Lecture 9 - Pathologies of Digestive System: Esophageal Diseases Flashcards
what 4 structures does the upper GI tract include?
mouth
esophagus
stomach/gaster
duodenum
what are 4 functions of upper GI tract?
mastication
deglutition
ingestion
digestion
what 2 structures does the lower GI tract include?
small and larger intestine
what does the small intestine do?
digestion and absorption of nutritients
what does the large intestine do?
absorb water and electrolytes
produce vitamins
store waste products of digestion until elimination
what are the 6 accessory structures of the GI tract?
teeth tongue salivary glands liver gall bladder pancreas
what are the 6 basic processes involved in digestion?
ingestion secretion mix/propulsion digestion absorption defecation
what system is called the “second brain”?
enteric NS
what are the two plexus of the enteric NS?
submucosal plexus
myenteric plexus
what systems provide neural innervation to the GI tract?
enteric and autonomic NS
what % of immune cells of the body are in the gut?
70-80%
what part of the brain possess the reflex area of vomiting?
medulla oblongata
what are 4 drugs that may cause nausea?
morphine
codeine
anesthetics
chemo drugs
what are 3 overarching SSx of GI disease?
nausea/vomiting
diarrhea
constipation
the hypothalamus relates so what sign of diarrhea?
fever (due to dehydration=higher blood temp)
how does diarrhea result in acidosis?
depletion of bicarbonate
what demographic is constipation more prevalent in?
women and 65+
what are two functional causes of chronic constipation?
psychogenic and neurogenic disorders
what are hemorrhoids?
varicose veins of anus and rectum
what are anal fissures?
cracks in the skin around the anus
what is ileus?
painful obstruction of ileum or other part of intestines
what does the relaxation of upper esophageal sphincter result in?
permits entry of bolus from laryngopharynx into esophagus
esophageal peristalsis results in?
bolus pushed down into stomach
relaxation of lower esophageal sphincter results in?
bolus enters stomach
secretion of mucus into esophagus results in?
lubricates esophagus for smooth passage of bolus
what are the 5 most important disease of the esophagus?
hiatal (diaphragmatic) hernia
GERD (esophagitis)
neoplasms
esophageal varices (circulatory disturbances)
congenital conditions (tracheoesophageal fistula)
what are 3 typical symptoms of esophageal disease?
dysphagia (difficulty swallowing) esophageal pain (substernal/retrosternal burning -heart burn) aspiration/regurgitation of food (re-entry to oral cavity)
what is a hiatal (diaphragmatic) hernia?
when the enlarges lower esophageal sphincter allows the stomach to pass through the diaphragm into thoracic cavity.
what results in a congenital hiatal hernia?
failed full development of diaphragm
what are 4 causes of an acquired hiatal hernia?
penetrating wound
blunt trauma from MVA
surgical trauma
sub phrenic abscess
what is the difference between sliding hiatal and rolling (para-esophageal) hernia?
sliding are affected by swallowing - with each swallow the stomach is pulled up and at the end it drops back into abdomen; rolling hernias remain in chest at all times and are not affected by swallowing
what is more common between sliding hiatal and rolling (para-esophageal) hernia?
sliding (90%)
what are two conditions that may aggravate reflux esophagitis?
tight clothing
laying down flat
what are 3 main symptoms of reflux esophagitis?
heart burn 30-60 min after meal
substernal pain (especially if large hernia)
dysphagia
what 2 external contributions may weaken the lower esophageal sphincter?
smoking and caffeine (pregnancy reduces tone of LES)
what is the most common cause of reflux esophagitis?
hiatal hernia
what is the opposite of a hiatal hernia?
achalasia (spasm/ increased tone of LES)
T or F: achalasia is an idiopathic condition?
True
What are 3 characteristics of achalasia?
spasm of LES
dilation of esophagus prox to spasm
dysphagia
(anxiety/emotional tension aggravates attacks)
what are 4 most common causes of GERD, leading to esophagitis?
gastric juice reflux (peptic esophagitis)
infections in immuno-suppressed or debilitated person (herpes, cytomegalovirus, systemic candida albicans)
chemical agents
physical trauma (radiation/intubation)
what other condition is GERD often associated with?
sliding hiatal hernia
what is the incidence of GERD?
