Diseases and pathology of the esophagus Flashcards
difficulty swallowing –> nasal regurgitation, aspiration
dysphagia
neurologic etiologies of propulsive/motility oropharyngeal diseases
stroke, ALS, Parkinson’s, MS, Polio
muscular etiologies of propulsive/motility oropharyngeal diseases
myasthenia gravis, muscular dystrophy, muscle injury (surgery, radiation therapy)
Zenker’s diverticulum, crycopharyngeal bar, thyromegaly, fibrosis
benign structural oropharyngeal diseases
outpouching of esophagus –> food regurgitation or bacterial colonization (halitosis)
Zenker’s diverticulum
Malignant structural oropharyngeal diseases
Squamous cell carcinoma of the tongue, oropharynx, soft palate or upper larynx
dysphagia to BOTH solids and liquids, chest pain
excluding structural lesion
esophageal motility disorders
Etiologies of esophageal motility disorders
Achalasia, spastic disorders of the esophagus, weak peristalsis, scleroderma
diagnosis of esophageal motility disorders
exclude structural lesion (upper endoscopy or barium esophagram), esophageal manometry
idiopathic, impaired relaxation of LES
achalasia
achalasia epidemiology
both genders, all races, adults
Achalasia manometry findings
Type I (classic) = swallowing –> no significant change in esophageal pressurization
Type II = swallowing –> simultaneous pressurization spanning entire esophagus length
Type III (spastic) = swallowing –> abnormal, lumen obliterating contractions/spasms
treatment of Type II achalasia
botox, pneumatic dilation, surgical myotomy
pathophysiology of achalasia
loss of inhibitory neurons in myenteric plexus –> unopposed excitatory (cholinergic) neurons –> hypertensive nonrelaxed esophageal sphincter
Direct mechanical obstruction of LES
pseudoachalasia
Causes of pseudoachalasia
infiltrative submucosal invasion, paraneoplastic, Chagas disease
medical treatment for achalasia
if contraindications to dilation or surgery
nitrates, Ca channel blockers, sildenafil
multisystem disorder featuring obliterative small vessel vasculitis, fibroses of mutiple organs
GI = smooth muscle atrophy and gut wall fibrosis
scleroderma
peristalsis preserved
due to overactivity of excitatory nerves or overreactivity of smooth muscle response
spastic disorders of the esophagus
dysphagia to solids, and eventually liquids much later
weight loss (ominous)
heartburn (sometimes)
structural esophageal dysfunction
strictures (GERD, caustic), Schatzki’s ring, eosinophilic esophagitis, extrinsic compression
benign structural esophageal disorders
Malignant structural esophageal disorders
Esophageal cancer (adenocarcinoma, SCC), metastasis (rare), direct invasion
DYSPHAGIA TO SOLIDS, painless, regular/daily basis sx, weight loss
esophageal stricture
treatment of benign esophageal stricture
endoscopic dilation using balloons or sequential commercial dilators
infiltration of eosinophils in esophagus. food avoidance, dysphagia
eosinophilic esophagitis
EoE demographics
white, middle aged men
associated with atopy, asthma, allergies
EoE treatment
3D’s
Drugs (TOPICAL steroids), diet, dilation
dietary treatment of EoE
eliminate milk, eggs, wheat, soy, seafood, nuts
post-prandial (after meal) heartburn, regurgitation with acidic taste, relieved by antacids or anti-secretory meds
GERD
Causes of GERD
inappropriate LES relaxation, hiatal hernia, surgery
rare: Zollinger-Ellison, Sjogren’s, Scleroderma
Risk factors for GERD
obesity, tobacco, meds, pregnancy
complications of GERD
erosive esophagitis, Barrett’s esophagitis
Barrett’s esophagus
acid –> change in esophageal epithelium from squamous to columnar
risk factors for Barrett’s esophagus
old, fat, white men
Complications of Barrett’s esophagus
risk of adenocarcinoma
Treatment of Barrett’s esophagus
Endoscopic ablation of Barrett’s tissue
endoscopic resection of visible lesions
infectious etiologies of esophagitis
fungal (candida), viral (HSV)
EGD –> punched out ulcers
histology –> viral inclusions
herpetic esophagitis
EGD –> white plaques
histology –> long, thin eosinophilic inclusions
candida esophagitis
EGD –> ringed esophagus, linear furrows
histology –> many eosinophils
eosinophilic esophagitis
disorders leading to functional esophageal obstruction
nutcracker esophagus, diffuse esophageal spasm, hypertensive LES, achalasia
disorders leading to structural esophageal obstruction
diverticula, esophageal mucosal webs/rings, congenital abnormalities, benign esophageal stenosis, tumors
congenital anomalies resulting from failure of the foregut to divide into trachea and esophagus during the 4th week of embryonic development
esophageal atresia and tracheoesophageal fistula
food regurgitation, drooling, aspiration
esophageal atresia and tracheoesophageal fistula
which form of tracheoesophageal fistula is associated with repeated bouts of pneumonia?
H shape
diffuse esophageal spasms
barium swallow –> corkscrew pattern
corkscrew esophagus
barium swallow –> megaesophagus with “bird beak” at lower esophagus
achalasia
EGD –> Mallory-Weiss tears
alcohol intoxication –> severe retching or vomiting
esophageal varicies
cirrhosis
Barrett’s esophagus histology –> elongated dark nuclei
low-grade dysplasia
Barrett’s esophagus histology –> rounded nuclei, crowded glands
high-grade dysplasia –> high risk for adenocarcinoma progression
