Esophagus - Pathoma Flashcards
What is an esophageal web?
- Thin protrusion of esophageal mucosa
- most often in the upper esophagus
How do patient’s with an esophageal web present?
- Dysphagia for poorly chewed food
Esophageal web is associated with what neoplasm?
Esophageal Squamous Cell Carcinoma
What three things are present in Plummer-Vinson Syndrome?
- Severe iron deficiency anemia
- Esophageal web
- Big beefy red tongue due to atrophic glossitis
What is a Zenker Diverticulum?
- Outpouching of pharyngeal mucosa through an acquired defect in the muscular wall
- “false” diverticulum
Where does a Zenker Diverticulum arise?
Just above the upper esophageal sphincter at the junction of the pharynx and esophagus
How do patient’s with a Zenker Diverticulum present?
- Dysphagia
- Obstruction
- Halitosis
What is Mallory-Weiss Syndrome?
- Longitudinal laceration of mucosa at the gastroesophageal junction
What causes Mallory-Weiss Syndrome?
- Severe vomiting
- usually due to alcoholism or bulimia
How does Mallory-Weiss Syndrome present?
- Painful hematemesis
What condition are people with Mallory-Weiss Syndrome at risk for?
Boerhaave Syndrome
(esophageal rupture)
What are Esophageal Varices?
- Dilated submucosal veins in the lower esophagus
Esophageal Varices often arise secondary to what condition?
Portal Hypertension
How do patients with Esophageal Varices present?
Asymptomatic OR Painless hematemesis
(risk of rupture always exists)
What is the most common cause of death in Alcoholic Cirrhosis?
Rupture of Esophageal Varices
What is Achalasia?
- Disordered esophageal motility with inability to relax the lower esophagael sphincter
What is Achalasia due to?
- Damaged ganglion cells in the myenteric plexus
- can be idiopathic or secondary to known insult
- Chagas disease
- can be idiopathic or secondary to known insult
What are the clinical features of Achalasia?
- Dysphagia for solids and liquids
- Putrid breath
- High LES pressure on esophageal manometry
- “Bird-beak” sign on barium swallow
Achalasia is associated with an increased risk for what condition?
Esophageal squamous cell carcinoma
What is GERD due to?
reduced LES tone
What are the risk factors for GERD?
- Alcohol
- Tobacco
- Obesity
- Fat-rich diet
- Caffeine
- Hiatal hernia
What kind of cells normally line the esophagus?
Non-keratinizing Squamous Epithelium
What are the clinical features of GERD?
- Heartburn (mimics chest pain)
- Asthma (adult onset)
- Cough
- Damage to enamel of teeth
What are late complications of GERD?
- Ulceration with stricture
- Barrett esophagus
- metaplasia to non-ciliated columnar epithelium with goblet cells
What are the two types of Esophageal Carcinoma?
- Adenocarcinoma
- Squamous cell carcinoma
How does Esophageal Adenocarcinoma arise?
- Don’t normally have glands in esophagus
- Get metaplasia in lower 1/3 of esophagus (e.g. Barrett esophagus)
- cells become glandular
What is the most common type of Esophageal Carcinoma in the WEST?
Adenocarcinoma of the Esophagus
What is the most common type of Esophageal Cancer worldwide?
Squamous Cell Carcinoma
Where in the esophagus does Squamous Cell Carcinoma arise?
middle or upper 1/3
What are the risk factors for Squamous Cell Carcinoma?
-
IRRITATION:
- Alcohol
- Tobacco
- Very hot tea
- Achalasia (rotting food)
- Esophageal web (e.g. Plummer-Vinson Syndrome)
- Esophageal injury (e.g. lye ingestion)
When does esophageal cancer present?
- Presents late
- progressive dysphagia
- weight loss
- pain
- hematemesis
What type of cancer may additionally present with a hoarse voice and cough as key clinical features? Why?
Squamous Cell Carcinoma
- hoarseness → invasion of recurrent laryngeal nerve
- cough → irritated trachea
What regions of the esophagus spread to the Cervical lymph nodes? Mediastinal/Tracheobronchial? Celiac/Gastric?
- Upper 1/3 → Cervical lymph nodes
- Middle 1/3 → Mediastinal/Tracheobronchial nodes
- Lower 1/3 → Celiac/Gastric Nodes
