esophageal patho

Question 1

esophageal obstruction

Answer 1

can be mechanical or functional (achalasia)
mechanical = obstruction via tumor
achalasia = defect in tone of LES or inflammatory degermation of neurons in distal esophagus

Question 2

achalasia

Answer 2

neuromuscular disorder (loss of ganglion cells in myenteric plexus) of esophagus leading to inability to relax LES and subsequently a dilated esophagus

S&S = dysphagia, regurg, heartburn, and chest pain

Question 3

esophageal varices

Answer 3

portal hypertension induces development of collateral channels to shunt blood from teh portal circulation to the caval circulation, creating dilated veins

can occur in distal esophagus and proximal stomach

veins are torturous and dilated and prone to rupture

Question 4

treatment for variceal bleeding

Answer 4

pharm treatments, sclerosant injection, banding, balloon tamponade, TIPS, surgical shunt

Question 5

Blakemore tube

Answer 5

something used to occlude esophageal varices during rupture

you need a secure airway and it should not be in place for > 6h

Question 6

mesocaval shunt

Answer 6

this is a portosystemic shunt between the superior mesenteric vein and the IVC to reduce portal hypertension

Question 7

esophagitis

Answer 7

inflammation of the lining of the esophagus, maybe caused by gastric acid, ingested chemicals, immune reactions, infectious agents

Question 8

GERD

Answer 8

esophageal mucosa exposed to gastric acid over time will develop inflammation and injury

caused by decreased LES or increased abd pressure

irritation leads to mucosa inflammation, infiltrated with eosinophils and neutrophils, can lead to ulcerations, infections, and perforations

Question 9

barrett esophagus

Answer 9

complication of GERD - metaplastic conversion of normal squamous esophageal epithelium to columnar epithelium

this dysplasia is a precursor of adenocarcinoma
may involve a genetic predisposition

often diagnosed at advanced stage

Question 10

eosinophilic esophagitis

Answer 10

inflammatory condition in response to allergens in food
eosinophils will be present in esophageal mucosa
dysphagia and intolerance of foods with allergen
treatment - PPIs are of limited efficacy, exclusion of offending allergen, systemic steroids