Esophageal Diseases Flashcards
What is atresia?
the esophagus segment comprises a thin, noncanalized cord with a proximal blind pouch connected to pharynx and distal pouch leading to stomach
How is it discovered after birth?
immediate regurgitation after feeding
How can atresia be treated?
surgery
What are the late complications?
- GERD - acid reflux as stomach acid or bile irritate the esophagus lining 2. esophagitis - inflammation of the stomach caused by stomach acids backing up into the esophagus, infection, some medication and allergies
Describe what atresia looks like?
- associated with fistula connecting the upper or lower pouch with the trachea or a bronchus 2. most common is a blind upper segment, fistula between blind lower segment and trachea
What is achalasia? (cardiospasm, megaesophagus)
Esophageal motor disorder characterized by lack of progressive peristalsis and partial/incomplete relaxation of lower esophageal sphincter (LES) preventing passage of food into stomach
What are the causes?
Chagas’disease (Trypanosoma cruzi destroys myenteric plexus of esophagus - common in South America)
What are the symptoms?
- progressive dilation of esophagus above LES 2. variable wall thickness 3. absent myenteric ganglia in middle of esophagus 4. non gastric regurgitation
Condition that can potentially arise cause of achalasia?
5% risk of esophageal squamous cell carcinoma
Describe achalasia on a micro level?
depletion/absence of ganglion cells
What is a hiatal hernia?
condition involving herniation of part of the stomach through an opening in the diaphragm - separation of diaphragmatic crura and widening of space between muscular crura and esophageal wall
Which hernia is the most common?
sliding hernia - 95% : protrusion of stomach above diaphragm creates bell shaped dilation
Describe the incidence?
1-20% of adults + increases with age 2. only 9% with sliding hernias have heartburn or regurgitation of gastric juices into the mouth
How is this type of hernia accentuated?
- bending forward 2. lying supine 3. obesity
What are the complications of this hernia?
- ulceration 2. bleeding 3. perforation 4. strangulation
What are lacerations? (Mallory-Weiss syndrome)
longitudinal tears at gastroesophageal junction or in proximal gastric mucosa
What are the causes?
severe wretching - associated with alcoholism (vomiting and reflux with alcoholic stupor)
Describe the tears?
can be mucosal or full thickness
Consequences of lacerations?
cause 5-10% of upper GI bleeds but are usually limited and surgery is not necessary
Describe the treatment?
- support 2. vasoconstrictors 3. transfusions 4. balloon tamponade
What is Boerhaave syndrome?
full thickness tear/esophageal rupture - may be lethal
What are varices?
- Dilated tortuous vessels, usually submucosal, that develop due to portal hypertension 2. Collaterals in lower esophagus divert flow from portal vein, through coronary veins of stomach, into esophageal veins, into azygous veins, into vena cava
Describe the incidence?
present in 90% of cirrhotic patients - associated with alcoholism
What are the consequences of varices?
may rupture and cause massive hemorrhage