Esophagus Flashcards
Where does the esophagus lie in reference to the trachea?
Posterior
Which esophageal sphincter is more associated with pathologies?
Lower
Atresia, tracheal fistula, and stenosis are examples of what kind of esophageal lesions?
Mechanical (diagnosed just after birth)
What are two examples of functional lesions of the esophagus?
Aperistalsis
Achalasia
Ectopic gastric mucosa affects what portion of the esophagus?
Upper 1/3
What is the cause of irritation with ectopic gastric mucosa in the esophagus?
Gastric acid irritates the esophagus
What is the major concern with ectopic gastric mucosa in the esophagus?
Rick of cancer development
Is ectopic gastric mucosa usually symptomatic or asymptomatic?
Asymptomatic
Esophageal varices is secondary to what condition?
Portal hypertension (cirrhosis)
What is achalasia?
Failure of lower esophageal muscles to relax
What is the triad seen with achalasia?
1 Incomplete LES relaxation
2 Increased LES tone
3 Esophageal aperistalsis
What is the treatment for achalasia?
Botulinum toxin, pneumatic dilatation
What is the most common form of achalasia?
Primary (loss of inhibitory innervation to LES)
What is the cause of secondary achalasia?
Co-morbitidy that impairs esophageal functioning
Chagas disease, irradiation, diabetes, and polio would be examples of conditions that could lead to what form of achalasia?
Secondary
Where is the inflammation specifically seen in secondary achalasia?
Auerbach’s plexus
What is the specific location for esophageal varices?
Distal esophagus (closest to liver)
What disease develops in 90% of cirrhosis patients?
Alcoholic liver disease
What two conditions can result from liver cirrhosis?
Alcoholic liver disease
Hepatic schistosomiasis
What makes 50% of first-time bleed with esophageal varices lethal?
Possibility for hypovolemic shock
What condition can arise due to toxins accumulating in the CNS from liver failure and advanced cirrhosis?
Hepatic encephalopathy (hepatic coma)
What is unique about the symptomatology of esophagitis?
Symptoms do not correlate well with the degree of inflammation
What is the term for pain when swallowing?
Odynophagia
What are the symptoms of esophagitis?
Odynophagia and dysphagia
What is the most common cause of esophagitis?
Reflux esophagitis (GERD)
GERD affects what percent of U.S. adults?
25-40%
What kinds of things can lead to reflux esophagitis?
LES dysfunction, increased gastric volume, obesity, hiatal hernia, pregnancy, smoking, alcohol
What is the most common outpatient gastrointestinal complaint?
GERD (esophagitis)
What is the usual age of onset for GERD?
Over 40 years
“Sour brash” is associated with what condition?
GERD
What is the treatment for GERD?
PPIs (omeprazole)
What are the three forms of esophagitis?
1 GERD
2 Chemical
3 Infectious
What kinds of things can lead to chemical esophagitis?
Tobacco, alcohol, pill-induced, hot liquids, irradiation, chemotherapy, increased consumption of acidic or alkaline foods
Infectious esophagitis most commonly develops secondary to what condition?
Ulcer
What kind of esophagitis arises in immunosuppressed patients?
Infectious
What are viruses that can cause infectious esophagitis?
HSV, CMV, fungal viruses
What kind of esophagitis arises secondary to AIDS?
Candida esophagitis
Which is a worse condition: esophageal varices or esophageal lacerations?
Esophageal varices
What is the most common type of esophageal laceration?
Mallory-Weiss tear
How can one develop an esophageal laceration?
Trauma, severe coughing/vomiting, primal scream therapy
What is the most common location for an esophageal laceration?
Gastroesophageal junction
Mallory-Weiss syndrome involves the relaxation of what muscles?
Lower esophageal sphincter (LES)
What visual and painful sign is seen in 50% of upper G.I. bleeds?
Hematemesis (vomiting of blood)
What are the treatments used to treat an esophageal laceration?
Vasoconstrictive medications, transfusions, balloon tamponade
What procedure is used to diagnose an esophageal laceration?
Esophagoscopy (endoscopy)
What is the clinical term for a widening of the esophageal hiatus allowing the stomach to protrude into the thorax?
Hiatal hernia
What is the most common type of hiatal hernia making up 95% of cases?
Axial (SLIDING down midline)
What type of hiatal hernia involves a “bell-shaped” dilation?
Axial
What is the less common type of a hiatal hernia?
Non-axial (ROLLING slightly off midline)
Are hiatal hernias common?
Yes, 20% of all adults
What is the age bias for a hiatal hernia?
70% of those with them are >70 years old
What type of hiatal hernia is most likely to be symptomatic?
Non-axial
What are the symptoms of a hiatal hernia when they’re present (usually asymptomatic at 90%)?
GERD-like esophagitis
Perforation and bleeding
What differential diagnoses are associated with a hiatal hernia?
GERD
Angina pectoris
How could on differentiate between angina pectoris and a hiatal hernia?
Pain from angina pectoris would be triggered by physical activity
What kind of preneoplastic lesion can be caused by overfilling the stomach and is associated with esophageal metaplasia?
Barrett esophagus
What is the cellular change seen in Barrett esophagus?
Stratified squamous changing to columnar epithelia
Why is the change to columnar epithelia with Barett esophagus detrimental?
Goblet cells are then present and able to secrete gastric mucosa which damages tissues in the esophagus (possibly leading to cancer)
What is the location for Barrett esophagus?
Distal esophagus
In what country to we see an increased risk of Barrett esophagus?
U.S.A.
What is the gender, race, and age bias for Barrett esophagus?
Males (4X) who are Caucasian and 40-60 years old
What are other risk factors for Barrett esophagus?
Obesity and familial history
What percentage of symptomatic GERD patients will have Barrett esophagus?
10%
What condition involves red, velvety mucosa developing in the esophagus that appear as bands or “tongues” that extend superiorly as pre-cancerous metaplasia?
Barrett esophagus
A failure of closure of which esophageal sphincter is usually to blame with Barrett esophagus?
LES
Barrett esophagus increases the risk of what kind of cancer by 30-100X?
Esophageal adenocarcinoma
What is the treatment for Barrett esophagus?
Stop irritants, omeprazole (PPIs), surgery, laser ablation
How does omeprazole (PPI) treat Barrett esophagus?
Slows gastric acid production
What is the term for a benign, smooth muscle tumor?
Leiomyoma
Why is a leiomyoma in the esophagus detrimental?
Interferes with peristalsis
What type of tumor makes up 50% of U.S. esophageal cancers?
Esophageal adenocarcinoma
What are the risks for developing an esophageal adenocarcinoma?
U.S., Barrett esophagus, GERD, Caucasians, males (7X), obesity, irradiation, tobacco
What is the most common type of esophageal cancer WORLDWIDE?
Squamous cell carcinoma (90%)
Increased consumption has shown to decrease the risk of which esophageal tumor?
Adenocarcinoma
Are esophageal carcinomas usually diagnosed early or late?
Late (poor prognosis due to early invasion of lymphatics)
What genetic mutation is commonly seen with an esophageal adenocarcinoma?
TP53
What type of esophageal tumor is seen in the distal 1/3 of the esophagus?
Esophageal adenocarcinoma
What type of esophageal tumor is seen in the middle 1/3 of the esophagus?
Squamous cell carcinoma
What is the age, race, and gender bias for esophageal squamous cell carcinoma?
> 45 years of age, African Americans males
What viral infection can irritate the esophagus and lead to squamous cell carcinoma?
HPV
Nitrosamines can irritate the esophagus and lead to which type of esophageal cancer?
Squamous cell carcinoma
