Esophageal Cancer, Disorders and GI Motility Disorders Flashcards
What are the 2 principal types of esophageal carcinomas?
Most commonly squamous cell carcinoma followed by adenocarcinoma.
What causes have been tied to these esophageal carcinomas?
Adenocarcinoma - associated with chronic acid reflux
SCC - associated with smoking and EtOH abuse
How do both esophageal carcinomas initially manifest?
Due to chronic irritation and inflammation.
- Clinical Presentation as a mechanical obstruction.
- Dysphagia with solids first then liquids.
- Odynophagia
- Anemia, weight loss, adenopathy
How is each esophageal carcinoma typically diagnosed and staged?
Labs: Barium swallow, EGD with biopsy
Treatment: Esophagectomy &/or Chemotherapy
What are the 2 gastroesophageal (anatomical) barriers to stomach acid?
- Crural diaphragm and LES
Understand the difference between paraesophageal and hiatal hernias – what type can require surgical amendment?
Paraesophageal hernias can require surgical amendment
What is achalasia?
Achalasia is tonically contracted LES that fails to relax appropriately during swallows along with a dilated, aperistaltic esophagus.
How is achalasia diagnosed?
Bird-beak appearance, dilated fluid-filled
What are the basic surgical and pharmacologic treatments for achalasia?
Heller myotomy, Balloon dilation, Nitrates/CCBs
What are the esophageal manifestations of systemic scleroderma?
Dilated, aperistaltic esophagus
How is systemic scleroderma treated?
treated with PPI to reduce reflux/gastritis
What is the composition of a Schatzki’s ring and what is it almost always associated with? How does it manifest and how is it treated?
Schazki’s ring is a circumferential mucosal ring in the setting of a hiatal hernia (“steakhouse syndrome” solids dysphagia); dilation during EGD.
What is Plummer-Vinson syndrome and what are 2 symptoms?
Esophageal webs that form in the proximal esophagus in association with iron deficiency anemia;
Symptoms include the web, fatigue, pica etc.
What is the most common disorder of the esophagus?
GERD
Although GERD can often be diagnosed empirically based on history of symptoms and response to PPI medications, how can it be documented and graded?
GERD can be documented and graded based on severity and classified into four grades according to the Los Angeles Classification
What are the symptoms and complications of GERD?
Heartburn, epigastric pain, dysphagia, odynophagia, water brash etc.
How are mild, moderate and severe GERD treated?
Mild/moderate are treated with H2-antagonists/PPIs, antacids temporarily, lifestyle changes;
Severe can be treated by laparoscopic fundoplication
What is gastroparesis?
Delayed gastric emptying resulting in early satiety, bloating, N/V, anorexia, wt loss
Inflammation of the stomach
What are the symptoms of gastroparesis and what are possible underlying causes?
Mechanical, endocrine/metabolic (DM is the most common), CNS, miscellaneous causes;
What are effective treatments for gastroparesis?
Treated by dietary changes and with medications including erythromycin, Zithromax, domperidone, metaclopramide etc.
How is gastroparesis diagnosed?
x
How is GERD treated?
- Lifestyle modifications
- Antacids (Magnesium or Aluminum based)
- H2 receptor blockers
- Proton pump inhibitors
- Promotility agents
- Surgery
What are the symptoms of achlasia?
Dysphagia, Regurgitation of nonacidic material
What are the radiographic findings of achlasia?
- Dilated, fluid-filled esophagus
- Distal bird-beak stricture
