Esophagus Path II Flashcards
esophageal webs
thin membranes in midline of upper esophagus
pain and difficult swallowing
congeintal/acquired
plummer vinson syndrome
iron deficient anemia - esophageal webs
often progress to SCC of esophagus
also with bullous disease
tx - correct iron deficiency
schatzki ring
narrowing of esophagus
-dysphagia
-ring of mucosal tissue
upper - A rings
lower - B rings
seen wit barium swallow
postcricoid dysphagia, esophageal webs, iron deficient anemia
triad of plummer vinson
aka paterson-brown-kelly
most common hiatal hernia
sliding - GE junction above diaphragm
rolling hiatal hernia
part of stomach herniates esophagus hiatus
paraesophageal
hiatal hernia clinical
50yo or older
95% sliding
risk fx hiatal hernia
heavy lifting cough, sneezing, vomiting pregnancy constipation obesity heredity soking cocaine stress
dull pain in chest, SOB, heart palpitation, dysphagia
hiatal hernia
irritate vagal nerve
acid reflux occurs
zenker diverticulum
pressure in lower pharynx - weak portion of pharyngeal wall forms diverticulum
cricopharyngeus muscle spasm
killians triangle
point of ballooning in zenkers diverticulum
halitosis
smelly breath
-with zenker diverticulum
also dysphagia, regurg, feeling of lump in neck, can get food stuck
achalasia
incomplete LES relaxation, increased LES tone, aperistalsis of esophagus
risk for SCC
achalasia path
failure of smooth m to relax -
-referring to esophagus
failur eof distla esophageal inhibitor neurons during swallowing
chagas disease
trypanosoma cruzi
with achalasia**
diagnosis of achalasia
manometry and barium swallow
heller myotomy
cleave of smooth m in tx of achalasia
nifedipine
sublingual - improves achalasia disease
CREST syndrome
calcinosis raynauds esophageal dysfunction sclerodactylyl telangiectasias
unknown etiology
no tx
anti-Scl 70
lower 2/3 esophagus fibrotic changes**
rubber hose like tube
severe retching/vomiting in alcoholics
mallory-weiss lacerations
- not full thickness
- of esophagus
tx - supportive
cauterize or epi to stop bleeding
boerhaave syndrome
rupture of esophagus
-excessive vomiting/ eating disorder
full thickness - transmural
air in mediastinum - crepitus
majority of esophageal rupture
iatrogenic
-endoscopic procedure or feeding tube
esophageal varices
with portal HTN - alcoholics
also schistosomiasis mansoni or laponicum
massive bleeding can occur
dilated submucosal veins
esophagitis
lye strictures - suicide attempt
also with infection - candida, herpes, bacterial uncommon
and GERD
herpesvirus esophagitis
punched out lesion ulcers
punched out lesion in esophagus
herpesvirus
intranuclear inclusions
-multinucleated cells
GERD
mucosal damage from stomach acid
tx - PPIs, H2 receptor blockers, antacids
statins - reduce barrets and adenocarcinoma
GERD clinical
40yo, M, obese
-heartburn, dysphagia
barret mucosa
-long term risk for adenocarcinoma
barrets esophagus
intestinal metaplasia with GERD
eosinophilic esophagitis
allergic condition
-dysphagia, heartburn, food impaction
food allergy
dx - reflux not responsive to PPIs of pH rules out GERD
biopsy - eosinos in superficial epithelium - minimum of 14 per high power field
NERD
non-erosive reflux disease
-thought to have GERD, but don’t respond to PPIs and no erosion present on EGD
barret esophagus
complication of GERD
->3cm - 30-40x increased risk for aenocarcinoma
squamous metaplasia to glandular - goblet cells**
need biopsy
GIST
gastrointestinal stromal tumor
malignant in esophagus
adenocarcinoma of esophagus
more in male
hispanic
HERD and barrets mucosa increase risk
tobacco and obesity
prognosis poor
h. pylori - reduced risk**
distal third esophagus
common site of adenocarcinoma
SCC of esophagus
90% of malignant esophageal tumors worldwide
50% in US
age 50
hx of heavy smoking/ethanol
males
AAs
poor prognosis
HPV - high risk regions
keratin pearl
squamous cell carcinoma
middle third esophagus
SCC
