Dysphagia, Esophageal Cancer and Eosinophilic Esophagitis Flashcards
Patho
Oropharybngeal from NM dysfunction or obstruction…can’t form bolus
5,7 - mastication
12- propulsion into hypopharynx
Pharyngeal - 9 and 10…elevation of soft palate, closure of epiglottis, propulsion
9,10 - upper esophageal sphincter - opening and closing
Zenkers diverticulum - post diverticulum prox to cricopharyngeus muscle…disrupts musc continuty so ineffective peristalsis in distal pharynx
Also outpouhcing permites foot and liquid collection
Lastly, as it enlarges, tone of upper esophageal sphincter will inc and result in obstrcution
Etiology of oropharyngeal
Myopathic
Neurologic
Structural
Zenker’s - tends to occur over 60 and have bad breaht with regurg
Food impaction
Esoph stricture
Eosinphilic esophagitis
Esophageal web
Acute pain after swallowing meat incompletely masticated
Older male pts with long duration of reflux
Teen and adults with dysphagia and food impaction
Infants and younger children
Adenocarcinomda
Radiation
Infectious esophagitis
Pill eosphagtits
Rapidly progressing for solids
Lots of causes
HSV most commonly
Large pills allowing prolonged direct contact of pill with mucosa and can create ulcer
Achalasia
Scleroderma
Diffuse spasm
Loss of ganglion cells in myenteric plexus…beak like imaging appearance
Deposition of collagen and fibrosis of distal…cholinergic dysfunction so iminished tone
Endogenous NO synthesis inadequacie…acute chest pain after eating
Oropharyngela vs. esophageal CM
Oro - above suprasternal notch…neck
Initial upon swallowing
Nasal regurg, tracheobronchial asp, hoarseness
Eso - below suprasteran lnotch or chest
Delayed
FOod impaction
Motility problems - liquids and solids
Sturctural - problems more with solid food
Oro may also have CN abnormality
Dx of dysphagia
Oro structural - modified barium swallow
Oro function - modified barium
Esoph struc - upper endoscopy
Esoph func - barium swallow
Mg of dysphagia
Rule out malignancy
Obstruction can be mamaged with baloon dilation
RUle out infection
Tx of oropharyngeal is focused on lifestlye mods if from NM disorders
Adeno vs. squmaous cell
Adeno - GERD, hiatal hernia, obseity
WHite
Distal 1/3
Flat and ulcerated
SCC - cigarette, alocohol, nitrates, pickled vegetabls
AA
Prox 2/3 of esopbhagus most common
Fungating
Esoph adeno path
Associated with Barrett’s esophagus
INtestinal metabpalia - appearance of glands resembling intestinal glands at GE jxn and advancing proximally
Dysplasia - dysplastic cells in the glandular structures
INvasive - formation of ulcerating mass
her2/neu oncogene
Esoph SCC path
HPV, and diets
Progression and epi of esoph cancers
Can spread to lung and liver
Lymphatic may happen
CM and comps of esoph cancers
Key sx are dysphagia and weight loss
Normally only solid foods at first
May show Fe def anemia because of blood loss
Can get an obstruction or a fistula if SCC
Dx fo esoph cancers
Test of choice is upper ednoscopy with visualization of esoph lumen
Squamous cell - middle 1/3 mostly…fungating…invasive islands of squmouas epithelium and keratiziation
Adeno - t GE jxn…islands of atypical glands with irregular architecture that bliterate mucosa
Sceeen men over 50 with long standing GERD sx and other risk factors
Mg and prognosis of esoph cancer
Surgical resection of tumor and adjacent lumph nodes
Esophagectomy is choice
Early detection key to survivla
