GI: Esophagus Flashcards
incidence of cleft lip/ palate
1:1,000 births
Female or male MC for cleft lip
F>M
Female or male MC for cleft palate
M>F
ethnic groups with highest rate of CL or CP
asians
native americans
difference between syndromic and nonsyndromic CL or CP
syndromic: occurs as part of a chromosomal, mendelian or teratogenic syndrome
nonsyndromic: when CL CP occurs alone
epigenetic causes of CLP (3)
EPIGENETIC=non genetic causes
- maternal smoking
- maternal ETOH, steroid or statin use
- maternal folate deficiency
define cleft lip
*when does it start
incomplete fusion of the nasomedial or intermaxillary process
*starts fourth week gestation
what other structures of the face can a cleft lip affect
not only the lip but also:
- external nose
- nasal cartilages
- nasal septum
- alveolar processes
cleft lip unilateral or bilateral?
MC one nostril but can be bilateral
cleft palate:
-define
often associated with cleft lip but can occur alone
- fissure involves the uvula and soft palate
- can extend forward into the nostril and involve hard palate and maxillary alveolar rdige
CMs for CL and CP
- feeding difficulties
* obvious malformation
Evaluation and tx for cleft lip/palate
US and postnatal imaging
surgical correction
speech training
prosthodontist and orthodontit follow up
increase risk of ____ with CLP
middle ear infections
what is the MC congenital esophageal anomaly
Esophageal atrisia
how does the esophagus usually end?
in a blind pouch
what can esophageal atresia be accompanied with?
tracheoesophageal fistual
esophageal atresia MC associated with?
other congenital disorders
Infantile hypertrophic pyloric stenosis
- define
- common cause of?
- incre freq in who?
- why is there stenosis
acquired (or congenital**)
- narrowing and distal obstruction of the pylorus
- common cause of postprandial vomiting
- increased frequency in first born males
- individual muscle fibers thicken– entire pyloric sphincter becomes enlarged and inflexible*
postprandial vomiting want to think of?
infantile hypertrophic pyloric stenosis
why is the vomit with pyloric stenosis nonbilious?
because the food is not making it to the duodenum
what is pyloric stenosis also associated with
other developmental abnormalities
is infantile GERD pathologic in a normal healthy baby?
no
when does infantile GERD become pathologic
when reflux causes troublesome symptoms or complications
causes of infantile GERD
- transient lower esophageal sphincter relaxations
- inadequate adaption of spichter tone to changes in abdominal pressure
define reflux
passage of gastric content into the esophagus
define dysphagia
difficulty swallowing
list two general causes of dysphagia
mechanical (structural) obstruction
OR
Functional (motility) disorders
functional dysphagia
causes?
PROPULSION: caused by NEURONAL or muscular disorders -interfere with voluntary swallowing or peristalsis **achalasia *strokes *PD *MS *Musc Dystrophy
list the primary esophageal motility disorders
DIRECT ISSUE WITH ESOPH ITSELF: achalasia diffuse esophageal spasm nutcracker esophagus hypertensive LES
list the secondary esophageal motility disorders
SEQUELAE OF ANOTHER DZ:
- GERD
- scleroderma (collagen depositions impairs contractility)
- chagas dz
- post-op
list the mechanical dysphagia DZs
structural obstructions***** -Hiatal hernias -rings and webs -esoph stricture -
hiatal hernia
- what is it
- MC where
herniation of the viscera
MC the stomach (GE junction)
goes into the mediastinum -through the esophageal hiatus of the diaphragm
list the rings and webs
Schatzki Ring
Schatzki Ring
- define
- often assoc with? (3)
- etiology
thin membranous narrowing often associated with episodic dysphagia (solids)
Noncircumferential thin membrane in the UPPER/MID ESOPHAGUS–can be assoc with Zenkers
narrows the esophagus**
congenital or acqiuired
Associated with:
- episodic dysphagia to solids
- Zenkers
- Plummer-Vinson Syndrome: triad of dysphagia, esophageal webs and iron def anemia
MC type of hiatal hernia?
