GI Section 1: Luminal (Esophagus) Flashcards
The muscular ring above the vestibule. Dynamic on swallow.
A ring
The mucosal ring Below the vestibule. Not Dynamic.
B Ring
This is a thin constriction at the GE junction
B ring
What happens if narrowing of the B ring occurs? how narrow?
Symptomatic dysphagia (<13 mm)
Call in Schatzki ring
Represents the squamocolumnar
junction (boundary between esophageal and gastric epithelium).
Z Line
This is an endoscopy finding, and is only rarely seen as a thin serrated line.
Z Line
The “true upper esophageal sphincter.”
Cricopharyngeus
Loication of Zenker Diverticulum
Hypopharynx
Location of Killian-Jamieson Diverticulum
Cervical Esophagus
This muscle represents the border
between the pharynx and cervical
esophagus.
What is the typical level?
Cricopharyngeus
C5-C6
When you swallow the larynx does two things:
- It elevates
- Moves anteriorly
Reflux Esophagitis:
A common cause of fold thickening, which if left unchecked can cause some serious problems.
Behold the potential spectrum o f unchecked aggression ->
This is a precursor to adenocarcinoma - that develops secondary to chronic reflux.
Barretts Esophagus
Barrett’s - High Stricture + Hiatal Hernia
“Reticular Mucosal Pattern
Barretts Esophagus
Feline esophagus
fine transverse folds which course mid and lower esophagus.
*Folds are Transient (they go away with swallowing)
*Folds are ONLY in lower 2/5
Consider esophageal cancer when you see this
“irregular contour”, and “abrupt (shouldered) edges. ”
(+)drinker
(+)smoker
(+)alkaloid ingestion
Squamous cell CA
+ stress = chronic reflux
+ history of PPI use
+ Hx of Barretts
AdenoCA
+ Stricture/ulcer/mass in the MID esophagus
Squamous cell CA
+ Stricture/ulcer/mass in the LOW esophagus
AdeoCA
Critical Stage of Esophageal CA
Invasion
T3 =
T4 =
T3 = Adventitia
T4 = Adjacent Structures
T3 vs T4 is in the radiologists world - and therefore the most likely to be tested.
Herniation o f the stomach comes in several flavors with the most common being?
The sliding type I (95%)
Rolling para-esophageal Type 2
Gastric herniation Type 1 and Type 2 difference
The distinction between the two is based on the position of the GE junction.
Small type Is are often asymptomatic but do
have an association with reflux if the function of the GE sphincter is impaired.
the Para-E Type 2 - higher rate of incarcertion
What is this Fundoplication ?
The gastric fundus is wrapped around the lower end of the esophagus and stitched in place, reinforcing the lower esophageal sphincter.
“Nissen” = 360 degree wrap
Loose = <360 wrap
COmplication of fundoplication:
Esophageal obstruction or narrowing (post op edema or wrap made too tight)
two main indications for Fundoplication
- Hiatal Hernia
- Reflux
Failure of fundoplication =
Recurrence of Hiatal hernia and reflux (telescoping of GE junction through the wrap or “Slipped Nissen)
Most common reason for recurrent reflux after fundoplication?
Slipped Nissen
Mosct common reason for slipped Nissen?
Short esophagus
WTF is a “short esophagus ” ?
“Hiatal Hernia that isfixed/non- reducible, and greater than 5cm ”
How can you tell i f the wrap (Fundoplication) has slipped ?
Fundoplication wrap should have length of narrowed esophagus < 2cm (anything greater suggests a slipped wrap)
What is the treatmentfor a “short esophagus” ?
Collis gastroplasty (lengthening + fundoplication).
HIV/Transplant patient (immunocompromised + achalasia/scleroderma
Esophageal Candidiasis
Esophageal Candidiasis
discrete plaque-like lesions
nodularity, granularity, and fold thickening as a resuU of mucosal inflammation and
edema.
When it is most severe, it looks more shaggy with an irregular luminal surface.
epithelial collection of glycogen - but is known best as a mimic of candidiasis.
Glycogenic Acanthosis
Multiple elevated benign nodules in the esophagus in an asymptomatic elderly patient
Glycogenic Acanthosis
Esophgeal Herpes
Small and multiple with a halo of edema
{Herpes has a Halo)
“Aphthous Ulcers” - (discrete ulcers surrounded by mounds of edema)
CROHN’s
Esophageal (enteric) Duplication Cysts
Water density cyst in the posterior mediastinum
Most common location ? - The ileum
Either as an incidental in an adult, or if they are big enough - as an infant with dysphagia / breathing problems.
