Esophagus Flashcards
Plummer Vinson Syndrome
Combination of proximal esophageal webs and iron deficiency anemia
Most common type of hiatal hernia
Type I or sliding hernia
This type of hiatal hernia is a combined sliding and paracetamol esoohageal hernia
Type III
Gastroesophageal junction remains fixed at the hiatus
Type II
Most common viscera to herniate into the mediastinum in Type IV hernias
Colon
What is a B ring?
Lower esoohageal sub mucosal ring
Lumen diameter of B ring before episodic solid dysphagia occurs
13 mm
True diverticula caused by traction from adjacent inflammation (classically TB)
Mid esophageal diverticula
How is achalasia diagnosed?
Barium swallow xray and esoohageal menometry
Endoscopy– to exclude achalasia
Most sensitive test for achalasia
It identifies early disease before soohageal dilatation and food retention
Manometry
Rare disease caused by loss of ganglion cells within the esoohageal my enteric plexus
Achalasia
What is the diagnostic criteria for achalasia with esoohageal manometry
1) impaired LES relaxation
2) absent peristalsis
Likely explanation for the association between achalasia and ESOPHAGEAL SQUAMOUS CELL CANCER
Stasis esophagitis
Pharmacologic therapy of achalasia given before eating
Nitrates
CCBs
May also use sildenafil
Improves dysphagia in 66% of cases
Injected into LES under endoscopic guidance, inhibits acetylcholine release
Botulinum toxin
Major complication of pneumatic dilatation in the treatment of achalasia
Perforation
Episodes of dysphagia and chest pain attributable to abnormal esoohageal contractions with normal deglutitive LES relaxation
Diffuse esophageal spasm
Only controlled trial showing efficacy medicine for DES
Anxiolytics
Corkscrew esophagus
Rosary beading
Diffuse esophageal spasm
Extraordinarily vigorous and repetitive contractions with normal peristaltic onset and normal latency of the contraction
Jackhammer esophagus
Gold standard treatment in high grade dysplasia
Esophageal only
The MC esoohageal symptoms
Heartburn:pyrosis
Pain exacerbated by swallowing
Odynophagia
Perception of lump or fullness in throat that is felt irrespective of swallowing
Globus sensation
Excessive salivation resulting from a bagal reflex triggered by acidification of esoohageal mucosa
Water brash
Rare entity due to dilatation of excretory ducts of sub mucosal glands
Diffuse intramural esophageal diverticula
MC congenital esoohageal anomaly
Esoohageal atresia
Congenital abn where the esophagus is compressed by an aberrant right subclavian artery
Dysphagia lusoria
Criteria esophageal manometry dx achalasia
Impaired LES relaxation absent peristalsis
Rate of development of CA from
Barrett’s
0.1-0.3 % per year
Spontaneous rupture at GE junction
Boerhaave syndrome
Radiation exposure with increased risk of esophageal strictures
5000 Gcy
MC location pill esophagitis
Mid esophagus near crossing of aorta or carina
Complications of herd
Barrett’s metaplasia
PPI therapy side effects: compromised Vitamin B12and iron absorption
Regluxogenic food that one should avoid in GeRD
Fatty food Alcohol Spearmint Peppermint Tomato based foods
Treatment for Candida esophagitis
Fluconazole 200 14 days
Serpiginous ulcers in an otherwise normal mucosa occurring at the distal esophagus
CMV esophagitis
Rx ganciclovir
Valgancyclovir
God aren’t
Diverticula caused by Traction from adjacent inflammation (TB)
Midesophageal diverticula
Which is a TRUE DIVERTICULA
Diverticula associated with achalasia or distal esophageal stricture
Epiphrenic diverticula
Diverticula associated with esophageal motor disorders
Midesophageal
Diverticula associated with esophageal candidiasis and proximal esophageal structures
Diffuse intramural esophageal diverticulosis
Submucosal glands affected
Efficacy of botulinum toxin for achalasia
66% effective and good for 6 mos
What type of esophagitis
1) proximal esophagus ulcers punctuate and diffuse
2) ulcers solitary and distal
3) multiple rings linear furrows with white punctuate exudate
4) singular deep points of luminal narrowing near the carina, with distal sparing
1) infectious
2) peptic
3) eosinophilia
4) pill
