Esophagus/Stomach Flashcards
Esophageal structure- derived
Tracheo bronchial diverticulum
UES at C5/C6
Intraabdominal esophagus
crura arise from
Phrenoesopgeal membrane
Foregut
Separation of esophagus/trachea at weeks 4-6
Cricophayngeus muscle attaches, muscle fibers run to T10
Lumbar vert and Anterior long lig
Inserts around esoph, above/below diaphragm
Esophageal layers
Mucosa
Submucosa
Muscularis propria
Adventitia
No serosa, tumors metastasize readily
Esophageal duplication cysts
May cause dysphagia
Cancers have been reported
Tx is surgical
Schatki’s ring
Possible
Treat
Thin membranous ring at squamo-columnar jxn
GERD
Dilation
Zenker’s Diverticulum
Older male
Aspiration/halitosis
GER/GERD
Reflux esophagitis
GER- regurg gastric content
GERD- sx of tissue damage
Inflamm/evidence of injury
Patho of GER/GERD
Dec LES tone caused by
Others
Transiet LES relaxation and reflux of stomach content
Drugs, Alcohol, caff, CNS dep, Tobacco
Hiatal hernia, inc ab pressure, delayed gastric emptying, inc gastric volume
Reflux esophagitis Esophageal
Extra-esophageal
Sx
Heartburn, dysphagia, odynophagia, regurg, hematemesis, CP
Cough/wheeze/sore throat/ear pain
Gold standard to confrim GERD
Ambulatory pH monitoring
Endoscopy parameters
Failure to respond to PPI after 4-8 wks Weight loss dysphagia Older men Fam history of esoph ca Tobacco Hematemesis
Treatment of RE
Weight loss PPI (relapse off therapy) take 30/60 min before meal H2 blocker Surgery (erosive)
Eosinophilic esophagitis sx
Peds
Biopsy finding
Food impaction/dysphagia
Feed intol/failure to thrive/reflux refractory to tx
Furrows/rings in esoph, red eosinophils
EE Associated features
Therapy
Atopy, peripheral eosinophila, failure to respond to PPI
PPi, topical steroids, allergen id, Elim diet
No eggs/milk/soy/nuts/seafood/gluten
Infectious esophagitis
Common pt
Org
Look for
IC
Candida (colonizes esoph)
Yeast/hyphae
Inherent IC
Meds/steroids
Herpes esophagitis
Appearance
Biopsy location
CMV esophagitis
Biopsy location
IC/competent
Multinucleated cells, ground glass appearance of nucleus/vacuoles
Edge of ulcer
Giant cells w intranuclear inclusions
Ulcer bed
Pill induced esoph injury
Doxy- young person, acne Emepromium Bromide KCl Quinidine Iron sulphate NSAIDs Alendronate
Barrett Esoph
Metaplastic columnar epithelium- intest metaplasia/goblet cells replaces squamous epithelium
BE complication of
Abnormal mucosa above
Inc risk of
Surveillance
Therapy for
GERD
GEJ/goblet cells
Adenocarcinoma
3-5 yrs no dysplasia
Annually for low grade dys
High grade
BE dx
Biopsy findings
Endoscopy, directed biopsy
Esophageal sparing tx
endoscopic mucosal resec, RF ablation
Goblet cells, nuclei not neat
Treatment for HGD
Ablation- RF, photodynamic, cryo
Endoscopic mucosal resec
Esophagectomy
Carcinomas of esoph
SCC most common
Adenocarcinoma (think BE, obesity, GERD, tob, low H pylori)
SCC Geographic
Characteristic
Dietary risk
Vitamins
Central China, Iran, South Af
Male, black
Mutagenic compound in fungus contaminated foods
VE, betacarotene, selenium, FE, VD
SCC genetics
chronic mucosal injury
Sx
Area/appearanc
SOX2, cyclin D1, TP53
Lye, achalasia, HPV
Dysphagia, grad obst, aspiration PNA
Middle esoph, fungating
Lacerations
Syndrome
MC
Causes
Boerhaave syndrome
longtiudinal tears in GEJ
Mallory-weis tears
alcoholics
excessive vomiting, retching
