Esophagus GI issues Flashcards
What is esophagitis?
Inflammation of the esophagus primarily affecting the mucosa. Associated with GERD or other not infectious causes.
What is dysphagia?
Difficulty in swallowing caused by a number of underlying causes: stroke, local trauma, muscle dysfunction, tumor or swelling that obstructs the passage of food
List some neuromuscular causes of oropharyngeal dysphagia
CVA MS Thyroid dysfunction CP Head trauma Bells palsy
List some structural disorders that cause oropharyngeal dysphagia
Oropharyngeal tumors Zenker's diverticulum Thyroidomegaly Prior surgery/radiation Prox. esophageal webs Cleft palate
List some neuromuscular causes of esophageal dysphagia?
achalasia
diffused esophageal spasm
nutcracker esophagus
scleroderms
List some structural disorders that cause esophageal dysphagia?
peptic stricture esophageal rings and webs diverticula carcinoma foreign bodies mucosal injuries ---> infections or GERD
List dysphagia red flags
weight loss odynophagia vomiting early satiety GI bleeding Iron deficiency ---> carcinoma
When does oropharyngeal dysphagia begin?
begins within 2 seconds of swallowing
When does esophageal dysphagia begin?
begins several seconds after swallowing and often in a feeling of food being stuck in lower sternal area
What is the best test for esophageal dysphagia?
Esophagogastroduodenoscopy (EGD)
What is achalasia?
Motliltiy disorder of the esophagus characterized by incomplete relaxation of the lower esophageal sphincter and peristalsis of esophagus smooth muscle.
—-> failure to relax
Short term symptom relief of achalasia?
CCB and Nitrates
What is esophageal spasm?
increase number of uncoordinated peristaltic waves
What is esophageal stricture?
narrowing of the esophagus usually due to gastric reflux can be d/t toxic liquids or solids
What is an esophageal ring (schatzki ring)
narrowing of the diameter of the esophageal lumen usually at the level of the lower esophageal sphincter. This mucosal ring is a thin annual web-like tissue usually at the level of the squamocolumnar junction
What is esophageal web?
a thin membrane that may develop across the lumen of the esophagus usually at the level of the cricoid cartilage
What is esophageal web associated with?
iron def. anemia.
What is Zenker’s Diverticulum?
obstruction of the esophageal introitus that results from mucosal herniation posteriorly between the cricopharyngeus muscle and the inferior pharyngeal constrictor muscle.
S/Sx of Zenker’s Diverticulum?
dysphagia to solids and liquids (MC)
regurgitation
sensation of lump/fullness
cough
halitosis
aspiration pneumonia
weight loss
voice changes
sialorrhea
What is the test of choice to diagnose Zenker’s diverticulum?
Barium swallow
What is a hiatal hernia?
protrusion of intra-abdominal contents through an enlarged esophageal hiatus of the diaphragm
Barrett’s esophagus is predisposed to develop what?
esophageal adenocarcinoma
Clinical sxs and findings of Barretts esophagus?
chronic hearburn
dysphagia w/ solid foods
epigastric TTP
Etiology of Barretts esophagus?
metaplasia is thought to result from re-epithelialization of esophageal tissue injured as a result of chronic GERD
Red flag sxs with Barretts esophagus?
dysphagia
odynophagia
weight loss
vomiting
early satiety
GI bleeding
Iron deficiency
What is Mallory Weiss tear?
longitudinal mucosal laceration in the region of the gastroesophageal junction
OR
nonpenetrating tear of the gastroesophageal junction w/ hx of vomiting
Mallory Weiss tear DDx?
esophageal or gastric varices
esophageal, gastric, duodenal ulcers
gastric erosions
A-V malformation
neoplasms
Mallory Weiss tear hx/clinical findings?
hematemesis
vomiting, retching, or vigeous coughing
tachy
hyoTN
melana
hematochezia
Alcoholics
What are esophageal varices?
dilated submucosal vein that occurs in pts w/underlying portal HTN. Can results in sever upper GI hemorrhage
Clinical presentation of esophageal varices?
hematemesis
hypovolemia
palmar erythema
telangiectasis
gynecomastia
caput medusea (abdominal varices)
What is some clinical presentation of Budd-Chiari syndrome?
IVC thrombosis w/ subsequent hepatocellular carcinoma (Africa and south Asia)
primarily myeloproliferative disorders and underlying hypercoagulable states (United States)
Diagnostic/work up for Budd-Chiari syndrome?
US and color and pulsed doppler
Etiology of squamous cell esophageal neoplasm?
MC in African Americans
Etiology of adenocarcinoma esophageal neoplasm?
MC in whites
esophageal neoplasm ratio of males vs females?
3-4:1 —> highest in the Hispanic population
Link between barretts esophagus and esophageal adenocarcinoma?
familiar clustering –> genetic link between the two
Clinical presentation of esophageal neoplasm?
Dysphagia (MC)
Unintentional weight loss
Hoarseness
Cervical adenopathy
Iron def. anemia
hypercalcemia
Etiology of esophageal neoplasm?
Excess alcohol
Tobacco
obesity
hiatal hernia
high fat diet
mucosal damage
achalasia
chronic GERD
celiac sprue
How common is esophageal neoplasm and where does it rank in number of deaths worldwide?
8th MC cancer, 7th leading cause of cancer death worldwide.
