Esophageal Pathology Flashcards
What are general signs and symptoms of a GI pathology?
Dysphagia
Chest pain
Abdominal pain
Changes in eating/bowel habits
Icterus (Jaundice)
What quadrant is the ascending colon in?
RLQ
What is an atresia?
Incomplete failure of a vessel to form
What is a fistula?
Abnormal communication between two vessels
What is the main clinical feature in a patient with an esophageal atresia?
Vomiting upon first feeding almost immediately
What is the main clinical feature in a patient with a tracheoesophageal fistula?
Aspiration pneumonia or choking upon first feeding
What are esophageal diverticula?
Outpuchings of the esophagus
What is a Zenker diverticulum?
Esophageal diverticula located above the upper esophageal sphincter
What is the main symptom in a patient with a Zenker diverticulum?
Chronic fetid halitosis (ass breath)
What is a traction diverticulum also called?
Epiphrenic diverticulum
What is a traction or epiphrenic diverticulum?
Esophageal diverticula located above the lower esophageal sphincter but below the upper esophageal sphincter
Patient presents to your office complaining that no one will talk to him at work. You immediately recognize that his breath is putrid. You order a barium swallow just to get this guy out of your office ASAP. Barium swallow shows a pouch posteriorly on the esophagus above the upper esophageal sphincter. What is the likely diagnosis?
Zenker diverticulum
Zenker’s diverticulum occurs (Above/Below) the upper esophageal sphincter?
Above
What is the most common location of intestinal diverticulosis?
Sigmoid colon
Traction/Epiphrenic diverticulum occurs (Above/Below) the upper esophageal sphincter?
Below
What is an esophageal web/ring?
Concentric, smooth, thin extension of normal esophageal tissue
Where is an esophageal web/ring most common?
Distal esophagus
What is an esophageal web/ring called when it is at the gastroesophageal junction?
Schatzki ring
What is a Schatzki ring?
Narrowing of the lower esophagus due to an esophageal web/ring at the gastroesophageal junction
What syndrome is an esophageal web/ring often associated with?
Plummer-Vinson syndrome
25 year old male patient presents to your office complaining of occasionally having difficulty swallowing. Notable in the patients history is a severe form of iron deficiency anemia. A barium swallow of the esophagus is ordered. Imaging shows a thinning of the esophagus due to a muscular band at the gastroesophageal junction. What is the likely diagnosis? What syndrome is this patient co-presenting with?
Schatzki ring; Plummer-Vinson syndrome
What is esophageal achalasia?
Failure of the lower esophageal sphincter to relax with swallowing with absence of peristalsis in the upper esophagus
How does esophageal achalasia occur?
Loss of or absence of ganglion cells in the esophageal myenteric plexus
How will esophageal achalasia present on a radiograph?
Rat’s tail or “bird-beak” deformity
MEGA-ESOPHAGUS is associated with what pathology?
Esophageal achalasia
What is a treatment modality for an esophageal achalasia?
Nitroglycerin to relax the lower esophageal sphincter (smooth muscle relaxer)
At a business dinner amongst fellow doctors you notice one of your colleagues consistently going to the bathroom after a few bites of his steak. After the third time, you ask him why he keeps going to the bathroom. He explains his condition to you without naming it. Stating that he has trouble holding down food and pain upon swallowing. He details a recent barium swallow stating that his esophagus looked like a birds beak. What is the likely condition that this person possesses?
Esophageal achalasia
What is scleroderma also known as?
Progressive Systemic Sclerosis
What is scleroderma?
Autoimmune disease causing thickening and tightening of the skin with systemic fibrosis deposition in all areas of the body including the esophagus and GI
57 year old female presents to your office complaining of heartburn and decreased movement of her hands. Her skin upon palpation is shiny, and she has a fairly expressionless face. Her hands are cold and stuck in a certain position and are only mobile with passive assistance. A swallowing test is performed and the patient reports noticeable difficulty swallowing. What is the likely diagnosis?
Scleroderma (Progressive Systemic Sclerosis)
What is a hiatal hernia?
A protrusion of the stomach into the chest through an enlarged diaphragmatic opening
What spinal level is the esophageal hiatus?
T10
What are the two types of hiatal hernias?
Sliding and rolling (paraesophageal)
What is a sliding hiatal hernia?
GE junction displaces upward through the esophageal hiatus
What is a rolling hiatal hernia also called?
Paraesophageal hernia
What is a rolling or paraesophageal hernia?
