Esophagus Flashcards
What is oesophageal varices
Dilated submucosal vein @ lower oesophagus secondary to portal hypertension
What is the most common cause of death in cirrhosis?
Oesophageal varices
Explain the venous drainage of the oesophagus
Most blood drains into azygous into superior vena cava
Some blood drain into left gastric vein -> portal vein
Explain how alcoholism can lead to oesophageal varices
Alcoholic – >portal hypertension – >
back up into left gastric vein – >
back up into oesophageal vein – >
submucosal vein dilation = rupture open GI bleed
Explain how oesophageal varices presents and how it differs from Mallory-Weiss syndrome
Present = haematemesis that is PAINLESSSSSSSSSSSSSSSSSSS!!!!!
unlike Mallory-Weiss syndrome
What is Achalasia
Failure of relaxation of lower oesophageal sphincter
due to loss of AUERBACH myenteric plexus
Resulting in disordered motility
What are the two causes of achalasia
Idiopathic +
trypanosome cruzi - Chagas’ disease
Explain the whole pathogenesis of achalasia
Idiopathic/T.Cruzi - chagas – >
Achalasia = loss of Auerbach plexus – >
Increased LOS resting pressure (barium swallow = dilated esophagus + distal stenosis = bird beak)
+
uncoordinated peristalsis – >
Dysphagia of solids+liquids=food rot = shit breath ->
⬆️p(SqCC)
Explain GOR D
Decreased LOS tone – >
gastric acid/food reflux into oesophagus – >
Stress on lower oesophagus cells – >
metaplasia – >
(Sq.cell – >non-ciliated col. epithelium + goblet cell)
What are the risk factors for GORD
Caffeine Hiatal hernia Alcohol Tobacco Obesity Fat rich diet
what are the two types of diaphragmatic hernias
Hiatal hernia + ParaEsophageal hernia
What happens when in a hiatal hernia?
Stomach herniates through oesophageal hiatus of diaphragm
Gastro-oesophageal junction displaced upwards – > cardia pressing against oesophagus = don’t really have a LOS – >reflux = GORD
Gastrooesophageal junction displaced upward – > LOS is still normal @hernia + has tone –>
hourglass appearance
Explain paraoesophageal hernia
Fundus protrudes into thorax = bowel sound heard @lower lung field
If the para-oesophageal hernia is congenital what is its relationship to the lung?
Congenital – >⬇️ space for long to develop – >
lung hypoplasia
What clinical features are associated with GOR D
Asthma + cough
Enamel damage
epIIIIIIIgastric pain = heartburn
OOOOOesophagus UUUlcerated
What kind of metaplasia happened and Barrett oesophagus
Glandula metaplasia
Two types of oesophageal carcinoma is
Adenocarcinoma + squamous cell carcinoma
The oesophagus does not have any glands. How on earth do you still get adenocarcinoma in the oesophagus?
Barrett oesophagus = glandula metaplasia @Lower 3rd of oesophagus –>
dysplasia carcinoma sequence –> adenocarcinoma
What is the most common type of oesophageal cancer in the west
Adenocarcinoma
What is the most common oesophageal cancer worldwide
Squamous cell carcinoma
Where on the oesophagus does oesophageal squamous cell cancer occur
Upper 3rd/middle 3rd
What are the risk factors for Esophageal Cancer
Achalasia + alcohol (S) Barrett's oesophagus (A) Cigarettes (B) Diverticuli zenkers (S) Esophageal Webb (S) Familial + Fat people (a) GORD (a) Hot liquids – Tea (China + Iran) (S) Injury e.g. Lye ingestion
Explain what Plummer Vinson syndrome is
A web = Protrusion of mucosa – >
Block food – >pile up along web – >rot – >
IRRITATE mucosa
Triad:
Atrophic glossitis (beef red tongue) Dysphasia
Iron deficient anaemia
Esophageal webs
Does oesophageal cancer present early or late
Late
