)
- CMV
1 and 2 can get pseudomembranes, more common with superinfections
Chemical esophagitis: (Acid or Alkaline)
- Generally odorless and easily swallowed
- Liquefactive necrosis/saponification of membrane lipids
- Coagulative necrosis with protective eschar that limits injury
What else can cause esophageal dysmotility and cardiac enlargement?
- Alkaline: severe injury is the rule but less than 25% who ingest have complications (…….)
- Alkaline
- Acidic (despite protection half of patients have severe injury) (see #1 again if you aren’t confused enough after that one)
Drug ingestion with capsules getting caught in esophagus (don’t be a hero, drink water with that pill)
Fun Fact: I was too afraid to drink the water somewhere while traveling abroad and took my antibiotic before going to bed without water….kinda super painful the next morning
Name some systemic illnesses that esophagitis can complicate
Epidermolysis bullosa (can get strictures of upper esophagus too)
Bullous pemphigoid
Graft vs Host
Irradiation for thyroid cancer and NG tubes can cause it too!
Common complication of cirrhosis and portal hypertension due to an anastomoses?
Common clinical sign?
Esophageal varices
Painless hematemesis
Prominent blue venous channels on gross exam with numerous dilated submucosal veins on histology
