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MHD > Esophagus > Flashcards

Esophagus Flashcards

1
Q

What is a fistula?

A

Abnormal connection between two tubes

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2
Q

TE Fistula

Describe the basic defect

A

Congenital defect resulting in connection between esophagus and trachea

Proximal esophagus undergoes atresia (blind pouch)
Distal esophagus connects to trachea

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3
Q

TE Fistula

Describe some clinical consequences and associations of the defect

A

Any consumed food going into the atretic esophagus will project back out.

Polyhydramnios

Abdominal distension

Some stomach contents will be aspirated into trachea

Often associated with congenital heart disease

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4
Q

Esophageal Web

What is the basic defect?

A

Thin protrusion of esophageal mucosa, most often in upper esophagus

Presents with dysphagia of poorly chewed food

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5
Q

Esophageal Web

Causes a higher risk of….

A

Esophageal squamous cell carcinoma

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6
Q

Plummer Vinson Syndrome

What are the 3 cardinal symptoms?

A

Severe iron deficient anemia
Esophageal web
Beefy red tongue due to atrophic glossitis

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7
Q

Zenker Diverticulum

Describe the basic pathologic issue

A

Outpouching of pharyngeal mucosa through acquired defect in muscle wall, mostly at junction of esophagus and pharynx

It is a false diverticulum

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8
Q

Zenker Diverticulum

Presenting symptoms

A

Dysphagia
Obstruction
Halitosis

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9
Q

Mallory Weiss Syndrome

What is the basic pathologic issue?

A

Severe vomiting (alcoholics or bulimics) causes a longitudinal laceration of mucosa and submucosa at the GE junction

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10
Q

Mallory Weiss Syndrome

Presenting symptoms

A

Painful hematemesis (due to laceration)

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11
Q

Mallory Weiss Syndrome

High risk of progressing to…

A

Boerhaave syndrome

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12
Q

What kind of epithelium is normal for the esophagus?

A

Stratified nonkeratinized squamous epithelium

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13
Q

When is TE fistula most commonly identified?

A

At birth (whereas pyloric stenosis is identified at 2-6 weeks of age)

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14
Q

What is Boerhaave syndrome? What is a clinical consequence/sign of it?

A

Rupture of the esophagus through the entire wall, resulting in air in mediastinum
(Medical emergency)

May cause subcutaneous emphysema (crackling noise when you press on air beneath skin- rice krispies)

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15
Q

Esophageal Varices arise secondary to…

A

Portal HTN

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16
Q

Esophageal Varices

What is the main risk of this condition?

A

Asymptomatic, but there is a risk of rupture that would cause painless hematemesis

Rupture of esophageal varices is most common cause of death in cirrhosis patients

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17
Q

Achalasia

What is the pathogenesis and the ultimate problem?

A

Damage to the ganglion cells of the myenteric plexus results in disordered esophageal motility and inability to relax LES

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18
Q

Achalasia

Clinical Features

A

Dysphagia for solids and liquids
Putrid breath
High LES pressure on esophageal manometry

Bird beak sign on barium swallow

Increased risk esophageal squamous cell caricnoma

19
Q

GERD

Basic pathogenesis

A

Reflux of acid from stomach due to reduced LES tone

May lead to intestinal metaplasia and Barrett’s esophagus over time

20
Q

GERD

Risk factors

A 
Alcohol
Tobacco
Obesity
Fat-rich diet
Caffeine
Sliding hiatal hernia
21
Q

Describe the basic pathogenesis of hiatal hernias

A

Esophagus plugs into stomach after traversing the diaphragm

Classified as sliding or paraesophageal

22
Q

Describe a sliding hiatal hernia

A

Cardia of stomach is above the diaphragm, allowing for reflux and increasing GERD risk

Hourglass appearance of stomach due to normal LES tone below hernia

23
Q

Describe a paraesophageal hital hernia

A

Small outpouching to the side of the esophagus

LES is in place and there are no reflux symptoms, but could cause obstruction and cut off blood supply

24
Q

GERD

Symptoms

A 
Heartburn 
Asthma/cough
Damage to tooth enamel
Ulceration with stricture (fibrotic healing of ulcer in esophagus, narrowing esophageal lumen)
Barrett esophagus
25
Q

What is Barrett esophagus?

A

Nonciliated columnar cells and goblet cells are present in the esophagus

Response of esophageal epithelium to acidic stress
Could progress to dysplasia and adenocarcinoma

26
Q

Infectious esophagitis is commonly caused by what 3 agents?

A

Candida
Herpes simplex virus
Cytomegalovirus

27
Q

Candida Esophagitis

What is commonly seen grossly? Histologically?

A

White depositions down the esophagus (psuedomembranes)

May see pseudohyphae on PAS stain

28
Q

Herpes Esophagitis

What is seen on histology?

A

3 M’s of herpes –
Molding- nuclei are spooning eachother

Multi-nucleation

Marginization- chromatin in nucleus is being pushed to the edge

29
Q

CMV Esophagitis

What is seen on histology?

A

Characteristic owl eye inclusions

30
Q

Eosinophilic Esophagitis

Most commonly seen in what patients? Why?

A

Children with food allergies

31
Q

Eosinophilic Esophagitis

What is the most common treatment?

A

Dietary restrictions

32
Q

Chemical/Pill-induced esophagitis may be caused by…

A 
Mucosal irritants, such as...
Alcohol
Corrosive acids/alkalis
Hot fluids
Smoking
Meds
Cytotoxic chemotherapy
Uremia
33
Q

Adenocarcinoma

What is the most important risk factor?

A

Barrett’s esophagus

34
Q

How is Barrett esophagus diagnosed?

A

Endoscopy- salmon colored area is Barrett’s

Histology- presence of goblet cells and intestinal metaplasia (columnar epithelium present)

35
Q

Adenocarcinoma

Where in the esophagus does it primarily occur?

A

Distal esophagus, where the GERD would have its most pronounced effect

36
Q

Adenocarcinoma

What are the malignant cells?

A

Malignant proliferation of glands arising from preexisting Barrett esophagus

37
Q

Adenocarcinoma

Symptoms

A 
Difficulty swallowing
Progressive weight loss
Bleeding
Vomiting
Chest pain with normal EKG
38
Q

Squamous Cell Carcinoma

Where in the esophagus does it tend to arise?

A

Upper and middle 2/3 of esophagus

39
Q

Squamous Cell Carcinoma

Clinical Symptoms

A

Insidious onset
Patient changes diet slowly from solids to liquids due to dysphagia
Weight loss

40
Q

Squamous Cell Carcinoma

Risk Factors

A 
Irritation of the mucosa
Alcohol
Tobacco
Hot tea
Achalasia
Esophageal web
Esophageal injury
41
Q

Squamous Cell Carcinoma

What is the diagnostic histological feature?

A

Keratin pearls

42
Q

Where would cancer spread from the upper 1/3 of esophagus? Middle? Lower?

A

Upper 1/3 - cervical nodes

Middle 1/3 - mediastinal or tracheobronchial nodes

Lower 1/3 - celiac and gastric nodes

43
Q

Scleroderma

What is the CREST syndrome?

A

Calcinosis- calcium deposits in skin

Raynaud phenomenon

Esophageal dysmotility- atrophy of esophageal smooth muscle in lower 2/3

Sclerodactyly

Telangiectasia

44
Q

Scleroderma

Cause

A

Connective tissue autoimmune disorder.

Damage to small blood vessels and progressive fibrosis of the skin

MHD (57 decks)

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