Esophagus Flashcards
What seems to be the most prevalent mechanism of GER in both asymptomatic patients (physiological reflux) and patients with GERD (pathological reflux)?
Transient LES
relaxation
3 complications of reflux esophagitis?
Bleeding
-Strictures
-Barrett’s (11%)
The 3 mechanisms that cause GER all require
a low LES pressure (relative to gastric pressure)
4 acid clearance mechanisms?
Saliva
- Gravity
- Esophageal Bicarbonate secretion
- Peristalsis
Complications of GERD?
- erosive esophagitis
- esophageal ulcer
- bleeding
- esophageal stricture
- intestinal metaplasia (Barrett’s epithelium)
- adenocarcinoma arising in Barrett’s epithelium
- other - cough (bronchitis), hoarseness (laryngitis), pneumonia, asthma, pulmonary fibrosis, chest pain, worsening asthma
80% of patients w/ _____ have an associated esophageal motility disorder
Scleroderma (Progressive Systemic Sclerosis)
Achalasia
Failure to relax the LES (absence of inhibitory input)
- High basal tone of LES & incomplete relaxation during swallowing
- Can lead to enlarged, dilated esophagus
Best diagnostic study for evaluating mucosal injury of the esophagus?
Endoscopy w/ biopsy
Causes/pathophysiology of reflux esophagitis?
Multifactorial - 4
Multifactorial
- Decreased Lower Esophageal Sphincter (LES) tone (alcohol, CNS depressants, pregnancy, hypothyroidism)
- Mechanical defect in LES (TE fistula repair)
- Associated sliding hiatal hernia
- Inadequate clearance of refluxed material
Characteristics of malignant tumors of esophagus: Cell type? Most common type worldwide? Epidemiology? Gender? Race? Age?
Usually Epithelial
- Worldwide, squamous cell carcinoma most common
- China, Iran, South Africa, Puerto Rico
- Men:women=2:1 (4:1 in U.S.)
- Blacks>whites
- Age >50 Years
Describe “esophageal” chest pain
Usually:
- “Squeezing, pressure-like sensation”
- Located substernally in the xiphoid area
- May radiate to the arm or jaw (like cardiac angina)
- Not exercise related & is relieved more slowly by
nitroglycerin (unlike cardiac angina)
Does Candida invade the superficial mucosa?
Yes
Esophageal Adenocarcinoma characteristics?
Usually moderate or well differentiated, mucin producing
- Glandular proliferation infiltrating esophageal waal (mucosa and submucosa, etc)
- Atypical low cuboidal cells with vesicular nuclei and prominent nucleoli
- Signet-ring cells
Esophageal Dysphagia: how to distinguish between a motility vs. structural disorder?
Motility- dysphagia to both solids & liquids
Structural- dysphagia to solids that may progress to include liquids
Esophageal obstruction:
A ring vs. B ring?
A ring = muscular B ring = mucosal (note: web also mucosal)
Esophageal Peristalsis
Initiated in Two ways:
- Primary?
- Secondary?
- Swallowing
- Esophageal distension