Esophageal Disorders B&B Flashcards
GERD is due to a failure of…
lower esophageal sphincter (decrease in tone)
what would histology show in a patient with reflux esophagitis? (3)
- basal zone hyperplasia (epithelium)
- elongation of lamina propria papilla
- eosinophils and neutrophils
what are teh symptoms of GERD beyond heartburn? (3)
- dysphagia (pain with swallowing)
- asthma (adult-onset) due to reflux into respiratory tract
- damage to teeth enamel
which 2 medical therapies are used to treat GERD?
- H2 blockers - famotidine, ranitidine, nizatidine, cimetidine —> block receptors on parietal cells
- proton pump inhibitors - omeprazole, pantoprazole, lansoprazole, esomeprazole —> block H+/K+ pump in parietal cells
what is the danger of accidental lye ingestion?
lye: alkali substance found in household cleaners, may be accidentally ingested by children
cause liquefactive necrosis of mucosa in esophagus —> may result in strictures (fibrous blockages) later in life
of what is Barrett’s esophagus a compilation?
Barrett’s esophagus = metaplasia of esophagus (squamous —> intestinal columnar)
result of long-standing GERD
regular surveillance/endoscopy is done to monitor for esophageal adenocarcinoma
what are the 2 types of esophageal cancer, and how do they present?
squamous or adenocarcinoma
smoking is a risk factor for both, present late with advanced metastasis
presents with progressive dysphagia
where anatomically does squamous vs adenocarcinoma esophageal cancer occur?
squamous: results from damage to upper/middle esophagus - can involve recurrent laryngeal nerve or trachea (cough)
adenocarcinoma: involves lower 1/3 - epithelium transforms to intestinal columnar
to which lymph nodes does the upper, middle, and lower portion of the esophagus drain?
upper (neck) —> cervical nodes
middle (chest) —> mediastinal and tracheobronchial nodes
lower (abdomen) —> celiac and gastric nodes
what are 3 infectious causes of esophagitis?
- candida - white membranes + pseudohyphae on biopsy
- HSV-1 - oral herpes, “punched out” ulcers
- CMV - AIDs patients (CD4<50), linear ulcers
Patient presents with dysphagia and is treated with H2 blockers and PPI for GERD. They are unresponsive to therapy, so a biopsy is taken which shows eosinophils. What is the dx?
eosinophilic esophagitis - note this is dx of exclusion because eosinophils are seen in GERD, as well!!!
what causes achalasia? with what infection is it associated?
achalasia: inability to relax lower esophageal sphincter due to loss of ganglion cells in Auerbach’s plexus (found in muscular layer)
often idiopathic, but associated with chronic Chagas disease (Trypanosoma cruzi)
which layer of the esophagus is involved in Malloy-Weiss Syndrome?
damage to esophageal mucosa at GE junction
causes painful hematemesis (epigastric pain/ back pain + bloody vomit)
caused by severe, chronic vomiting (alcoholism, bulimia)
what are 2 causes of Malloy-Weiss Syndrome?
damage to esophageal mucosa at GE junction
causes painful hematemesis (epigastric pain/ back pain + bloody vomit)
caused by severe, chronic vomiting (alcoholism, bulimia)
BoerHaave Syndrome
transmural esophageal rupture as a result of severe, chronic vomiting/retching
air exits esophagus - can see air in mediastinum on CXR or under skin of neck (“subcutaneous emphysema”)
Pt presents with severe pain in their chest. They have been violently ill for many days with frequent vomiting and retching. CXR shows air in the mediastinum. When the neck is palpated, there is bubbling and crackling felt beneath the skin. What occurred?
BoerHaave Syndrome: transmural esophageal rupture as a result of severe, chronic vomiting/retching
air exits esophagus - can see air in mediastinum on CXR or under skin of neck (“subcutaneous emphysema”)
Schatzki Ring
esophageal ring (extension/protrusion of mucosa) occurring specially at the squamocolumnar junction
common cause of dysphagia to solids
what is the triad of Plummer-Vinson Syndrome?
- iron deficiency anemia
- beefy red tongue (damage to mucosal layer)
- esophageal web (protrusion of mucosa)
most common in middle-age white women
iron deficiency anemia + beefy red tongue + esophageal web =
Plummer-Vinson syndrome - most common in middle-age white women, cause unknown
what is the cause of Zenker’s Diverticulum? where does is classically occur?
mucosa + submucosa protrude through muscular wall at junction of esophagus and pharynx (classically at Killian’s Triangle, just proximal to upper esophageal sphincter)
usually result of chronic swallowing problem in which cricopharyngeal muscle fails to relax, so there is chronic high pressure in pharynx to force the food down