Part of the fundus of the stomach moves through the esophageal hiatus of the diaphragm
22 year old male patient presents to your office complaining of heartburn after meals occasionally resulting in vomiting if he eats too much. He states that he is getting fuller quicker, and has painful difficulty swallowing when eating a meal. When the patient is put supine for palpation, he reports that laying down makes him nauseous and makes his heartburn significantly worse. Without an ultrasound or other imaging, what pathology does this patient likely possess?
Hiatal hernia
What is the most common cause of esophagitis?
GERD
Esophagitis is a risk factor for cancer (TRUE/FALSE)?
t
What are lifestyle choices that can predispose a patient to esophagitis?
Alcohol, chocolate, fatty foods, cigarette smoking, obesity, CNS depressants
37 year old male patient presents to your office with a sore throat and pain upon swallowing. When asking about the patients history, he reports drinking roughly 4-5 drinks a day after work. He recently underwent shoulder surgery and has also been taking 500 mg of morphine at night to help him sleep. An endoscopy is performed. The esophagus of the patient is red and inflamed. What is the likely diagnosis for this patient?
Reflux esophagitis
What is candidal esophagitis?
Infective esophagitis common in immunosuppressive individuals
36 year old male patient presents to your office with difficulty swallowing due to pain. The patient is HIV positive. An endoscopy is performed and the esophagus has evidence of a fungal infection. What is the likely diagnosis for this patient?
Candidal esophagitis
What is metaplasia?
Change in cell type where one cell type is replaced by another in response to stress
Barrett’s esophagus is a form of _________________ metaplasia?
Columnar
Most metaplasia cases are of the ____ type
Squamous
What is the clinical feature of Barrett’s Esophagus?
Heartburn
What is Barrett’s esophagus a precursor to?
Esophageal adenocarcinoma
What is the normal epithelium of the upper esophagus?
Stratified squamous
What is the normal epithelium of the lower esophagus and rest of the GI tract to the anal canal?
Simple columnar
Where is Barrett’s metaplasia most common?
Gastroesophageal junction
What are esophageal varices?
Dilated veins just beneath the mucosa of the esophagus that are prone to rupture and hemorrhage
Where do esophageal varices commonly occur?
Lower 1/3 of the esophagus
What pathologies are correlated strongly with esophageal varices?
Hepatic cirrhosis, chronic alcoholism, and portal venous hypertension
What is the hallmark sign of esophageal varices?
Severe hematemesis (vomiting blood)
The autopsy report of a patient currently has an unknown cause of death. Notable in the persons history is that he is a 67 year old male with a long history of alcoholism. He was diagnosed with hepatic cirrhosis 12 years ago. Upon inspection there is noted dilation of the veins around the persons belly button. An eyewitness reports seeing the patient throwing up blood. What is the likely cause of death for this person?
Esophageal varices resulting in hematemesis
What is caput medusae?
Dilated periumbilical veins indicative of portal venous hypertension
A patient who dies from severe hematemesis undergoes which type of shock?
Hypovolemic
After a rough night at Red’s your 35 year old male patient presents to your office looking hungover AF. He reports vomiting for most of the night and into the morning and sleeping for just a few hours. This isn’t the first time he has been hung over. This time, the patient came in because he noticed that he was vomiting up a little bit of blood. What does this person likely have?
Mallory Weiss syndrome
What is a Mallory Weiss tear?
Linear mucosal tear in the esophagus at the GE junction
What is the unique radiographic appearance of an esophageal spasm?
Corkscrew or “Rosary bead” appearance
27 year old male patient presents to your office feeling like he is choking. He just came from the Carolina reaper store next door and his wife states that he may have tried a sample. For the sake of science, a barium swallow is performed on the spot and a radiograph is taken. Radiograph show a “Rosary bead” appearance to his esophagus. What is the diagnosis?
Intermittent esophageal spasm
What may be a trigger of esophageal spasms?
Spicy or hot foods
What is a benign tumor of the uterus called?
Leiomyoma
What is a leiomyoma?
Benign tumor of smooth muscle origin
What is the most common benign neoplasia of the esophagus?
Leiomyoma
What is the most common malignancy of the esophagus worldwide?
Squamous cell carcinoma
What is the most common malignancy of the esophagus in the US?
Esophageal adenocarcinoma
Esophageal adenocarcinomas occur in the (Lower/Upper) esophagus?
Lower
Squamous cell carcinoma of the esophagus occurs in the (Lower/Upper) esophagus?
Upper
What is the primary risk factor for a squamous cell carcinoma of the esophagus?
Smoking
What is the primary risk factor for a adenocarcinomas of the esophagus?
Barrett esophagus
