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
What is the single most important risk factor for adenocarcinoma?
Barrett’s esophagus
What is Barrett’s esophagus? What is the clinical presentation of Barrett’s esophagus?
Complication of GERD
-considered a premalignant condition
Clinical Presentation:
40-60yrs
M>F
Secondary complications: ulceration, bleeding, stricture, malignancy
-30-40X rate of adenocarcinoma with long segment Barrett’s esophagus
(long>3cm)
-salmon or red velvet covered mucosa
What is the histologically sign of barrett’s esophagus?
intestinal metaplasia=presence of goblet cells
-classified as low and high grade dyplasia-50% of high may already have adenocarcinoma
What is the epidemiology of squamous cell carcinoma of the esophagus?
male more than female
most common worldwide
-iran, central china, hong kong, south africa, southern brazil
-more common in AA than white
What is the clinical presentation of squamous cell carcinoma?
insidious onset
patient subconsciously changes diet from solids to liquids
dysphagia and weight loss
9% overall 5 year survival
What are some causative factors of squamous cell carcinoma?
-dietary-hot tea
lifestyle-alcohol/smoking
-esophageal disorders
-achalasia, webs, injury
genetic predisposition
- p53 point mutation
- p16/ink4a mutation
- stepwise acquisition and accumulation of genetic alteratioson
Where does squamous cell carcinoma normally arise?
upper 1/3 ln spread depends on esophageal location upper 1/3-cervical middle-mediastinal or tracheobronchial lower-celiac and gastric
Epidemiology of adenocarcinoma?
> 40 yrs
M>F
White>AA
-associated with obesity and barrett’s
WHat are the clinical symptoms of adenocarcinoma? Prognosis
Difficulty swallowing, progressive weight loss, bleeding, vomiting, chest pain with normal EKG
What are causative factors of adenocarcinoma?
- Barrett’s
- p53 mutation
- amplification of c-ERB-B2, cyclin D1, cyclin E
- mutation in Rb suppressor gene
- allelic loss of p16/ink4
- increased expression of TNF and NFKB
