esophagus Flashcards
histology of esophagus
upper 1/3: skeletal
middle 1/3: skeletal + smooth
lower 1/3: smooth
failure of LES relaxation due to loss of Auerbach plexus (in muscularis externa layer between inner + outer muscular layers) → uncoordinated persistalsis → food stuck in esophagus
achalasia
dysphagia to solids AND liquids
achalasia
dysphagia to SOLIDS ONLY
esophageal scarring - obstruction
cancer
dilated proximal esophagus + constricted lower esophagus on barium swallow
“birds beak”
achalasia
disease due to infection with trypanosoma cruzi infection (makes everything bigger):
cardiomegaly
mega-esophagus →2° achalasia
chagas disease
Calcinosis Raynaud's phenomenon Esophageal dysmotility Sclerodactyly Telangiectasia
CREST syndrome
outpouching immediately above the upper esophageal sphincter
Zenker diverticulum
outpouching near midpoint of esophagus
traction diverticulum
outpouching immediately above LES
epiphrenic diverticulum (above diverticulum)
hematemesis → esophageal variceal bleeding
caput medusa
ascites
associated with alcoholic cirrhosis
signs of portal HTN
treatment of esophageal variceal bleeding
vasoconstrictors: vasopressin
diagnosis of esophageal variceal bleeding
endoscopy (r/o acute PUD bleed)
complete rupture of esophagus due to severe retching
complication: L pneumothorax
risk factor: GERD
Boerhaave syndrome
laceration of GE junction due to severe retching or cough
less serious than Boerhaave
seen in alcoholics and bulimics
Mallory-Weiss tear
symptoms after lying down
associated with obesity, overeat, some trigger foods
GERD
treatment of GERD
H2 blockers
PPI
complication of chronic GERD
barrett esophagus
repeated stomach acid exposure of lower esophagus →
metaplasia in cells of lower esophagus from squamous → columnar + Goblet cells
associated with ↑ risk with esophageal adenocarcinoma
barrett esophagus
most common type
GE junction displaced upward into thorax
“hourglass” stomach constriction at diaphragm
sliding hiatal hernia (weakness in diaphragm)
no change in GE location
stomach lies next to esophagus
paraesophageal hiatal (weakness in diaphragm)
causes of esophagitis
GERD
candida: white pseudomembrane (immunosuppresed)
CMV: large cells, intranuclear + cytoplasmic inclusions with clear, perinuclear halo
HSV: large, pink intranuclear inclusions and host cell chromatin pushed to edges of nucleus
causes of esophageal stricture
GERD
swallow lye (NaOH)
dx: barium swallow
dysphagia (esophageal webs: protrusion of mucosa in upper esophagus)
glossitis
iron deficiency anemia
plummer-vinson syndrome
distal 1/3 of esophagus: where metaplastic change from squamous to columnar has occurred whites risk factors: GERD, BE, smoking, obesity, nitrosamines most common EC in US
esophageal adenocarcinoma
alcohol, tobacco, nitrosamines, achalasia, esophageal webs, strictures
blacks
most common EC worldwide
esophageal squamous cell carcinoma
dysphagia
anorexia
pain
weight loss
esophageal adenocarcinoma
or
esophageal squamous cell carcinoma
what substance is important for relaxing the LES
NO
