Diseases Of The Oesophagus Flashcards
What are some diseases of the esophagus
GERD/Barrett’s esophagus
Achalasia
Hiatal hernia
Diverticula
Webs/rings
Varices
Mallory Weiss syndrome
What are the triad in achalasia
Incomplete relaxation of the LES
Increases LES tore/pressure
Aperistalsis of the esophagus
What is the cause of achalasia
Damage to the inhibitory ganglion cells of the esophageal myenteric plexus
The primary cause of achalasia is ………..
Idiopathic
What is the disease cause of the secondary cause of achalasia
Chagas’ disease (caused by T. cruzi)
What is the etiology of Chagas’ disease
Destruction of the myenteric ganglion plexus cells of the GIT by T. cruzi
Which disease could cause injury to the vagal nerve
Diabetes mellitus
What is the presentation of achalasia
Dysphagia to both solids and liquids
Regurgitation
Retrosternal pain
Halitosis
How is achalasia diagnosed
Barium swallow
Manometry
CXR
What are the ways through which achalasia could be treated
Endoscopic pneumatic dilation
Heller myotomy
Pharmacological (nitrates, CCB, or botulinum)
What is hiatal hernia
The abnormal protrusion of a portion of the stomach into the thoracic cavity through a lac diaphragmatic hiatus
What are the risk factors of hiatal hernia
Advanced age
Smoking
Obesity
Pregnancy
What are the treatments for hiatal hernia
Lifestyle modifications
PPI
Surgery (hiatoplasty)
What are the two types of hiatal hernia
Sliding and rolling types
Describe sliding hiatal hernia
GE junction and the gastric cardia slide up into the post mediastinum (hourglass stomach). It associates with GERD and ulcerations
Describe the paraesophageal or rolling part of the gastric fundus
Part of the gastric fundus herniates into the thorax. GE junction stays in the anatomical position. It presents with early satiety and pain
What is the most common type of esophageal diverticula
Zenker diverticulum
Describe zenker diverticulum
A false diverticulum (outpouching) as it only contains the mucosa and submucosa
Where does Zenker diverticulum occur
In the weak spot proximal to the upper esophageal sphincter (just above the cricopharyngeal muscle) in the Killian triangle (ie. pulsion type)
What are some symptoms of an esophageal diverticulum
Dysphagia
Halitosis
Regurgitation
Retrosternal pain and pulmonary symptoms secondary to aspiration
What are some other types of diverticula besides Zenker’s diverticula
Middle diverticulum (diverticulum at the trachea bifurcation. Traction type)
Lower diverticulum (epiphrenic diverticulum)
They are rare
How are esophageal diverticula diagnosed
Barium swallowing or endoscopy
What is the treatment for esophageal diverticula
Surgery
What are esophageal webs
Thin protrusions of the esophageal mucosa into the lumen most often in the upper esophagus
Which condition is associated with esophageal squamous cell carcinoma
Esophageal webs
In what condition does esophageal webs occur in
Plummer- Vinson syndrome (severe iron deficiency anaemia, esophageal webs, atrophic glossitis)
What are esophageal (Schatzki) rings
Circumferential narrowing of the lower esophagus. It can be congenital or acquired (Eg. congenital GERD)
Causes dysphagia or rarely complete obstruction of the esophagus
Mention some pathogens or other causes that could cause esophagitis
Candida (white or yellow adherent plaques - pseudomembranes)
HSV-1
CMV
Chemical esophagitis (caused by ingestion of a string acid or base, alcohol, hot drinks or heavy smoking)
Medications (antibiotics or NSAIDs)
Eosinophilic esophagitis
Associated with atopy and allergic disorders (Eg. Food allergies)
What are some presentations of esophagitis
Dysphagia
Heartburn
Food impaction
What are esophageal varices
They are extremely dilated submucosal veins in the lower third of the esophagus (drained by the left gastric vein). Most commonly occurs as a consequence of portal hypertension (cirrhosis or portal vein thrombosis) and can lead to sudden onset of severe upper GI bleeding (hematemesis or melene) which could be fatal
Mallory Weiss syndrome (longitudinal linear laceration or tear in the mucosa at the GE at the lower oesophagus) could also cause it
What is Mallory Weiss syndrome associated with
Forceful repeated vomiting (Eg. Alcohol and bulimia) can lead to painful acute upper GI bleeding and in extreme case to Boerhave syndrome (spontaneous rupture of the esophagus results in mediastinitis and subcutaneous emphysema)
Esophagitis could manifest in immunocompromised patients
True or false
True
Hourglass stomach is associated with what kind of condition
A sliding hiatal hernia
What is Plummer-Vinson’s syndrome
Plummer-Vinson syndrome is defined by the classic triad of dysphagia, iron-deficiency anemia and esophageal webs
What is Mallory-Weiss syndrome
A tear in the esophagus mostly found in the esophageal junction
