Chapter 17-Esophagus Flashcards by Michael Dennis

What is the embryological derivation of the esophagus

Cranial portion of the forget

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What is nutcracker esophagus

High amplitude contraction of the distal esophagus due to the loss of normal coordination of the inner circular layer and outer longitudinal smooth muscle contraction

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What is diffuse esophageal spasm

Repetitive, simultaneous contractions of the distal esophageal smooth muscle

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What is the cause of lower esophageal sphincter dysfunction

-high resting pressure of incomplete relaxation

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What can esophageal dysmotility result in

Development of small diverticula (epiphrenchic)right above the lower esophageal sphincter

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What is the cause of Zenker diverticulum

Impaired relaxation and spasm of the cricopharyngeus after swallowing, which results in increased pressure within the distal pharynx

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What is another name for Zenker diverticulum

Pharyngoesophageal diverticulum

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Where do Zenker diverticulum develop

-Above the upper esophageal sphincter in the pharynx

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What is the age group commonly to have Zenker diverticulum

Over 50

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What is the cause of benign esophageal stenosis

Narrowing of the lumen caused by fibrous thickening of the submucosa due to atrophy of the muscularis propia due to GERD, irradiation

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What are the physical side effects seen in patients with benign esophageal stenosis

Usually maintain the appetitive and weight

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What are esophageal mucosal webs

Ledge like protrusions of mucosa and are composed of fibrovascular connective tissue overlying epithelium

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What conditions are associated with esophageal mucosal webs

GERD, chronic graft versus host, blistering skin diseases

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What conditions will accompany esophageal mucosal webs

Iron deficiency Anemia
Glossitis
Cheilosis

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What is the name of the condition that has esophageal webs along with the anemia

Paterson Brown Kelly or PLummer-Vinson syndrome

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What is the main symptom of esophageal webs

Nonprogresive dysphagia with incomplete chewed food

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What are Schatzki rings

Similar to Webs but are thicker and include mucosa, submucosa, and hypertropic muscularis propria

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What is the location and make up of A rings

Distal esophagus, above the gastroesophageal junction, and contain squamous mucosa

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What are the location and make up of B rings

Located at the squamocolumnar junction of the lower esophagus and contain gastric cardia-type mucosa

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What is the triad that is characteristic of alchalasia

Incomplete LES relaxation
Increased LES tone
aperistalsis of the esophagus

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What are the symptoms of achalasia

Difficulty swallowing both liquids and solids
Difficulty burping
chest pain

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What is the cause of primary alchalasia

Distal esophageal inhibatory neurons, aka ganglion degeneration
-can be of the extraesophageal vagus nerve or the dorsal motor nucleus of the vagus

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What are some causes of achalasia like diseases

Diabeteic autonomic neuropathy
malignancy or amyloidosis
downsyndrome
Allgrove syndrome (triple A)

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What is algrove syndome aka triple A syndrome

Autosomal recessive

Alchalasia
Alacrima
adrenocorticotripic hormone resistant adrenal insufficiency

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What are Mallory Weiss tears associated with

Vomiting secondary to vomiting, especially with alcohol toxicity

What are the symptoms of Boerhaave syndrome

Causes mediastinitis Severe chest pain, tachycardia, shock, and present as a MI -Can also be causing vomiting of blood/hematemsis due to esophageal perforation.

What is pill induced esophagitis

Pill is taken, but dissolves in the esophagus rather than making it to the stomach

What are esophagus infection in healthy individuals caused by

HSV, but is very rare

What are the histological and morphological findings of herpes virus in the esophagus

Punched out ulcers | Nuclear viral inclusions within the rim of degeneration

What are the histological and morphological findings of CMV in the esophagus

Shallow ulcers with nuclear and cytoplasmic inclusions within the capillary endothelium and stromal cells

