Diseases Of The Esophagus Flashcards
Boerheave Syndrome
Transmural tear in the esophagus Career bulimic or alcoholic; violent retching CXR-Air in mediastinum Sounds like rice crispies Surgical emergency
Eosinophilic esophagitis
Path: asthma, allergies, atopy
Food allergens lead to dysphasia, heartburn, and strictures
Dx: EGD Bx >15eos
Tx: trial PPI then oral aerolized steroids
Esophageal stricture
Path: lye ingestion, acid reflux
Pt: GERD, dysphagia, weight loss
Dx: barium is symmetric
Tx: PPI, dilation
Esophageal varices
Path: portal HTN, dilated submucosal veins in lower 1/3
Pt: cirrhotic, alcoholic, upper GI bleed
Dx: EGD
Tx: octerotide (cirrotics), balloon, banding, TIPS, transplant
Ppx: propranolol
Esophagitis causes
PIECE pneumonic Pill induced Infectious Eosinophilic Caustic G(E)RD
Most common causes of infectious esophagitis and their treatments
Candida- fluconazole
HSV- val/a cyclovir (punched out ulcers)
CMV- val/a cyclovir (linear ulcers)
HIV- HAART
Mallory Weiss Syndrome
Path: superficial mucosal tear at gastroesophageal junction due to severe vomiting, hematemesis
Pt: weekend warrior alcoholic, bulimic
Dx: EGD
Tx: self-limiting
Plummer-Vinson Syndrome
Pt: triad dysphagia, iron def anemia, esophageal webs
Dx: see webs on barium
Tx: screen for cancer, more likely to get SCC esophagus
PLUMBERS DIE
Scleroderma
Path: collagen deposition, LES cant contract, smooth muscle atrophy Pt: acid reflux, dysphagia Dx: manometry, barium, EGD w Bx Tx: PPI Serology to confirm path
CREST SYNDROME
Barrett esophagus
Replacement of nonkeratinized stratified squamous epithelium with intestinal epithelium (nonciliated columnar) in distal esophagus.
Assoc: GERD, esophagitis, esophageal ulcers, increased risk of esophageal adenocarcinoma
The AABCDEFFGH of esophageal cancer
Achalasia Alcohol- SCC Barrett- adenocarcinoma Cigarettes Diverticula (Zenker)- SCC Esophageal web- SCC Familial Fat (obese)-adenocarcinoma GERD- adenocarcinoma Hot liquids - SCC
Achalasia
Path: absent myenteric plexus, LES cant relax
Pt: progressive dysphagia, food gets stuck at GE junction
Dx: barium shows dilated esophagus (birds beak) with distal stenosis
Manometry tells us what type
Tx: myotomy
Achalasia may arise secondary to
T. Cruzi infection (Chagas disease)
Malignancies
Diffuse esophageal spasms
Path: crazy contractions
Pt: MI like feeling in chest
Dx; r/o ACS, then barium, manometry, EGD Bx
Tx: Calcium channel blocker and nitrates as needed
Dysphagia: motility and mechanical. Which is progressive?
Mechanical dysphagia shows progressive- first solids, then liquids
Zenker’s diverticulum
Path: diverticula in esophagus
Pt: halitosis, regurgitate undigested food
Dx:barium- it fills up
Tx: surgery
Difference between stricture and cancer diagnosis
Stricture: upper 1/3, barium symmetry
Cancer: lower 1/3, barium asymmetry
Schatzki’s ring
Path: ring at GE junction
Pt: steakhouse dysphagia
Dx: barium EGD bx
Tx: lyse
Examples of mechanical dysphagia
Benign tumor Stricture Diverticula Malignancy Esophagitis Rings and webs
Examples of motility dysphagia
Achalasia, chagas disease, esophageal spasm, LES issue, scleroderma, nutcracker esophagus
What part of esophagus is SCC found?
Upper 2/3
What part of the esophagus is adenocarcinoma found?
Lowe 1/3
Barrett’s esophagus is associated with increased risk of developing what?
Adenocarcinoma
Sliding hiatal hernia
GE junction and stomach slide up above the diaphragm