-explain it
sliding– GE junction slides into the mediastinum (increases reflux)
esophageal stricture
-define
narrowing of the esophagus due to internal damange
-often from inflammation like GERD, eosinophilic esophagitis, infection, external compression from scarring/fibrosis of mediastinum or CA
how long is food held in the stomach
about two hours
which hormone is the most effective in lowering gastric pH
pepsin
which hormones stimulate proton pump to secrete H+
AcH
Gastrin
Histamine
GERD can be considered a disorder of?
motility because reflux back—- causes issues with gastric emptying
what is GERD
*reflux of acid and pepsin from the stomach to the esophagus–causes esophagitis
*inappropriate relaxation of LES that leads to RETROGRADE flow of stomach contents into the esophagus
*abdominal pressure or delay gastric emptying can contribute to the development of reflux esophagitis
*multifactorial problem
*
GERD is often associated with?
hiatal hernias
Which CN brings sensory and motor innervation to pharynx and larynx?
VAGUS
define gastroparesis
delayed gastric emptying in the absence of mechanical gastric outlet obstruction
gastroparesis assciated with? (3)
DM
surgical vagotomy
fundoplication–
**basically anything to damage vagus nerve
what is the pacemaker of the stomach
Vagus nerve
Upper GI bleed
- anatomic locations
- causes
esophagus
duodenum
stomach
Causes:
- tears
- ulcers
- varices
- severe gastritis
Lower GI bleed
- anatomic locations
- causes
Jejunum, ileum, colon, rectum
Melena suggests
UGIB– the stomach digested the protein in the blood
Hematochezia suggsets (2)
RAPID UGIB (very very large bleeding varcies for ex)
or
LGIB
*bright red because the protein in the blood not digested
Mallory-Weiss Syndrome
- what is it
- anatomical location
- what is resp for the bleeding
- assoc with?
- patho behind it
longitudinal superficial mucosal lacerations/tears
*at the gastroesophageal (GE) junction OR at the gastric cardia aka distal esophagus
- submucosal arteries responsbile–5-10% of acute UGIB
- assoc with: ETOH, overeating and over 75% have a hiatal hernia, bulemic PT, severe gastroenteritis,
PATHO:
- sudden rise in intraabdominal pressure or gastric prolpase into the esophagus (incr in pressure when you retch or vomit)
- hiatal hernias
Mallory-Weiss tears are the cause of ___-___% of all acute ____ GI bleeds
5-10%
UGIB
DDs of Mallory-Weiss syndrome includes what other diseases?
- Reflux esophagitis
- Medication induced esophagitis
- infectious esophagitis
Boerhaave's syndrome AKA? *dsecribe *MC affecting where *associated with MC?
Esophageal Rupture *****
- FULL THICKNESS rupture
- MC affecting left posterolateral wall of the lower (distal esoph)
- MC etiology=esophagus perf during endoscopy w
what are some things that can create an increase in intraluminal pressure to lead to Boerhaave’s syndrome
seizure childbirth coughing straining on defication/forceful valsalva weightlifting
list the different esophagitis
- reflux esophagitis (GERD)
- Infectious–causes ulcerations and lesions
- Eosinophilic esophagitis–chronic
- drug induced/pill induced
- caustic
Medication/pill induced esophagitis
- how does it occur
- typical medications tht can cause it
Prolonged pill contact with the esophagus
etiologies:
* NSAIDs
* bisphosphonates
* iron pills
* BB
* CCB
* vit C
* some ABX….doxycycline, ampicillin
Infectious esophagitis
- MCC?
- other causes
Candida*** esp in immunocomp (HIV, transplants, CA)
CMV
HSV
Eosinophilic esophagitis define
MC in who?
allergic, inflammatory eosinophilic infiltration of the esophageal epithelium
MC in kids with atopic dz (asthma, eczema)
caustic esophagitis
define
esophagitis caused by ingestion of corrosive substances
- alkali: –draino, lye, bleach)
- or acids
Barretts esophagus
-describe the patho
esophageal squamous epithelium REPLACED by precancerous metaplastic columnar cells from the cardia of the stomach
- **precursor to Esophageal adendocarcinoma
- *compliaction of chronic GERD
Barretts esophagus is an example of pre-cancrous state of what kind of CA
adenocarcinoma
what kind of epithelium is in the upper part of esophagus
Squamous epithelium
what type of cells replace the normal epithelium in barretts esophagus
squamous epithelium (normal) is replaced by metaplastic columnar cells from the cardia of stomach
what kind of epithelium is in the cardia of stomach
columnar
Achalasia
- define
- progressin
- MC in what age group
rare form of dysphagia–ACUIRED motor disorder of the esophageal smooth muscles
- idiopathic proximal degeneration of Auerbach’s plexsus (myenteric plexsus)–>leads to increased LES pressure and impaired LES relaxation
- loss of peristalsis
- leads to smooth muscle atrophy in the middle-lower parts of esophagus
MC >50
Zenker’s Diverticulum
- define anatomic location
- why does it occur
- MC in?
