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Oesophagus Flashcards

1
Q

What are the normal oesophageal contour deformities?

A
  • Cricopharyngeus
  • postcricoid impressions- mucosal fold over vein
  • Aortic impression
  • Left mainstem bronchus-LMB
  • Left atrium-LA
  • Diaphragm
  • Peristaltic waves
  • Mucosa
    • Thin transient transverse fold- feline oesophagus
    • Thick fold in chronic reflux disease
    • Tiny nodules in elderly: glycogenic acanthosis.
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2
Q

What is a feline oesophagus?

A

AKA oesophageal shiver- ie the transient transverse bands seen in the lower (distal 2/3) oesophagus on a double contrast barium swallow after swallowing, its asso w active gastro-oesophageal reflux. It results in shortening of the oesophagus and ‘bunching up’ of the overlying mucosa.

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3
Q

List the different types of ring in the GOJ:

A
  1. A ring-(Above; wolf ring) indentation at the upper boundary of the phrenic ampulla.
  2. B ring-(Below) indentation at the lower boundary of the phrenic ampulla- not seen unless there is hiatus hernia.
  3. Z line- (Zigzag line) squamocolumnar mucosal jnctn bwn oesophagus and stomach- not visible Rx.
  4. C ring - Diaphragmatic impression
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4
Q

What types of rings are present?

A

A and B ring

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5
Q
A

Schatzki rings-symptomatically narrow oesophageal B-ring.

10% population with 30% being symptomatic

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6
Q

What is Schatzki ring associate with?

A

More than half of patients will have an associated oesophageal condition such as:

  • hiatus hernia
  • reflux oesophagitis
  • oesophageal web
  • oesophageal diverticulum
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7
Q

The oesophagus lacks a serosa. Upper 1/3 has…………muscle and lower 2/3 have ……..

A

The oesophagus lacks a serosa. Upper 1/3 has..striated …muscle and lower 2/3 have …smooth muscle…..

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8
Q

What is the difference bwn web and a ring?

A

A ring is symmetrical whereas a web is asymmetrical.

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9
Q

What are the asso of web/rings?

A
  1. Fe def anaemia- cervical web: Plummer vinson syndrome
  2. hypopharyngeal ca
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10
Q

What are the two types of hiatus hernia?

A
  1. sliding hernia- most common 95%-
    1. reflux
    2. mixed when hernia and oesophagus are not in straight axis
  2. paraoesophageal hernia- 5%
    1. GOJ is at normal position
    2. Reflux not necessarily associated
    3. non reducible
    4. prone to mechanical complications-surgery
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11
Q

What are the imaging features of sliding hiatus hernia?

A
  • gastric folds above diaphragms
  • concentricindentation-B line above diaph
  • Schatzki’s ring above diaph
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12
Q

What is a lateral pharyngeal pouch?

A

lateral outpouchings through weakness in thyrohyoid membrane

Large in glass blower and wind instrument player.

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13
Q

What are the complications of the zenker’s diverticulum?

A
  • Aspiration.
  • ulceration
  • Carcinoma
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14
Q

Where would you see a Zenker’s diverticulum?

A

in the midline of the posterior wall of the hypopharynx** at anatomic weakpoint known as **Killian’s dehiscence

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15
Q

What is a Killian-Jamieson diverticulum ?

A

located just below the cricopharyngeal muscle, anteriorly and laterally, as a left sided or less commonly bilateral out pouchings from the cervical oesophagus.

-Off midline in Cervical oesophaus

  • smaller than Zenker’s diverticulum (usually < 1.5 cm),
  • rarely symptomatic.
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16
Q

What does this picture show?

A

Epiphrenic diverticula:

These are pulsion diverticula of the distal oesophagus arising just above the lower esophageal sphincter (LES), more frequently on the right posterolateral wall.

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17
Q

What does this picture show?

A

outpouching of mid oesophagus due to adjacent inflammatory process-eg TB

Calcified mediastinal lymphnode.

18
Q

What does this picture show?

A

Pseudodiverticulosis:

  • numerous, tiny (1-4 mm), flask-shaped outpouchings
  • may be diffusely distributed or clustered.
  • clustering may occur next to peptic strictures
  • viewed in profile, often appear “floating” next to the oesophageal wall, as the channel to the lumen is imperceptible
  • viewed en face, may look like ulcers
19
Q

What are the 3 underlying diseases for pseudodiv?

A
  1. candidiasis
  2. Diabetes
  3. Alcoholism
20
Q

What are the asso findings with pseudodiv?

A
  • oesophageal stricture
  • oesophagitis

Flask shaped

21
Q

What are the different types of oesophagitis?

