GI: Esophagus Flashcards
What is tracheoesophageal fistula
congenital defect resulting in a connection between the esophagus and trachea
what is the most common variant of tracheoesophageal fistula
proximal esophageal atresia with distal esophagus arising from trachea
what are clinical symptoms of tracheoesophageal fistula
vomiting
polyhydramnios
abdominal distension
aspiration
what is esophageal web
thin protrusion of esophageal mucosa, most often in upper esophagus
clinical presentation for esophageal web
dysphagia for poorly chewed food
dysphagia
difficulty or discomfort in swallowing
esophageal web increases the risk for what
esophageal squamous cell carcinoma
What is Plummer-Vinson syndrome
severe iron-deficiency anemia
esophageal web
beefy-red tongue due to atrophic glossitis
what is Zenker diverticulum
outpouching of pharyngeal mucosa through an acquired defect in the muscular wall ( false diverticulum)
clinical presentation of zenker diverticulum
dysphagia
obstruction
halitosis
what is halitosis
bad breath
zenker diverticulum arises from what
above esophageal sphincter at junction of esophagus and pharynx
What is Mallory-Weiss syndrome
longitudinal laceration of mucosa at the gastroesophageal (GE) junction
what causes mallory-weiss syndrome
severe vomiting, usually due to alcoholism or bulimia
clinically how does mallory-weiss syndrome present
painful hematemesis
what is Risk of Boerhaave syndrome
rupture of esophagus leading to air in the mediastinum and subcutaneous emphysema
What is esophageal varices
dilated submucosal veins in lower esophagus
esophageal varices arise secondary to what
portal hypertension
how can portal hypertension cause esophageal varices
- distal esophagus vein normally drains into portal vein via left gastric vein
- left gastric vein backs up into esophageal vein
symptoms for esophageal varices
asymptomatic ( painless hematemesis), but risk of ruptures exists
what is the most common cause of death for esophageal varices
cirrhosis
What is achalasia
disordered esophageal motility with inability to relax the lower esophageal sphincter (LES)
what causes achalasia
damaged ganglion cells in the myenteric plexus
where are ganglion cells of myenteric plexus located and what is their role
- b/w inner circular and outer longitudinal layers of the muscularis propria
- regulating bowel motility and relaxing the LES
what can cause damage to ganglion cells
idiopathic or secondary to tyrpanosoma cruzi infection in Chagas disease
what are 4clinical features of achalasia
- dysphagia for solids and liquids
- putrid breath
- high LES pressure on esophageal manometry
- ‘brid-break’ sign on barium swallow study
Achalasia has an increased risk for what
esophageal squamous cell carcinoma
what is gastroesophageal reflux disease (GERD)
reflux of acid from stomach due to reduced LES tone
what are risk factors for GERD
alcohol tobacco obesity fat-rich diet caffeine hiatal hernia
What are 3 clinical features of GERD
- heartburn (mimics cardiac chest pain)
- asthma ( adult-onset) and cough
- damage to enamel of teeth
what are late complications of GERD
- ulceration with stucture
2. Barret esophagus
What is Barrett esophagus
metaplasia of lower esophageal mucosa from stratified squamous epithelium to nonciliated columnar epithelium with goblet cells
why does Barrett esophagus occur
response to lower esophageal stem cells to acidic stress
what can Barret esophagus progress to
dysplasia and adenocarcinoma
what is esophageal carcinoma subclassified as
adenocarcinoma or squamous cell carcinoma
what is the most common type of esophageal cancer in the west
esophageal carcinoma
what is adenocarcinoma
malignant proliferation of glands
esophageal carcinoma arises from what
preexisting Barrett esophagus
- usually involves the lower 1/3 of esophagus
What is the most common esophageal cancer worldwide
esophageal squamous cell carcinoma
what is esophageal squamous cell carcinoma
malignant proliferation of squamous cells
- usually arises from upper or middle of esophagus
name 5 major risk factors for esophageal squamous cell carcinoma
- alcohol and tobacco (most common cause)
- very hot tea
- achalasia
- esophageal web (e.g., Plummer-Vinson syndrome)
- Esophageal injury (e.g., lye ingestion)
when can esophageal carcinoma present and what are some symtpoms
- late (poor prognosis)
- progressive dysphagia (solids to liquids)
- weight loss
- pain
- hematemesis
hematemesis
vomiting of blood
what are some more symptoms for esophageal squamous cell carcinoma
hoarse voice ( recurrent laryngeal nerve involvement) cough ( tracheal involvement)
what is the lymph node for the esophagus
upper 1/3: cervical node
middle 1/3: mediastinal or tracheobronchial nodes
lower 1/3: celiac and gastric nodes
