esophageal disorders Flashcards
what does GERD represent ?
failure of the LES of the oesophagus
what are the histology findings of reflux esophagitis ?
1- basal zone of the epithelium can be hyperplastic
2- lamina propria papilla elongate
3- eosinophils and neutrophils
what is the treatment for refractory GERD ?
nissen fundoplication
what are the common pharma drugs for GERD ?
histamine H2 blocker
proton pump inhibitors
what kind of damages is associated with the consumption of alkali ?
liquefactive necrosis of the oesophageal mucosa
what are the complications of ingestion of lye ?
strictures
what is barrets esophagus ?
metaplasia of the esophageal lining
intestinal mucosa ( non ciliated columnar epithelium)
due to long standing GERD
what does barrets esophagus predispose to ?
squamous or adenocarcinoma
what is the classic symptom with oesophageal carcinoma ?
progressive dysphagia
what is the difference in location between adenocarcinoma and squamous carcinoma ?
adenocarcinoma - men ta7t
squamous - fo2
what are the symptoms of squamous cell carcinoma of the oesophagus ?
1- hoarsness of voice ( recurrent laryngeal nerve involvement )
2- cough
what are the other causes of esophagitis and what are the associated findings ?
candida- white membranes , pseudohyphae on biopsy
HSV-1 - oral herpes, punched out ulcers
CMV - AIDS , linear ulcers
what is the cause of eosinophilic oesophagitis ?
allergic reaction
immune mediated
what is the classic scenario associated with eosinophilic esophagitis ?
dysphagia
poor response to GERD treatment
eosinophils on biopsy
what is the pathology associated with achalasia ?
inability to relax lower esophageal sphincter
due to loss of ganglion cells in Auerbachs plexus
what are the causes of achalasia ?
often idiopathic
associated with chronic chagas disease
what are the symptoms o achalasia ?
dysphagia to both liquids and solids
bad breath
how is a diagnosis of achalasia made ?
barium swallow - bird beak appearance
esophagela maometry - shows increase in LES tone
what is the difference in manometry findings between scleroderma and achalasia ?
high tone in LES in achalasia
low tone in LES in scleroderma
what are the causes of esophagela varicies ?
usually due to portal hypertension
what is mallory weiss syndrome and what are the associated ?
damage to oesophageal mucosa at GE junction
causes painful hematemesis
what are the causes of mallory weiss tears ?
alcoholism
bulimia
what is boerhaave syndrome ?
transmural rupture of the oesophagus
what are the classic findings associated with boerhaave syndrome ?
air exits the esophagus
air in mediastinum or chest x ray (pneumomediastinum)
air under the skin in the neck - subcutaneous emphysema
where are oesophageal webs and rings ?
these are extensions of the mucosa
webs - upper esophagus
rings - lower esophagus
what are schatzi rings ?
rings at the squamocolumnar junction
involve the mucosa and the submucosa
common cause of dysphagia to solids
what is plummer vinsion syndrome ?
classic triad
iron defeciency anemia
beefy red tongue
esophageal web
common in women
where does zenkers diverticulum occur ?
the classic location is in killians triangle
in the hypopharynx
cleaves the plane between the cricopharyngeus muscle and the thyropharyngeus muscle
what is the pathology associated with zenkers diverticulum ?
failure of relaxation of the cricopharyngeal muscles , causig difficulity to swallow
what are the symptoms of zenkers diverticulum ?
dysphagia
halitosis
what are the causes of meciation induced esophagitis >
secondary to biphosphonates \tetracyclines
NSAIDS\ferrous sulphate
potassium chloride
what is seen on endoscopy in associated with eosinophilic esophagitis ?
esophagel rings
linear furrows on endoscopy
what is seen on barium swallow of distal esophageal spasm ?
corkscrew appearance on barium swallow
