GIT I (Esophagus) Flashcards
Clinical manifestations of GIT
Loss of appetite
Heartburn
Abdominal pain
Indigestion
Nausea and vomiting
Swollen belly
The esophagus has been subdivided into 3 portions
The cervical portion
The thoracic portion
The abdominal portion
Esophagus formed from:
Outer longitudinal layer and inner circular layer of smooth muscle
Between them, there is Auerbach’s plexus that responsible for **peristalsis
In the submucosa, there is Meissner’s plexus that is responsible for sensation
The esophagus has four normal constrictions:
1st: at level of C6 (15cm from incisor teeth)
2nd: where the arch of aorta crosses it, at T3 (22.5 cm)
3rd: where the left bronchus crosses it, at T6 (27.5 cm)
4th: where it passes through the diaphragm, at T10 (40 com)
The narrowest part of the esophagus
1st constriction
The normal indentations of the esophagus
Aortic arch (22.5cm)
Left bronchus (27.5cm)
Enlarged left atrium (Abnormal)
What is cardio-esophageal syndrome:
It happens when the left atrium is enlarged, it may compress in the esophagus and cause dysphagia.
Symptoms of esophageal disorders
Dysphagia
Odynophagia
Regurgitations (esophangitis or esophageal ulcer)
Vomiting
Related to the age, Achalasia most common in:
Young
Related to age: Cancer most common in:
Elderly
During reflux, some food regurge into the pulmonary system and causes aspiration pneumonia
Particularly in which age?
Pediatrics age
Patients with esophageal anomaly that are susceptible to recurrent infections:
Tracheoesophageal fistula (TOF)
Imaging modalities of esophagus:
Plain X-ray
Fluoroscopy (by Barium swallow)
Ultrasound
CT scan
MRI
Nuclear medicine
Using of X-ray in esophagus
Dilated esophagus (achalasia)
Foreign bodies
Air fluid level
Mass
What is the type of contrast used in barium swallow
Barium sulfate (45% weight/volume)
Double vs single contrast:
Single: esophagus is full of barium and has a smooth outline
Double: Then emptying esophagus and barium lies b/w mucosal folds, it appears as three or four long, striaght parallel lines
The normal indentations of the opacified esophagus are seen in which view during barium swallow?
Right anterior oblique
The barium sulfate is the preferable contrast media using fluoroscopy because:
It provides a good coating of the internal part of lumen
Barium sulfate is conisder as positive (bright) or negative (dark) contrast media:
Positive
Stricture is the main cause of dysphagia:
It caused by:
Peptic (GERD)
Carcinoma
Achalasia
Corrosives
Surgery
The stricture can be:
Tapering ends with smooth outline =benign
Overhanging edges or shouldering with irregular outline = malignant
Peptic stricture:
• Found at lower end of the esophagus
• associated with hiatus hernia/GERD(reflux esophangitis)
Signs of peptic stricture
Short
Smooth outline
Tapering ends
Ulcer may be seen close to the stricture
What is Achalasia
Rare swallowing disorder, which affects the esophagus
Primary: functional dt neuromascular abnormality (defect on **myenteric (Auerbach’s) plexus)
2ry: non-functional, may cause by malignancy
Features of achalasia:
Failure of organized esophageal peristalsis
Impaired relaxation of LES
Food stasis (marked dilation)
Occurs at middle and late adulthood
Patients with achalasia may comes with
Dysphagia
Chest pain
Regurgitation
Complications of achalasia
Pneumonia and brochiectasis due to aspiration
Esophageal carcinoma
Candida esophangitis
Radiological findings of achalasia:
Markedly dilated esophagus
Tapering in inferior esophagus
Rat tail (bird beak)
CT rule in achalasia
It has little role in directly assessing patients with achalasia, but it is useful in assessing commin complications
Used to identify any focal regions of thickenning (malignancy)
Inspection of lungs for evidence of aspiration
A number of entities may mimic achalsia
Scleroderma
Esophageal or gastric malignancy
Esophageal stricture
Chagas disease
Anti-Hu antibodies from lung cancer (paraneoplastic syndrome)
Corrsive stricture
Long stricture, which begins at the level of aortic arch
Features of corrosive stricture
Smooth
Tapered ends
May be irregular
Esophageal carcinoma
Usually involves the full circumference to form stricture for several centimeters in length.
Features of malignant carcinoma stricture
Occur anywhere
Irregular outline
Shouldered edges
Deep ulceration
There is always dilatation before any stricture
If you suggest that the stricture from esophageal carcinoma
What is the next step?
CT scan
Types of filling defects on barium swallow
Intraluminal
Intramural: acute angle made with the wall
Extramural: There is a shallow obtuse angle with the wall of the bowel
Ex of intramural filling defect
Leiomyoma
esophageal carcinoma
Ex of extramural lesion
Carcinoma of the bronchus
Enlarged mediastinal lymph node
Aneurysm of aorta
Intra-luminal filling defects
Foreign body like coin/lump food
Esophageal varices:
Dilated submucosal veins dt ++ collateral blood flow from portal system to azygos system
Mainly caused by portal hypertension
What is the next step if suggested on the esophageal varices
Endoscopy
How to describe the finding in case of esophageal varices
Multiple tortuous worms like filling defects
Most likely esophageal varices
Other findings may you get them with esophageal varices:
Liver cirrhosis and splenomegaly (CT)
Esophageal web:
Thin, shelf-like projection arising from the anterior wall of cervical portion of the esophagus
not shouldering
The combination of a web, dysphagia , and iron deficiency anemia that is usually found in middle-aged females is known as:
Plummer vinson syndrome
How to describe the esophageal web in the barium x-ray
Thin non circumferential defect arising from the anterior wall of the cervical esophagus
Esophageal diverticula
A pouch or sac that protrudes from the gastrointestinal wall and can derive from any tubular organ in the gastrointestinal wall
True vs. False esophageal diverticula
False: consists of mucosa, submucosa, and strands of muscle fibers
True: contains all layers of the gastrointestinal wall
Which level of the esophagus can diverticula occur at?
At any level
Clinical features of diverticula
It is often Asymptomatic, may cause dysphagia, aspiration…
Diverticula more common in age and gender:
Older male
Common types of esophageal diverticula
Pharyngo-esophageal (Zenker’s diverticulum) : most common
Mid-esophageal (para-bronchial)
Epiphrinic
Esophageal atresia
It is an absence in the continuity of the esophagus due to an inappropriate division of the primitive foregut into the trachea and esophagus.
Most common congenital anomaly of the esophagus
Atresia
Esophageal atresia may associated with :
Duodenal atresia
Pyloric stenosis
Types of esophageal atresia :
- Proximal atresia with distal fistula (85%)
- Isolated esophageal atresia (8%)
- Double fistula with esophageal atresia (1%)
- Proximal fistula with distal atresia (1%)
X-ray finding of the proximal esophageal atresia with distal tracheoesophageal fistula
Non progression of an orogastric catheter in the blind esophagus pouch and the presence of air in the stomach
The non-progression radiopaque tube in the esophageal pouch with no air in the stomach
Esophageal atresia without tracheoesophageal fistula
