Esophagus Flashcards
Esophageal atresia/fistula
Disruption of elongation and separation of esophagus and trachea during embryogenesis
Commonly associated with trachea-esophageal fistulas.
Excessive drooling of saliva in newborn
Choking and cyanosis with first feed
Hiatal hernia
Herniation of stomach thru enlarged esophageal hiatus in diaphragm
Sliding type (95%)
Paraesophageal (rolling) type
incompetence of lower esophageal sphincter (LES), especially sliding type
Reflux of gastric contents 🡪 epigastric pain, heart burn
Achalasia/Cardiospasm
dysphagia, odynophagia, reflux of contents, vomiting, aspiration PNA
Progressive dilatation of esophagus above LES, manometry is diagnostic
Risk of developing squamous cell carcinoma (in ~5%)
aperistalsis, partial/incomplete relaxation of LES, of LES
Primary – loss of intrinsic inhibitory innervation of LES and smooth muscle, loss or absence of ganglion cells in myenteric plexus
Mallory Weiss Syndrome
Longitudinal mucosal tears at esophageal gastric junction (*KNOW FOR EXAM)
In alcoholics, after bout of severe retching (dry heaving)
Inadequate relaxation of LES during vomiting
Tear may be only mucosal or transmural
Hematemesis
Esophageal varices
Dilated tortuous vessels (collaterals) in the lower end of esophagus, associated with portal HTN
30-60% in cirrhotic patients, dilated tortuous veins in mucosa and submucosa
Esophagitis
Irritants – alcohol, acids, alkalis, etc 🡪 reflux esophagitis
Infections (herpes simplex/CMV, candidiasis), allergic
Reflux esophagitis (GERD)
decreased LES tone, delayed esophageal clearance, decreased reparative capacity of esophagus, increased gastric volume
Barrett’s esophagus
esophageal mucosa is replaced by metaplastic columnar epithelium because of prolonged injury (ex: chronic esophageal reflux)”
Squamous epithelium is replaced by glandular epithelium
Usually in patients with long standing reflux esophagitis
neopalsms can arise
Esophageal Adenocarcinoma
5-10% of all esophageal carcinomas, lower 1/3rd of esophagus, Barrett’s esophagus is precursor lesion, median age 50 years, more common in whites; salmon covered patch
Squamous cell carcinoma
20% upper 1/3rd of esophagus
50% middle 1/3rd of esophagus
30% lower 1/3rd of esophagus
3 patterns – exophytic, infiltrative, excavated
Diet – deficiency of vitamin A, r
Congenital hypertrophic pyloric stenosis
More common in 1st male child, M:F=3:1, concentric hypertrophy of circular muscle coat of the pylorus
Clinically – regurgitation, projectile vomiting, palpable epigastric mass,
Acute gastritis
Acute, often transient inflammation of the mucosa
Etiological factors – NSAIDs (*KNOW FOR EXAM), excessive alcohol, heavy smoking, ischemia and shock, severe stress (burns, surgery), cancer chemo, systemic infections, uremia
Chronic gastritis
mucosal atrophy and/or epithelial metaplasia”
Etiology – chronic infection with H. pylori (in the antrum), immunologic causes (autoimmune), alcohol and smoking, post-surgical (ex: antrectomy), radiation, granulomatous conditions (Crohn’s disease, sarcoidosis)
Peptic ulcer disease (PUD)
breach in the mucosa of the alimentary tract that extends thru the muscularis mucosae into submucosa or deeper”
Peptic ulcers are chronic, o
Autoimmune gastritis
Autoimmune antibodies against parietal cells and/or Intrinsic Factor 🡪 gland destruction 🡪 atrophy 🡪 loss of acid production (Achlorhydria) or loss of intrinsic factor leads to vitamin B12 deficiency (pernicious anemia)
Mainly involves body and fundus (no parietal cells in antrum, H. pylori is more common in antrum)
