GI Section 1: Luminal (Esophageal Diverticulum) Flashcards
Killian-Jamieson Pulsion Diverticulum
It protrudes through an area of
weakness below the attachment of the cricopharyngeus muscle and lateral to the ligaments that help suspend the esophagus on the cricoid cartilage
Zenker Diverticulum:
Pulsion Diverticulum in the back (Z is in the back ofthe alphabet).
Traction Diverticulum
Mid esophageal, and often triangular in shape.
site of weakness in Zenker
Killian Dehiscence or triangle
Zenker Diverticulum arise from?
arise from the hypopharynx (not the cervical esophagus).
This one is in the cervical esophagus.
Killian-Jamieson Pulsion Diverticulum
These occur from scarring (think granulomatous disease or TB)
Traction Diverticulum
Triangular + Will empty =
Traction Diverticulum
Round + Will NOT empty (contains no muslce in the wall)
Pulsion
Located just above the diaphragm
(usually on the RIGHT).
Epiphrenic Diverticula
Epiphrenic Diverticula
Located just above the diaphragm
(usually on the RIGHT).
** The para-esophageal hernia is usually on the LEFT.
They are considered pulsion types (associated with motor abnormality).
Esophageal Pseudodiverticulosis
dilated submucosal glands that cause multiple small out pouchings.
Usually due to chronic reflux esophagitis.
Esophageal Pseudodiverticulosi
The most common benign mucosal lesion of the esophagus. It’sbasically just hyperplastic squamous epithelium.
Papilloma
Young man + hx of dysphagia (atopia and periphearl eosinophilia)
+ Concentric rings in barium
+ fail tx with PPI, Improve on Steroids
Eosinophilic Esophagitis
Eosinophilic Esophagitis - “Ringed Esophagus”
Esophageal web
This thing is basically a ring (you never see posterior only web) caused by a thin mucosal membrane.
risk factor for esophageal and hypopharyngeal carcinoma
Esophageal web
Iron def anemia + Dysphagea + thyroid issues + “Spoon shaped nales”
Plummer - Vinson Syndrome
Esophageal Pseudodiverticulosis is associated with these:
esophageal strictures (90%),
reflux, and
candidiasis.
Tons of little tiny out- pouchings which aren’t really diverticula but instead dilated excretory mucosal ducts.
“corkscrew” tertiary contractions favoring the distal esophagus.
Esophageal spasm
“corkscrew” tertiary contractions favoring the distal esophagus.
“nutcracker esophagus” requires manometric findings (>180mmHg).
Syndrome refers to problems swallowing secondary to compression from:
an aberrant right subclavian artery (most patients with aberrant rights don’t have symptoms).
Dysphagia Lusoria
If you get shown a big dilated esophagus, think about these 3 things
- Achalasia
- Pseudoachalasia
- Scleroderma
Motor disorder where
2/3 of the esophagus (smooth muscle part) doesn’t have normal peristalsis ( “absent primary peristalsis ”)
+ Lower esophageal won’t relax
=
Achalasia
The esophagus will be dilated above a smooth stricture at the GE junction (Bird’s Beak).
repetitive simultaneous non-propulsive contractions. It’s more common in women, but the secondary cancer occurs more in men.
Vigorous Achalasia
Failure of the lower esophageal sphincter to relax + Increased risk of Candida
Achalasia
The esophagus get paralyzed by some parasite transmitted by a fly.
Chagas disease
has the appearance of achalasia, but is secondary to a cancer at the GE junction.
Pesudoachalaisa (Secondary Achalasia)
real Achalasia will eventually relax, the pseudo won’t
The LES is incompetent and you end up with chronic reflux, which can cause scarring, Barretts, and even cancer (Adeno).
Scleroderma
lower 2/3 of the esophagus stops working normally
+ lung changes (NSIP)
+ Small bowel with closely spaced valvulae conniventes
Scleroderma
Varices
Linear often serpentine, filling defects causing a scalloped contour.
DDx:
Varicoid Carcinoma
Varices Caused by portal hypertension
Uphill varicess
Varices confined to bottom half of esophagus
Uphill varicess
Varices caused by SVC obstruction (catheter related, or tumor related)
Downhill varices
Varices Confined to Top Half of Esophagus
Downhill varicess