A
  1. Infectious:
    • Herpes/Candidiasis/CMV
  2. Chemical
    • Reflux oesophagitis
    • Corrosive
  3. Iatrogenic
    • Radiotherapy/ NGT/ Drugs:
      • Tetracycline/ NSAID/ K/Fe
  4. Other
    • HIV/Scleroderma/Crohn’s disease
  5. Dermatological manifestation:
    • Pemphigoid/ dermatomyositisbullosa
22
Q

What are the imaging features of infectious oesophagitis- Herpes simplex?

A
  • Small ulcers, <5 mm
  • Normal mucosa between ulcers
  • More diffuse than reflux ulcers
23
Q

What are the imaging features of infectious oesophagitis- Candidiasis?

A
  • Plaquelike, reticular
  • Shaggy margins
  • Often involve entire esophagus
24
Q

What are the imaging features of infectious oesophagitis- CMV and HIV?

A
  • Typically elliptical large ulcers but may be tiny ulcers such as herpes
  • Aetiologic distinction between CMV and HIV ulcers is important because therapies are different.
  • Behçet disease may have a similar appearance.
25
Q

What are the imaging features of infectious oesophagitis- Mycobacterial?

A

Ulcers and sinus tract.

26
Q

What is Inflammatory Eosinophilic Esophagitis

A
  • The dysphagia may be chronic, with history of allergies, oeosinophilia
  • Segmental proximal or midesophagus mild narrowing
  • May involve entire esophagus
  • Increased risk of iatrogenic tear
  • Responds to steroids
27
Q

What is a Barrett’s esophagus?

A

*** Reticular pattern, hiatus hernia and high stricture.***

***ADENOCARCINOMA***

  • The oesophagus is normally lined with columnar metaplastic acid secreting gastric mucosa.
  • Usually due to chronic reflux oesophagitis.
  • Increased risk of oesophageal cancer, close F/U and repeated Bx.
28
Q

What are the imaging features of Boerhaave syndrome?

A
  1. Pneumomediastinum
  2. Pleural effusion (left > right)
  3. Mediastinal hematoma
  4. Rupture immediately above diaphragm, usually on left posterolateral side (90%)
29
Q

What is a Mallory-weiss tear?

A

This is a mucosal tear in proximal stomach, across GEJ, or in distal esophagus (10%), usually due to prolonged vomiting (alcoholics) or increased intraluminal pressure.

Because the tear is not transmural, there is no pneumomediastinum.

30
Q

What are the imaging features of Mallory-weiss tear?

A

Radiographs are usually normal.

  • Intravasation rather than extravasation.
  • There may be subtle mucosal irregularity
31
Q

What is achalasia?

A

The gastroesophageal sphincter fails to relax because of degeneration of Auerbach’s plexus. The sphincter relaxes only when the hydrostatic pressure of the column of liquid or food exceeds that of the sphincter; emptying occurs more in the upright than in the horizontal position.

32
Q

What are the three types of achalasia?

A
  1. Primary (idiopathic)
  2. Secondary (destruction of myenteric plexus by tumor cells
    • Metastases
    • Adenocarcinoma invasion from cardia
  3. Infectious: Chagas disease
33
Q

What are the clinical findings of achalasia?

A
  • Primary occurs predominantly in young patients (in contradistinction to esophageal tumors); onset: 20 to 40 years
  • Dysphagia, 100% to both liquids and solids when symptoms begin
  • Weight loss, 90%
34
Q

Discreet plaque like lesion in the oesophagus with nodularity and granularity with fold thickening

Shaggy with irregular luminal surface

The Patient is immunocompromised.

A

Candidiasis

35
Q

What level is the cricopharyngeus?

A

border bwn pharynx and cervical oesophagus

C5-C6

36
Q

Idiopathic eosinophilic oesophagitis:

A

ringed’ oesophagus: concentric, ring-like strictures of the oesophagus on a barium swallow

Fail treatment on PPI but get better with steroid.

37
Q

Diagnosis?

A

Squamous cell- 81-95% worldwide

38
Q

Multiple elevated nodules in the Oesophagus in an asymptomatic elderly patient

A

Glycogen acanthosis

39
Q

Uphill vs downhill varices

A

Uphill:

  • Caused by portal HTN
  • Confined to lower half of oesophagus

Downhill varices

  • Cused by SVC obstruction
  • confined to top half of oesophagus
40
Q

Young boy presenting with difficulties and noisy breathing since birth. Persistent cough.

A

Oesophageal duplication cyst

water density cyst in posterior mediastinum.

Most common location:

  1. ileum
  2. oesophagus
41
Q

Transient horizontal ridges throughout the oesophagus (they disappear with a subsequent swallow).

A

feline oesophagus.

GI (3 decks)

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