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Hannah MS2 GI > esophagus > Flashcards

esophagus Flashcards

1
Q

what disorder is seen with “birds beak” on CXR

A

achalasia

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2
Q

define reflux esophagitis

A
  • inflammation of esophagus caused by GERD (LES relaxation) or hiatal hernia
    sx: chest pain, dysphagia, odynophagia

-can lead to hemorrhagic esophagitis

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3
Q

infectious esophagitis RF and key features

A
  • neutrophils are present
  • RF: immunocompromised, diabetes, systemic steroids, radiation, abx
  • pathogens:
    1. candida: yellow white plaque on mucosa
    2. HSV: multiple small DEEP ulcers
    3. CMV: 1+ large SHALLOW ulcers
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4
Q

diffuse vs limited scleroderma antibodies

A

diffuse: Scl-70 Ab, and anti- topiosomerase Ab

limited (CREST syndrome): anti-centromere Ab

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5
Q

what is Killians triangle

A

area of muscular weakness around the level of the upper esophageal sphincter in which Zenkers Diverticulum protrude
(cricopharyngeus M. and inferior constrictor M.s)

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6
Q

define hemorrhagic esophagitis

A
  • inflammation of the esophagus that presents with hematemesis
  • RF: GERD (dyspepsia, water brush), reflux esophagitis
  • sx: dysphagia, odynophagia, sharp chest pain, at night and early morning
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7
Q

risk factors of esophageal variceal bleed

A
  1. size of varices (>5mm)
  2. red wale marks on EGD
  3. liver disease severity (raises hepatic venous pressure)
  4. active alcohol abuse

(others: hepatic venous pressure or previous bleed)
prevention by nonselective beta blockers

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8
Q

risk factors of esophageal adenocarcinoma

A
  • hiatal hernia (causes GERD)
  • GERD
  • BARRETTS ESOPHAGUS
  • obesity

(all factors related to development of chronic GERD and subsequent BARRETTS)

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9
Q

most common type of esophagitis

A

reflux esophagitis

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10
Q

most common diaphragmatic hernia and associated complications

A

sliding hiatal hernia (displacement of GEJ superiorly)
-leads to GERD–> Barretts esophagus –> increased risk of adenocarcinoma
(also but less commonly associated with reflux esophagitis–> hemorrhagic esophagitis)

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11
Q

esophagitis

A

leads to stricture sites

  • it is ulcers with superficial necrosis that leads to fibrosis
  • major sx: odynophagia , dysphagia (second), Chestpain (third)
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12
Q

what can cause acquired esophageal webs

A

eosinophilic esophagitis and plummer vinson syndrome

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13
Q

histological characteristics of Barretts esophagus

A

Histo: distinct mucous vacuoles that stain pale blue by H&E (hematoxylin and eosin)
-dx: EGD and biopsy

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14
Q

treatment risk associated with eosinophilic esophagitis

A

dilitation can cause PERFORATION –>hematemesis, pnuemomediastinum, subcutaneous emphysema, Hammans sign

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15
Q

what is Romana sign

A

painless peri-orbital swelling

seen in achalasia associated with Chagas Dz

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16
Q

pill esophagitis RF and key features

A

RF: NSAIDs, Potassium chloride pills, ronate, abx, injured esophagus

  • EGD shows 1+ ulcers
  • complications: stricture, hemorrhage, rupture
  • tx: stop meds or take with 4oz water and stand for 30 minutes
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17
Q

characteristics of nutcracker esophagus

A
  • esophageal dysmotility disorder caused by hypertensive peristalsis (tight contraction) of the DISTAL portion of the esophagus
  • Unique features:
    1. NL coordinated contractions (except at distal part there is incoordination),
    2. NL relaxation of the LES,
    3. high amplitude pressure on manometry, (high baseline pressure of LES)

(SX same as DES)
sx: intermittent (nonprogressive) esophageal dysphagia (solids and liquids), atypical Chest pain

