Esophagus Pathologies Flashcards
- Congenital OR acquired
- Trachea and esophagus connects
- Can be acquired from:
- malignancy
- infection
- trauma
Tracheoesophageal Fistula (TEF)
How would a TEF appear on x-ray w/ contrast?
Contrast outlines areas with esophageal communication(connection)
- Esophagus fails to develop properly and it ends abruptly into a pouch
- Usually comes with TEFs
Esophageal Atresia
What are the symptoms of TEF?
- coughing/choking when trying to eat
- difficulty breathing
- white frothy bubbles in the mouth
TEFs often lead to severe and fatal ____________
Pulmonary complications (like aspiration pneumonia)
Symptoms of Esophageal Atresia
- coughing
- choking
- cyanosis
when eating
How would esophageal atresia appear on x-ray?
Contrast would pool into the pouch and stay there which shows where the esophagus ends
- A broad term for any type of stomach content reflux into the esophagus
- usually comes with hiatal hernia
Gastroesophageal Reflux Disease (GERD)
What does GERD cause?
- reflux esophagitis
- superficial ulcerations
- burning chest pain
How does GERD develop?
When the lower esophageal sphincter does not work properly
How does GERD appear on x-ray?
- barium is seen returning to esophagus from stomach
- Ulcerations trap a lil bit of contrast so you’ll see dots or streaks on the esophagus
- Barium-filled esophagus’ outer border will look hazy
If there is a risk of perforation, what should we do when performing a contrast exam?
Do NOT use barium, use iodinated CM instead
What is erosion?
loss of superficial epithelial layers of mucosa
What is ulceration?
loss of all epithelial layers of mucosa extending into submucosa
GERD can result in _______
large, discrete and penetrating ulcers in the distal esophagus
What is dysphagia?
Difficulty swallowing
What usually causes dysphagia?
malignancy in esophagus
What would we see on x-ray when patient has dysphagia?
structural abnormalities
masses
barium not getting swallows normally
What is esophageal carcinoma?
Cancer of the esophagus
most commonly found at esophagogastric junction
What does esophageal carcinoma cause?
progressive dysphagia
What is the most believed cause of esophageal carcinoma?
smoking and alcohol
What is used to stage esophageal carcinoma the best?
CT
Radiographic appearance of esophageal carcinoma:
- Flat plaque-like lesions with an ulcer in the middle
- progressive constriction of esophagus as cancer encircles esophagus
- esophageal wall irregularity
How do we indicate early esophageal carcinoma?
Thickening of esophageal lumen
What is diverticula
small bulging pouches that form in the lining of the GI tract
Pharyngo-esophageal pouch that traps food and liquid
Zenker’s or Zenker Diverticulum
Whats the radiographic appearance of Zenker’s
Contrast outlines esophagus and separate posterior out-pouching
The posterior out-pouching of zenkers is caused by?
The cricopharyngeal muscle isnt working properly
What does zenkers cause?
increased risk of aspiration
Veins in the wall of the esophagus are dilated
Esophageal Varices
What causes esophageal varices?
Portal hypertension, blood cant use the liver route so it goes up the gastric and esophageal veins instead causing it get distended.
Radiographic appearance of esophageal varices
Looks like a snake or wavy, Serpiginous thickening of folds which look like oval or round filling defects
What is a fatal complication that can occur with esophageal varices?
Vessels can rupture and cause you to bleed out into your esophagus which can be fatal
What is the most common GI pathology seen on exams?
Hiatal hernia
What is a hiatal hernia?
- When the stomach protrudes THROUGH the diaphragm and into the chest cavity
- might slide, meaning it can slip through diaphragm back n forth
- can be symptomatic or not
What does hiatal hernia cause? (symptoms)
- acid reflux
- Inflamed esophagus (esophagitis)
- ulcers
- heartburn
- SOB
Radiographic appearance of hiatal hernia?
part of the stomach is seen above the diaphragm’s hole for the stomach (hiatus, hence hiatal)
A variety of birth defects that involve abnormal diaphragm development that lets abdominal contents to go into chest cavity which compromises the lungs and its development.
Congenital Diaphragmatic Hernia
Symptoms of congenital diaphragmatic hernia
- Dyspnea
- Tachypnea
- tachycardia
- cyanosis
- abnormal chest development
- Bowel sounds in the chest
radiographic appearance of congenital diaphragmatic hernia?
abdominal contents seen in chest above diaphragm
- Usually in adults from trauma
- Abdominal organs prolapse into thoracic cavity
Acquired diaphragmatic hernia
Symptoms of acquired diaphragmatic hernia?
- Dyspnea
- tachypnea
- tachycardia
- bowel sounds in chest
radiographic appearance of acquired diaphragmatic hernia
Abdominal organs seen in chest cavity
Obstruction of the distal esophagus because it doesn’t wanna work properly (functional obstruction)
Achalasia
Symptoms of achalasia?
- difficulty swallowing food
- food sticking in the esophagus
- chest pain
- cough
Foreign bodies often enter the body via:
aspiration
ingestion
penetration
radiographic appearance of achalasia
progressively dilated esophagus with narrowing at the distal end
If foreign body was ingested, it is often found where?
GI tract or nasopharynx
Radiographic appearance of foreign bodies
Some can be radiolucent or opaque so it depends. It’ll look like whatever it was they swallowed. Radiolucent FBs need CM to see secondary signs
Perforation of the esophagus is often caused by?
severe vomiting or coughing (but vomiting mostly)
What does esophageal perforation cause?
- difficulty swallowing
- fever
- low bp
- tachycardia
- tachypnea
- pain at site
Radiographic appearance of esophageal perforation
- free air in the mediastinum OR periesophageal soft tissue
- contrast media extravasation (leaks out of esophagus MAKE SURE ITS BARIUM)
- If theres a dissection, your gonna see a little lucent line
