Esophagus Flashcards
Barrett’s Esophagus
intestinal metaplasia of the esophagus
can be a complication of GERD (10-20% pts)
Barrett’s PP
squmaous to columnar epithelium
Barrett’s may lead ot?
adenocarcinoma of the esophagus (distal third)
squamous cell lesion tend to occur in the proximal two-thirds
Esophagitis
rare, except in immunocompromised persons
causes os esophagitis
Fungal (Candida), viral (CMV and HSV), HIV, mycobacterium tuberculosis, EBV,
esophagitis main CF
odynophagia (painful swallowing) or dysphagia (difficulty swallowing)
PE may show fever, lymphadenopathy, or rashes
what would endoscopy in esophagitis reveal?
large, deep ulcers (CMV or HIV). infx w/ HSV -multiple shallow ulcers)
candidal infxn shows white plaques
esophagitis definitive dx?
cytology of culture from endoscopic brushings
tx of esophagitis
fluconazole or ketoconazole
acyclovir for HSV
Ganiciclovir for CMV
Mallory-Weiss tear?
linear mucosal tear in the esophagus, generally at the gastroesophageal junction
what can cause a MW tear>
forceful vomiting or retching–> hematemesis
also often associated with alcohol use
how are MW tears dx?
with endoscopy
tx of MW tear
most resolve w/o tx, a ppi may be used if active bleed is resovled
*may need ingx of epi or thermal coag if bleeding doesn’t resolve on its own
what are esophageal varicies?
dilation of the veins of the esophagus, generally at distal end
what is the underlying cause of esophageal varicies?
portal htn due to cirrhosis from aocohol abuse or chronic viral hepatitis
what can make esoph. varicies bleed?
NSAIDs (hepatic vein obsturction)
what is Budd-Chiari syndrome?
thrombosis of portal vein, leading to varices: y occlusion of the hepatic veins that drain the liver. It presents with the classical triad of abdominal pain, ascites, and liver enlargement. The formation of a blood clot within the hepatic veins can lead to Budd–Chiari syndrome. The syndrome can be fulminant, acute, chronic, or asymptomatic.
how do most pats present with e/ varicies?
painless upper GI bleed that can be bright red frank bleeding or coffee ground in appearance
what are complications of eso. varicies?
hypovolemic shock
how are eso. varicies dx?
dx established when a pt with signs of cirrhosis presents wtih hematemesis- endoscopy localizes the bleed
asx until they bleed
tx of esopha. var?
prevention can be done wtih BB +/- isosorbied mononitrate (relaxies smooth muscle)
what is the method of tx for those who failed meds w/ esophageal varicies?
endoscopic band ligation
how is bleeding controlled with esop/ varicies?
endoscopic band ligation is the preferred therapy for acute bleed
octreotide can also be used
hemodynamic support
what are the most common esophageal neoplasms?
squamous cell carcinomas and adenocarcinomas
where and what is barrett esophagitis associated with?
adenocarcinomas and distal third of the esophagus
where do squamous cell carcinomas occur?
proximal 2/3
where can esophageal neoplasms spread?
to the mediatinum bc eosph. has no serosa
what are caustic agents of esophageal can?
cigarette smoking, chronic alcohol use, nitrosamines, fungal toxins, hot foods, mucosal abnormalities, poor oral hygiene, HPV
what is the s/sx of esophageal cancer?
progressive dysphagia for solid food, and marked weight loss
heartburn, V, and hoarseness may occur
what is the best initial test for esoopha. can dx?
biphasic barium esophagram-visualized the lesion
what is used for diagnosis of E. C?
endoscopy w/ brushings
what can be used for eso. Cancer stagin?
endoscopic sonogrpahy and CT
how is eso. cancer tx?
generally surgical. +/- adjunctive chemo