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18
Q

characteristics of Boerhaves syndrome

A
  • spontaneous TRANSMURAL tear at the GEJ leading to esophageal perforation
  • associated with hx of retching, vommiting, alcohol
  • sx: VERY SICK, PAINFUL hematemesis, shock, subcutaneous emphysema, Hammans sign
  • dx: CXR (seen pneumomediastinum)
    tx: NPO, Abx, stent, surgery
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19
Q

diagnostic triad of achalasia by esophageal manometry

A
  1. incomplete LES relaxation
  2. increased LES tone
  3. aperistalsis of the esophagus
20
Q

characteristics of Schatzki Ring

A
  • DISTAL structural obstruction that causes intermittent (Non progressive) esophageal dysphagia
  • aka “steakhouse syndrome”
  • associated with hiatal hernia
  • dx: barium swallow
  • tx: dilitation
21
Q

LN spread of esophageal cancer

A

upper 1/3- cervical LN
middle 1/3 - mediastinal, tracheobronchial LN
lower 1/3 - Celiac, gastric LN

22
Q

causes of esophageal obstruction (motility and mechanical causes)

A
  1. esophageal dysmotility (nutcracker esophagus, diffuses esophageal spasm, hypertensive LES, scleroderma CREST)
  2. esophageal stenosis / stricture
  3. esophageal webs (plummer vinson syndrome)
  4. Schatszki ring
  5. esophagitis
  6. cancer
  7. achalasia
  8. hiatal hernia

*causes sx: of esophageal dysphagia

23
Q

characteristics of esophageal stricture

A
  • structural esophageal obstruction caused by GERD or eosinophilic esophagitis at the GEJ
  • progressive
  • **GERD pain RELIEVES as stricture worsens !!!
  • MUST do an EGD to rule our cancer
  • tx: dilitation, ppi
24
Q

sx of esophageal SCC

A

progressive dysphagia (obstruction), weight loss, anoxeria, bleeding (hematemesis), hoarseness, cough

25
Q

characteristics diffuse esophageal spasm

A
  • esophageal dysmotility disorder caused by DIFFUSE multiple spastic circular M. contractions via excitatory/inhibitory imbalance
  • Unique features:
    1. COMPLETELY uncoordinated contractions
    2. NL LES function
    3. no high pressure on manometry
    4. corkscrew esophagus
    5. associated with GERD, diabetes, and stress

(SX same as NS)
sx: intermittent (nonprogressive) esophageal dysphagia (solids and liquids), atypical Chest pain

26
Q

characteristics of limited scleroderma

A

CREST syndrome (calcinosis, Raynaulds Phenomenon, esophageal dysmotility, sclerodactyly, telangiectasia)

  • structural, progressive, esophageal dysphagia
  • *May have chronic heartburn
  • Key features: esophageal smooth muscle atrophy, fibrosis–>aperistalsis, microangiopathy
  • tx: sx control
27
Q

characteristics mallory weiss tear

A

longitudinal MUCOSAL/SUBMUCOSAL tears of the GEJ due to severe retching, vommitting, vigorous coughing

  • associated with alcohol intoxication
  • sx: PAINFUL hematemesis
  • dx/tx: EGD

*can lead to Boerhaves Syndrome

28
Q

geographic distrubtution of esophageal adenocarcinoma vs esophageal squamous cell carcinoma

A

adenocarcinoma: US, UK, Cananda, AUS (westernized)
(*more common in men and distal location)

SCC: Iran, China, Hong Kong, (Asia)
(*more common in black men, and middle location)

29
Q

sx of esophageal varices

A

asymptomatic until it ruptures then PAINLESS hematemesis

*esophageal variceal bleed is the most common cause of death in cirrhosis patients

30
Q

characteristics if esophageal web

A
  • structural esophageal obstruction caused by protrusion of esophageal MUCOSA
  • usually in upper (mid/proximal) esophagus and causes oropharngyeal dysphagia, but can arise in distal esophagus and causes esophageal dysphagia
  • *(Structural (solids), intermittent, non progressive dysphagia )**
  • can be congenital or acquired via plummer vinson syndrome or eosinophilic esophagitis
  • *INCREASES RISK OF esophageal SCC
    dx: barium swallow
    tx: dilatation
31
Q

signs, sx, and Risk factors of food obstruction/impaction

A

sx: severe chest pain, dysphagia, odynophagia, choking,
- signs: vommiting, hypersalivation (drooling, foaming)
- RF: schatzi ring, webs, esophagitis, achalasia, cancer stricture (obstructions)