15% of population have daily symptoms
what are 5 primary symptoms of GERD in young adults?
heart burn (30-60 min after meal) reflux belching dysphagia/ painful swallowing burning pain moving up and down
what are 5 of the atypical symptoms of GERD seen in older adults (70+)
dysphagia vomiting respiratory difficulties weight loss/anorexia anemia
what are 2 types of neoplams affecting the esophagus?
- squamous cell carcinoma (90%)
2. adenocarcinoma (sign. rise in the West)
what is a precursor of adenocarcinoma?
barrett’s esophagus
what happens to the cells of the lower esophagus with Barrett esophagus?
metaplasia- normal epithelial cells of the lower esophagus are replaced with columnar cells (typically seen in intestine)
T or F: esophageal cancers are common?
false
how does H.pylori eradication in GERD relate to esophageal adenocarcinoma?
may play a role in increasing incidence of this cancer (h.pylori has a protective effect against esophageal cancer)
what does h.pylori predispose someone to?
peptic ulcers as gastric neoplasms
what 6 esophageal/related disease increases the risk of esophageal cancer?
hiatal hernia GERD (adenocarcinoma) Barrett's esophagus diverticula scarring strictures head and neck cancers
what racial group is more affected by carcinoma of the esophagus?
black 3x’s
what is the ratio of male to females affected by carcinomas of the esophagus?
4: 1 - states
1: 1 - china and south africa
T or F: esophageal carcinoma’s are locally invasive?
true - most have already spread by time of diagnosis
what are 5 contributing factors to the etiology of esophageal cancers?
chronic inadequate nutrition obesity (adenocarcinoma) changes allowing for food or fluid in the esophagus for a long time (metaplasia and ulcerations) alcohol and tobacco irritation nitrosamines (carcinogenic)
what are nitrosamines?
chemical compounds used in the manufacturing of cosmetics, pesticides, tobacco products and most rubber products
what are common clinical manifestations of esophageal cancers?
dysphagia with out without pain - predominant symptoms pressure pain between scapula heart burn after laying down anorexia/weight loss hoarseness
what is the prognosis of esophageal cancers?
~ 95% of patients die within 2 years of the diagnosis (rapid metastases = lowest cure possibility)
what are esophageal varices?
dilated veins in the lower third of the esophagus beneath the mucosa
what causes esophageal varices?
portal vein HTN secondary to liver cirrhosis
what size of dilation to the veins can lead to rupture and bleeding?
greater than 5 mm in diameter
in relation to esophageal varices, how does varicose vein bleeding present?
painless but massive hematemesis with OR without melena (hypovolemia = shock)
define ‘ melena’
dark, sticky stool with digested blood
the clinical picture of esophageal varices is consistent with what disease?
chronic liver disease
what % of bleeding episodes due to esophageal varices cease without intervention?
50% (others may need endoscopic interventions)
define ‘sclerotherapy’
injecting solution directly into vein to cause vein to scar and collapse forcing blood to reroute to healthier veins
what is Mallory-Weiss syndrome?
bleeding due to the laceration of the mucosa of the lower end of the esophagus (and junction of stomach)
what is the most common cause of Mallory-Weiss syndrome?
severe anti-peristalsis and vomiting from alcohol-abuse, bulimia or viral syndrome
what is the treatment method for Mallory- Weiss syndrome?
endoscopic ligation (closing off a blood vessel)
what are 5 conditions related to Mallory-Weiss syndrome outside of the primary cause?
pregnancy migraine hiatal hernia gastric ulcer sudden raise in trans abdominal pressure
what is tracheoesophageal fistula?
occurs when the esophagus fails to develop as a continuous passage and makes an abnormal communication with the trachea - congenital or acquired
what is one of the most common esophageal anomalies and congenital defects?
TEF (tracheoesophageal fistula) (1/4000 live births with equal gender distribution)
define ‘fistula’
an abnormal connection between 2 body parts
what are 3 clinical signs of congenital TEF following feeding?
coughing
choking
cyanosis
(newborn can have excessive drooling from oral secretions and occasionally aspiration)
