Esophagus Flashcards
What type of cells line the esophagus?
Stratified non-keratinized squamous epithelium
Esophageal Atresia
and
Fistula
a thin cord like non canalized segment of the esophagus associated with a proximal blind pouch and lower pouch leading to the stomach
Fistula: congenital or acquired communication between the trachea and esophagus
*most common TE Fisual
What are the symptoms of esophageal atresia and associated health problems?
Symptoms:
- regurgitation shortly after birth
- aspiration, paroxysmal suffocation, pneumonia, fluid and electrolyte disturbances
Associations
- congenital heart disease (frequently the cause of death in these infants)
- neurologic and GU disease
- GI malformations
- Single umbilical artery
What is achalasia? What are some secondary causes of achalasia?
anti-peristalsis, relaxation of LES with swallowing, increased resting tone of LES
- progressive dysphagia
- nocturnal regurgitation and aspiration
- BIRDS BEAK
chagas disease polio surgical ablation diabetes sarcoid malignancy amyloidosis
What are complications of achalasia?
5% develop SCC
Complications:
candida, diverticula aspiration pneumonia
What is scleroderma?
connective tissue autoimmune disorder -damage to small blood vessels and progressive fibrosis in skin -GI involvment (90%) -esophageal dysfunction-acid reflux and decrease in motility
- difficulty swallowing, reflux symptoms
- atrophy of smooth muscle in lower 2/3 of esophagus
- LES injury (reflux, barrett’s esophagus)
Hiatal hernia
Sliding and Paraesophageal
separation of diaphragmatic crura and widening of the space between the muscular crura and esophageal wall
Complications:
-ulceration, bleeding, perforation, strangulation and obstruction(paraesophageal), reflux esophagitis (sliding)
Mallory Weiss Tear
longitudinal tears at the esophageal junction or gastric cardia
- severe retching or vomiting
- seen in alcoholics
- hiatal hernia predisposing factor
Clinical:
hematemesis, mucosa and submucosa tear
boerhaave syndrome
transmural
usually distal esophageal rupture
-due severe vomiting
-high morbidity and mortality without surgical treatment
Clinical:
- retrosternal chest pain and upper abdominal pain with subsequent odynophagia, tachypnea, dyspnea, cyanosis, fever, shock
- subcutaneous emphysema pneumomediastinum
What reflux esophagitis caused by?
- decreased efficacy of esophageal anti-reflux mechanisms (decreased LES tone)
- sliding hiatal hernia
- slowed esophageal clearance of reflux meateria
- delayed gastric emptying and increased gastric volume
- reduction in the reparative capacity of the esophageal mucosa
What are clinical presentations of reflux esophagitis? What are complications?
- infants to adults
- dysphagia, heartburn, regurgitation of sour brash, hematemesis
- severe chain mimicking a heart attack
- hyperemia on endoscopy
Complication: bleeding, ulceration, stricture, barrett’s esophagus
CMV
owl eye
What is eosinophilic esophagitis?
Adult Symptoms
-dysphagia, food impaction
Children Symptoms
-feeding intolerance, GERD-like symptoms, dysphagia/food impaction
Treatment:
-dietary restrictions to prevent exposure to food allergens
-topical or systemic corticosteroids
What is chemical or pill induced esophagitis?
Mucosal irritants
- alcohol
- corrosive acids/alkalis
- excessive hot fluids
- heavy smoking
- medications (pil induced)
- cytotoxic anticancer therapy
- uremia
—see edema on histology
What are benign tumors of the esophagus?
leiomyomas fibromas lipomas hemangiomas neurofibromas lymphangiomas squamous papilloma condyloma inflammatory polyp