32
Q

eosinophilic esophagitis RF and key features

A

aka feline esophagus, tracheal esophagus

  • RF: GERD, PPI use, Celiac, Crohns,
  • ASSOCIATED with hx of ATOPIC ALLERGIES and food impaction
  • males> females
  • EGD= corrugated multiple circular rings
  • biopsy= eosinophils
  • tx: dilatation (RISK OF PERFORATION)
33
Q

_____ distinguishes between types of esophageal dysmotility

A

esophageal manometry

34
Q

what causes symptoms of orophargnygeal dysphagia

A
  1. proximal esophageal web (plummer vinson)
  2. zenker diverticulum
  3. Sjorgrens Syndrome
35
Q

caustic esophagitis RF and key features

A
  • usually due to acid/drain cleaner bc of accidents in children or suicide attempts in adults
  • sx: severe burning, gagging, dysphagia, drooling, stridor/wheezing
    dx: laryngoscopy, CXR (check for perforation, or pneumonitis)
  • **INCREASES RISK OF ESOPHAGEAL SCC
  • *DO NOT NASOGASTRIC LAVAGE or ORAL ABX
  • admit to ICU
36
Q

achalasia primary and secondary causes

A
  • primary cause: ganglion degeneration of the DISTAL myenteric plexus controlling esophageal inhibitory neuronal stimulation (loss of NO neurons)
  • secondary: Chagas Dz by trypano cruzi
37
Q

characteristics of Sjogrens syndrome (rheumatic dz)

A

sx:

  • dry eyes –> keratoconjuncitivitis sicca
  • dry mouth–> oropharyngeal dysphagia
  • parotid gland enlargement
  • population: postmenopausal females
  • association: Non Hodgkin B cell Lymphoma
    dx: lip biopsy
    tx: supportive
38
Q

characteristics of zenker diverticulum (ZD)

A

-structural esophageal anomaly caused by out pouching of pharyngeal mucosa at/above UES through ACQUIRED muscular wall defect of cricopharynxgeus M. and inferior pharyngeal constrictor M.s (false diverticula)
(*area of muscle weakness is called KILLIANS TRIANGLE)
(structural (solids) , progressive oropharyngeal dysphagia)
-sx: halitosis, spontaneous regurgitation, nocturnal choking, throat gurgling, neck protrusion, voice changes, weight loss, LUNG ABSCESS
-dx: video barium esophagraphy
-tx: upper mytomy /diverticulotomy

39
Q

risk factors of esophageal SCC

A
  • alcohol/ tabacco
  • hot beverages (reason why worse in places that drink hot tea)
  • achalasia
  • esophageal web
  • esophageal injury (CAUSTIC ESOPHAGITIS)
  • tylosis (Howel Evans Syndrome)
  • HIV/AIDS
40
Q

sx and complications of achalasia

A

sx: undigested regurgitation, nocturnal choking, substernal discomfort, adaptive food maneuvers, halitosis
(if chagas = romana sign)

-complications: increased risk of SCC (get EGD to rule out), if untreated it becomes SIGMOID ESOPHAGUS

41
Q

define “pseudoachalasia”

A

caused by cancer invading GEJ

42
Q

define GVHD esophagitis

A
  • basal epithelial cell apoptosis, mucosal atrophy, submucosal fibrosis WITHOUT acute inflammatory infiltrates
    sx: rash, vommiting, odynophagia
43
Q

what is Howel Evans Syndrome

A

tylosis

  • RHBDF2 mutation caused hyperkeratinosis
  • risk factor for esophageal SCC
44
Q

esophageal varices two most common causes

A

cirrhosis of the liver due to
1. alcoholism
2. hepatic schistosomiasis (shistosoma endemic in
Egypt)

45
Q

define plummer vinson syndrome

A
  • occurs mainly in middle aged women
  • iron deficiency anemia (kolionychia) , atrophic glossitis, esophageal webs, angular chelitis

(Plummer Vinson is A GEeK who hits on middle aged women )

46
Q

sensation of lump in throat without anything there or any dysphagia present

A

globus pharyngeus

Hannah MS2 GI (10 decks)

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