pharyngoesophageal pouch (false diverticulum)
- arises in the posterior wall of the hypopharynx–just above the cricopharyngeus muscle
- only involves the mucosa and possibly submucosa
OCCURS because of a natural weakness of the pharynx–Killian triangle–AND with impaired opening of the cricopharyngeus muscle
MC in males
cricopharyngeus muscle ??
UES
Distal/Diffuse esophageal spasm
- define
- patho cause
esophageal motility disorder characterized by severe non-peristaltic esophageal contractions (uncoodrinated contractions)
caused by impaired inhibitory innervation which leads to premature and rapidly propagated contractions
which is increased pressure DURING peristalsis and which is increased pressure NOT DURING peristalsis
Hypercontracticle (nutcracker) esophagus–during peristalsis
Distal/diffuse esophageal spasms–NOT during peristalsis
Hypercontracticle (nutcracker) esophagus
esophageal motility disorder
- increased pressure DURING peristalsis–normally sequential contractions in the smooth muscle of esophagus)
- classically known as nutcracker esophagus
Plummer-Vinson Syndrome:
at risk for?
MC in?
triad of :
- dysphagia
- esophageal webs
- iron def anemia
MC in women 30-60YO
high risk for esophageal CA
Esophageal (shatzki) ring
-define
MC where
-assoc with?
Circumferential** diaphragm of tissue that protrudes into the esophageal lumen
- **MC at the lower esophagus–squamocolumnar junction and accompanied with hiatal hernia
- assoc with corrosive esophageal injury (ingestion of bleach, etc) and eosinophilic esophagitis
Esophageal CA
- name the two types
- which is MCC worldwide?
- which is MCC in US young white males
- Squamous cell Carcinoma
* MCC worldwide - Adenocarcinoma
* MCC in US young white males
Squamous cell espohageal carcinoma
- location MC?
- RF
-usually in the mid- upper 1/3 of esophagus
RF:
- smoking
- ETOH
- WORLWIDE RF:
- HPV
- Poor nutrition
Adenocarcinoma
- location
- where does it start
- major RF?
MC in distal esophagus–esophagogastric junction
STARTS– in the glandular tissue–from stomach the columnar cells migrate to the esophagus–changing the normal squamous epithelium to columnar/glandular tissue=BAD
RF: Barretts esophagus***
smoking and obsetiy too
young white males is MC
esophageal varices
- define
- complication of?
- MCC?
- dilation of the gastroesophageal collateral submucosal veins
- complication of portal vein htn***** this incles HTN in left gastric vein
MCC: cirrhosis (adults)
% of patients with cirrhosis that develop esoph varices?
90%
percent of patients with esoph varices that end up bleeding?
30%
percent of patients with an esophageal bleed that die from the FIRST bleed?
30-50%
percent chance of a re-bleed within the 1st year of initial bleed?
*what is the percent chance of dying from second bleed
70% for re-bleed
if they rebleed: 33% die
why does cirrhosis cause such a high mortality rate for varices
liver produces factors for blood clotting— with cirrhosis the liver is not funct properly and the PT does not have normal amount of clotting factors– therefore when a varicose pops– they bleed A LOT because the body cannot clot it
how can the TIPS surgery for esophageal varices cause encephalopathy
the surgery connects the hepatic vein to a branch off the portal vein—- this dumps more ammonia into the body
- decrease the morbidity from bleeding varices
- but doesnt improve overall mortality
why do we put PT on BB for prophylaxsis of esoph varices
BB will decrease CO, slow HR, and decrease splanchnic blood flow
*prevents splanchnic vasodilation and decreases portal blood flow which all decrease pressure**
