esophageal disease Flashcards
longitudinal tears at GE junction or proximal gastric mucosa. usually due to severe retching associated with alcoholism
esophageal laceration
incomplete tear on the gastric side of the gastroesophageal junction which may extend to the distal esophagus
mallory-weiss syndrome
complete rupture at the lower thoracic esophagus which leads to bleeding into the posterior mediastinum
boerhaave’s syndrome
2 antireflux mechanism
- lower esophageal sphincter
2. crural diaphragm- external sphincter
three different mechanisms of LES incompetence in gastroesophageal reflux
- hypotensive LES
- increased intraabdominal pressure- obesity and pregnancy
- TLESR/ inappropriate LESR
factors that increase LES pressure
- Proteins
- gastrin
- metaclopramide
factors that decrease LES pressure
- fatty foods
- nicotine
- theophylline
transient lower esophageal sphincter relaxations motility disorder (LES hypotension)
GERD
NERD
GERD that is non-erosive
mechanism of heartburn in pregnancy
- hormonal due to the increase in estrogen and progesterone that leads to a dysfunctional LES
- mechanical with the increase in intra-abdominal pressure
treatment (2)
- lifestyle modifications
2. med such as antacids, H2A and PPI
causes of esophagitis (4)
- reflux
- pill-induced- ulcer formation with acne meds
- infectious- immunocompromised patient
- eosinophilic- allergic patient
histo triad for reflux esophagitis
- intraepithelial eosinophilia
- Basal zone hyperplasia
- papillary elongation
infectious esophagitis can be caused by
candida and herpes simplex
what is important about the diagnosis of eosinophilic esophagitis
the count we need > 15 eos in proximal and distal esophagus–> the eos limited to the esophagus
eosinophilic esophagitis results in barrett’s and malignancy
nope- no known long term effect
treatment is PPI, inhaled steroid and lifestyle changes to prevent food impaction
distal squamous mucosa is replaced by metaplastic columnar epithelium as a response to chronic injury from acid reflux
Barrett’s
barretts is a major risk for
esophageal adenocarcinoma
barrett’s treatment
- PPI
- radio-frequency ablation for those with dysplasia
- endoscopic surveillance every 1-3 years
esophageal cancer is the ninth most prevalent cancer worlwide but less than 1% of all cancers in US, but incidence has been increasing with a shift from
squamous cell carcinoma to adenocarcinomas
reduced risk in developing esophageal adenocarcinoma
H.pylori infection- there is lower gastric acid
location of esophageal adenocarcinoma
distal esophagus
location of esophageal squamous cell CA
more proximal esophagus
risk factor for esophageal squamous cell CAA
tobacco which might be synergistic with alcohol
esophageal squamous cell CAA
- common in men or female
- ethnicity
- men
2. african american
invasion into muscularis propria at presentation but 30-40% have invasion of adjacent mediastinal structures causing fistulas and 50% have lymph node metastases
esophageal squamous cell CAA
prevention of esophageal cancer
- PPI
- aspirin and NSAIDs
- statins
esophageal dysphagia
food sticks
oropharyngeal dysphagia
difficulty in initiating swallowing with coughing, choking and nasal regurgitation
solid food only dysphagia is
MECHANICAL OBSTRUCTION
solid food and liquids dysphagia
NEUROMUSCULAR DISORDER
solid food only dysphagia is a mechanical obstruction
- progressive symptoms
- intermittent symptoms
- progressive symptoms - chronic heartburn? peptic ulcer. age> 50 yr? carcinoma
- intermittent symptoms - esophageal ring
solid food and liquids dysphagia is a neuromuscular disorder
- progressive symptoms
- intermittent symptoms
- progressive symptoms - chronic heartburn? scleroderma. respiratory symptoms? achalasia
- intermittent symptoms- chest pain? diffuse esophageal spasm
esophageal ring can be identified by
barium swallow
inflammatory disorder at LES with selective destruction of NO containing neurons. Unopposed ach action at lES leads to excessive contraction
achalasia
achalasia can be diagnosed with
- barium swallowing- bird’s beak
2. motility tracing- LES hypertension
treatment of alchalasia
- nitrates, calcium channel blockers
- pneumonic dilation
- myotomy
esophageal gastric junction outflow obstruction results in
incompletely expressed achalasia due to the high pressures LES
distal esophageal spasm has ______ LES function and multiple premature contractions
normal
jackhammer esophagus
hypercontractile motility diosrder with prolonged high amplitude contractions but the LES pressure is normal
weak, low amplitude contractions with low LES pressure . associated with reflux esophagitis
scleroderma