transmural tear
Esophageal innervation
Motor
PNS
SNS
ENS
Vagus
Bagus
various
SM and LES
Achalasia
Primary
Secondary
Tx
LES fails to relax in response to swallowing
Dec/absent peristalsis- progressive esophageal dilation and hypertrophy
Idio- deg of nerves
Inflamm destruct MP, chagas
Laparoscopic myotomy, pBD, botox
Cardia
Funds
Antrum
Cells
Mucous
Parietal/chief
Mucous/G
Damaging
Protective
Injury mechanism
Factors for stomach dz
Gastric acids, peptic enzymes
Mucus, bicarb, blood flow, regen
H pylori, NSAID, T/A, reflux, ischemia, shock
H pylori
Location
Not in
Spiral/curled
Urease +. gram neg
Gastric mucosa location
Intestinal mucosa
H pylori factors for survival
Motility via flagellin
Urease- forms bicarb/ammonium
Adhesins
Cag A toxin
H pylori epid
Transmission
Prev high in developing
Inverse with SES
Fecal/oral
Dx of H pylori
Non invasive
Invasive
N- serologic test for AB, urea breath/stool antigen
I= requires endoscopy
Rapid urease, histology, culture, bacterial detec by PCR
H pylori causative of
Neutrophils with gastritis
Chronic gastritis, PUD, gastric carcinoma, MALT
Always H pylori
Urea breath test
Test of choice
Sensitivity affected by
Carbon isotope labeled urea
Metabolized to NH4 and labeled HCO3
Excreted as labeled CO2
Confirming eradification
Ab (off 28 days)
PPI (off 14 days)
Treat PUD
PPI, ab 2 weeks
Eradicate and avoid NSAIDs
PUD
Exudates
Complication
MC cause of ulcer death
deep ulcer, into muscularis propria
PMN and fibrin (think HP)
Necrosis, granulation tissue, scar
Bleeding
Perforation
Acute gastric erosion
Causes
Acute gastritis, acute hemorrhagic gastritis, erosive gastritis, stress ulcers
NSAIDs/Aspirin Alcohol/Tobacoo Stress- trauma/burn/surgery Uremia, food poisonng Chemo
AGE patho
Impaired local defense
Hypersecretion of GA
Mucosal hypoperfusion- shock/sepsis
Dec mucus (aspirin), PG def (NSAIDs)
Stimulate vagal nuclei w inc ICP
AGE presentation
treat
superficial, coagulative necrosis, no inflamm
Often asymptom
Correct underlying cx
Chronic gastritis causes
H pylori, Atrophic (autoimmune/HP)
Chemical- NSAIDs/bile reflux
Autoimmune type A
AB against
Location in the stomach
Presentation
inc risk of
Diffuse, atrophy, metaplasia
parietal cells, IF
Body
Achlorhydria, hypergastrinemia
PA (loss of IF)
Carcinoid tumor, gastric cancer
Multifocal atrophic gastritis type B
Causes
Location in stomach
MC precursor to
Presen
Multifocal, Atrophy, metaplasia
HP, diet, enviro
Antrum
AdenoCa (intestinal)
normal gastrin, no PA
Gastric carcinoma\
Geo
Gastric cancer typical population
Etio
2nd mc
East Asia, C/S America, EE
lack Refrigeratiors, fresh fruits/veggies/inc salt/smoke
Diet/enviro/HP for intestinal
RF for CG
Potential genes
Autoimmune Gastrits
Previous partial gastrectomy- bile reflux
Adeomas
Menetriers dz
CDH1, Ecadherin, BRCA2, tp53
Gastric ca location
presentation
Signet cells indicate
mostly antrum
polypoid, ulcerating
Adenocarcinoma
diffuse stomach cancer
Gastric cancer symptoms
Metastasis
Asympt until late
WL, ab pain, anorexia, NV
Melena, hematemesis, anemia
R/D LN
duodenum, pancreas, liver etc
Lauren classification
Intestinal
Diffuse
Gastric cancer
Gross, micro, intestinal metaplasia, M:F, etiology
I- polypoid, fungating/ well differentiated, universal, more M, diet/HP
D- ulcerative, infiltrative, signet cells, less, even, unknown
