Esophagus Flashcards
Zenker’s Diverticulum - true or false diverticulum? Why?
False
- mucosa and submucosa herniate through the muscularis externa!
What muscles pull the Zenker’s Diverticulum down and are beneath where it rests?
Cricopharyngeal muscles
What are 4 symptoms of Zenker’s Diverticulum?
- Choking
- Trouble swallowing
- Regurgitation of UNdigested food
- Halitosis
What are 4 symptoms of Zenker’s Diverticulum?
- Choking
- Trouble swallowing
- Regurgitation of UNdigested food
- Halitosis
What is the diagnostic measure for Zenker’s Diverticulum?
Barium Swallow
Treatment for Zenker’s Diverticulum?
Surgery to remove the diverticulum
What causes Achalasia?
Loss of the myenteric plexus
What occurs with Achalasia?
Loss of myenteric plexus
–> LES unable to relax
–> Absent peristalsis
If the LES is tight and unable to relax with absent peristalsis, what is the likely diagnosis?
Achalasia
What is a main symptom of Achalasia and where anatomically?
Retrosternal Dysphagia at the LES
Achalasia presents with retrosternal dysphagia that is progressive how?
Liquids FIRST!! –> Then solids
What is the diagnostic measure for Achalasia and what will be seen?
Barium swallow
= Bird’s beak (narrow LES, dilated esophagus)
What is the treatment for Achalasia?
Heller Myotomy
What is a possible complication when treating Achalasia with a Heller Myotomy?
Loosening the LES too much = GERD
A superficial laceration in the esophagus is commonly called?
Mallory Weis tear
What usually causes a superficial laceration?
Forceful vomiting
What is the sign of a superficial laceration?
Self-limiting hematemesis
If a person is still vomiting blood following a mallory weis tear, what do you do? If it has resolved?
Still vomiting blood –> EGD
If not –> supportive measures
A transmural laceration/perforation of the esophagus is commonly called?
Boerhaave’s Esophagus
What 2 things commonly cause a transmural laceration?
- Iatrogenic injury
- Prolonged wretching
What are 4 possible signs of a transmural laceration?
- Chest pain
- Pneumomediastinum
- SubQ air
- Crunchy heart sounds (Hamman’s Sign)
What are 4 possible signs of a Boerhaave’s transmural tear?
- Chest pain
- Pneumomediastinum
- SubQ air
- Hamman’s Sign (crunchy heart sounds)
What are 2 ways to diagnose a transmural laceration?
- Gastrograffin water soluble swallow study
- CT with ORAL contrast
What are 2 ways to diagnose a transmural laceration?
- Gastrograffin water soluble swallow study
- CT with ORAL contrast
If a transmural laceration is contained, what is the treatment? If not?
Contained = Endoluminal stent
If not = Surgery
What is GERD?
Reflux of acid into the esophagus due to a hiatal hernia or a weakened LES
List some symptoms of GERD?
- Burning chest pain
- Metallic taste in the mouth
- Regurgitation of partially digested food
- Symptoms worse with spicy foods/lying down
- Cough/nocturnal asthma
Initial treatment for GERD?
Lifestyle/meal changes + PPI
What is a possible surgical fix for GERD?
Fundoplication = wrapping stomach around LES to tighten it
What study is needed before a Fundopolication can be done?
24 hour esophageal pH monitoring
If GERD goes untreated what can develop?
Barrett’s Esophagus
What is Barrett’s Esophagus?
Stratified squamous –> Simple Columnar
If Barrett’s esophagus occurs, what can then develop?
Esophageal Adenocarcinoma
Where does Esophageal Adenocarcinoma occur?
LOWER 1/3
If a cancer is in the lower 1/3 of the esophagus, what type is it?
Adenocarcinoma
What are a few risk factors for Esophageal Squamous Cell Carcinoma?
- HPV
- Smoking
- Poverty
- Hot liquids
Where does Esophageal Squamous Cell Carcinoma occur?
UPPER 1/3
If a cancer is in the upper 1/3 of the esophagus, what type is it?
Squamous Cell Carcinoma
What is the shared presentation with Esophageal cancers?
Progressive dysphagia (solids –> liquids)
How are Esophageal cancers diagnosed?
Barium swallow
–> EGD with biopsy
