Oesophage: pathologies cliniques Flashcards
What is pyrosis?
Heartburn
P: position déclive/repas
Q: BRÛLURE
R: retrosternal, epigastric, central
S: 0-10
T: durée et évolution temporelle
What is odynophagie?
Pain when swallowing
P: swallowing (throat), transport (thorax)
Q: pression, burning, blockage, or cramp
R: neck, thorax
S: 0-10/10
T: évolution temporelle
What is dysphagie?
Difficulty when swallowing or moving food down the esophagus
P: déglutition, transport
Q: texture, solid vs. liquid
R: upper or bottom
S: cough
T: durée, évolution temporelle
What is dysphagie haute?
Difficulty swallowing
History: cough, pneumonia
Physical examination: deviation of epiglottis or tongue
Investigation: swallow study (Barium)
What is dysphagie bas?
Problems with peristalsis
History: trouble with liquids or solids
Physical examination: palpation sus-claviculaire (adénopathie gauche —> CANCER)
Investigation: transit, endoscopie, motility
What does acid reflux look like?
What are some possible complications related to œsophagite peptique? (5)
Œsophagite non-érosive: pyrosis (NERD)
Œsophagite érosive: pyrosis et odynophagie
Hémorragie aiguë: N/a
Hémorragie chronique: parfois, anémie ferriprive (iron deficiency)
Perforation: N/a
Sténose cicatricielle: dysphagie aux solides
Œsophage de Barrett: métaplaise (benin)
How is œsophagite peptique diagnosed?
Essai thérapeutique IPP —> proton pump inhibitor should fix in 48 hours-ish … if dysphagia and > 50, do an endoscopy because possible cancer
What is œsophagite peptique érosive?
Odynophagie
Most frequent complication of acid reflux
Treatment: IPP (need to take long term…)
If not treated or poorly
Fibrose cicatricielle: dysphagie
Sténose: dysphagie
Œsophage de Barrett —> RESOLUTION OF PYROSIS
What is Œsophage de Barrett?
A complication of œsophagite peptique
It is a form of metaplasia —> pav. epithelium replaced by cylindric epithelium with Goblet cells
If dysplasia… risk of malignant transformation increases by 30-40x
What is the symptomology of Œsophage de Barrett?
Pyrosis gets better —> severe at the start and diminishes progressively with replacement by intestinal metaplasia
If dysphagia —> associated with stenosis, should make you worry about esophageal cancer
What is the link between adenocarcinoma and Œsophage de Barrett?
Barrett = predisposition to adénoCa
Early detection = increase of survival rate therefore endoscopie aux 2 ans avec biopsies
What is œsophagite infectieuse?
Virale:
- herpes, recurring odynophagia w/o dysphagia
- cytomegalovirus, immunosuppressed individuals (post-transplant, HIV, chimio)
Mycotique:
- MUSHROOMS —> Candida albicans: immunosuppression from inhaled steroids for asthma treatment allows for their proliferation in the throat
What is œsophagite éosinophilique, allergique?
Typical in pediatrics: dysphagie from solids/allergies
- no resolution with IPP and pHmétrie normal (no reflux)
- endoscopy shows ring like appearance of esophagus… looks similar to the trachea
- diagnosed through biopsy showing presence of éosinophile en sous-muqueuse
How is œsophagite éosinophilique treated?
Local corticotherapy (aerosol) —> better if oral so no systemic effects
- exclusion diets to determine allergen
- elementary diet of amino acids
- dilations of esophagus when necessary
What is œsophagite caustique?
Ingestion of acide ou alkali (WORSE ONE)
- Ulceration by chemical necrosis, worry about perforation
- Scarring with irregular stenosis
- Brachyœsophage et herniation hiatale
- Risque in long term of epithelial neoplasia
What is œsophagite médicamenteuse?
Ingestion of Rx that sticks to the wall of esophagus and causes irritation/potential ulceration
Prevention: drink water before and during pill swallowing
What is œsophagite radique?
Local effect of radiation —> can be 10 years later
- acute: multifocal cellular necrosis
- chronic: radiation stenosis
What are the two most common pathologie tumorales of the esophagus?
Benign tumors are SUPER rare but called —> leiomyoma
-
Epidermoid/malpighien cancer
- upper 2/3rds: pav. epithélium
- 2/3 of esophageal cancers but the frequency is diminishing
-
Adénocarcinome
- bottom third: glandular epithelium
- frequency is increasing
Info about malignant esophageal tumours:
1/10 of GI tumours
Most frequent in Asia —> 20% of all deaths due to cancer
More frequent in men than woman and in people > 50
What are some common risk factors for epidermoid esophageal cancer?
Caustic esophagitis
Toxins (alcohol, tabacco, tea)
Diet (nitrites and nitrosamines typically used as preservatives)
Ethnicities —> Asian, Black >>> White
What are some common risk factors for esophageal adenocarcinoma?
Chronic reflux (even if they use IPPs) and Barrett’s Esophagus