What are the some of the factors that can increase the chances of GERD

``` Alcohol Tabacco Obesity CNS depressants Pregnancy Hiatal herniation ```

Which population of patients is GERD most common

Older than 40

What is the taste in patients with GERD

Tasting of sour tasting gastric contents

What are the treatments for patients with GERD

Proton pump inhibators

What is a condition that resembles GERD and what is it characterized by

Hiatal hernias cause similar symptoms, but are caused by speration of the diaphragmatic crura and protrusion of the stomach into the thorax

What is the characteristic finding in eosinophilia esophagus

Large number of intraepithelial eisinophils superficially

What are the symptoms that helps to differentiate GERD from eiosinphilic esophagitis

- Increased eiosinophils - No acid reflex - High doses of PPI does not work

What are the conditions that are associated with eosinophilia esophagitis

Atopic dermatitis Allergic rhinitis Asthma

Following portal hypertension, what is the next most common cause of varices

Hepatic schistosomiasis

What are the treatments used to treat esophageal varices

Splanchnic vasoconstriction Sclerotherapy (injection of thrombin agents) Ballon tamponade Varicella ligation

What is the main risk factor that needs to be addressed in patients with esophageal varices

The size and past history of bleeding - Large tend to bleed and recurrent bleeding - Small tend to not bleed

What is the typical patient group at risk for Barrett esophagus

White males between 40 to 60

What is the greatest risk associated with Barrett esophagus

Adenocarcinoma

The presence of dysplasia in Barrett esophagus is correlated with which things

- prolonged symptoms - longer segment length - increased patient age - Caucasian race

What is the change seen in Barrett esophagus

-squamous esophageal epithelium replaced with goblet cells

What are the histological stain findings with Barrett esophagus

Mucous vacuole that stain blue with an H and E stain, leading to the shape of a wine goblet to the remaining cytoplasm

What is the most common esophageal tumor in the US and worldwide

Adenocarcinoma

What is the most common esophageal tumor in the world

Squamous cell carcinoma

What is the majority of benign tumors of the esophagus

Mesenchymal, so include smooth muscle cells

Which risk factors increase the risk of adenocarcinoma

Barrett esophagus Tabacco use Radiation Lack of fresh fruits and vegetables

How does H pylori actually decrease the risk of adenocarcinoma

Causes gastric atrophy and the subsequent decrease in acid leads to decreased risk of Barrett esophagus

What is the patient group most commonly affected by adenocarcinoma

White Caucasian males

What are the mutations assocaited in the early transition from Barrett esophagus to adenocarcinoma

- TP53 | - CDK2NA

What are the mutations assocaited in the late transition from Barrett esophagus to adenocarcinoma

``` EGFR ERBB2 MET Cyclin D1 Cyclin E ```

The adenocarcinomas that from from Barrett esophagus typically produce what

Forms glands and secrete mucin

What are the clinal presentations of esophageal adenocarcinomas

``` Pain/difficulty swallowing Progressive weight loss Hematemesis Chest pain Vomiting ```

Where doe the tumor general spread in adenocarcinomas of the esophagus

Submucosa lymphatic Vessels

What is the population group that is affected by squamous cell carcinoma of the esophagus

African amaerican (8x more likely) Males (4x) older than 45 years

What are the risk factors for developing squamous cell carcinoma

- Alcohol and tobacco - achalasia - tylosis - Plummer-Vinson syndrome - Lacking fruits and vegetables - Very hot beverages*

Which cancer of the esophagus is increased via radiation and when does it typically present

-Squamous cell carcinoma, occurring 5 to 10 years after exposure

Which regions dent to have a higher risk for developing squamous cell carcinomas

- Rural and underdeveloped areas - Western Kenya - Iran, China, Hong Kong

Where is Africa is there a higher rate of squamous cell carcinoma and what is the cause

Western Kenya, due to consumption of mursik, which contains acetalaldehyde

What is the majority of squamous cell carcinomas of the esophagus due to in the US and western countries

Alcohol and tobacco use (synergistic)

What are the mutations associated with increased risk of squamous cell carcinoma of the esophagus

-SOX2 -Cyclin D1 TP53 -E Cadherin -NOTCH1

Where in the esophagus do adenocarcinomas occur

Distal 1/3

Where in the esophagus do squamous cell carcinomas occur

Middle 1/3

How do squamous cell carcinomas begin

As squamous dysplasia (aka intraepithelial neoplasm/carcinoma in situ)

What are some locations of complications of squamous cell carcinomas and their spreading in the cavity

- Respiratory tree leading to pneumonia - aorta leading to exsanguination - Mediastinum and pericardium

What is the location of Squamous cell carcinoma of the esophagus if it spread to the cervical lymph nodes

Upper 1/3

What is the location of Squamous cell carcinoma of the esophagus if it spread to the paratracheal lymph nodes

Middle 1/3

What is the location of Squamous cell carcinoma of the esophagus if it spread to the gastric and celiac lymph nodes

Lower 1/3

What are the clinical presentations of squamous cell carcinoma of the esophagus

``` Dysphagia Odynophagia (pain on swallowing) Obstruction Change in eating from solid to liquid Weight loss Iron loss ```

What is commonly a first symptom of squamous cell carcinoma

Aspiration of food via the tracheoesophageal fistula

What is associated with the poorer prognosis in esophageal squamous cell carcinoma

LN metastasis