P- Oral Cavity and Esophagus Flashcards
List the five causes of GI bleeding in order of most frequent to least frequent.
- gastric/duodenal ulcers
- gastric erosion
- varices
- Mallory Weiss tears
- gastric cancer
Describe the structure of the esophagus. It extends from where to where? It is made of what kind of cells? What type of muscle is present? What does it lack that the rest of the GI system has?
It extends from the cricopharyngeus (UES) to just below the diaphragmatic hiatus (LES).
It is made of stratified squamous epithelium and has a squamocolumnar junction where it meets the stomach.
The top is skeletal muscle, the middle is skeletal and smooth and the lower portion is smooth.
It lacks serosa.
What is the significance of the esophagus lacking serosa?
- It rips/tears more easily
2. cancers are able to metastasize more easily
What 5 symptoms commonly present with problems of the esophagus?
- dysphagia
- odynophagia
- regurgitation
- chest pain
- heartburn
Describe the 4 microscopic layers of the esophagus from innermost to outermost.
(what is the structure/function)
- non-keratinized mucosa - stratified squamous epithelial lining and lamina propria lined by muscularis mucousa (thin muscle)
- Submucosa- loose connective tissue and mucus glands to keep esophagus moist
- Muscularis Propria - Thick muscular layers to propel food down
- Adventitia- loose connective tissue [NO SEROSA]
What is achalasia?
What is a potential cause in Central/South America?
Inflammation of myenteric plexus of the esophagus that leads to LES failure to relax and lack of peristalsis when swallowing.
T. cruzi is a potential cause
A patient presents with difficulty eating, weight loss, halitosis and regurgitation of undigested food. This has been gradual for months/years before seeking treatment. What is the likely cause?
achalasia
What are treatments for achalasia?
You cannot restore peristalsis, but you do want to decrease LES pressure.
- endoscopic balloon dilations
- myotomy (division of sphincter muscle)
- temporary relief with botox
What is a hiatal hernia? What are the 2 major types? Which is more common?
What complications can arise?
It is when part of the stomach protrudes above the diaphragm into the chest cavity
- sliding hiatal hernia- part of the stomach protrudes in the same plane as the esophagus ** most common
- Paraesophageal hiatal hernia- protrusion of stomach through enlarged hiatus. It can result in torsion of the stomach cutting off blood supply (medical emergency)
What is Mallory-Weiss Syndrome?
What are causes?
Violent vomiting or retching tears the esophagus longitudinally at the GE junction.
- bulimia
- chronic alcoholism
If it contaminates the mediastinum it is called Boerhaave syndrome.
What are gastro-esophageal varices?
dilation of the esophago-gastric venous plexus due to high portal venous pressure and large portal-systemic gradient
When portal venous pressure is increased because of fibrosis (usually due to chronic liver disease/cirrhosis), where does the blood divert?
Into PRE-EXISTING vascular channels that can connect portal system to the SVC and IVC.
- proximal stomach/lower esophagus
- falciform ligament (periumbilical)
- hemorrhoids
- retroperitoneal
In western countries, what are the 2 leading causes of portal hypertension and gastro-esophageal varices?
In less developed countries what is a major cause of varices?
- viral (Hep C)
- alcoholic cirrhosis
Less developed: schistosomiasis
How are variceal bleeds treated?
- IV drugs to lower portal pressure (b-blocker, somatostatin, vasopressin)
- endoscopic ligation with banding
- TIPS (transjugular intrahepatic porto-systemic) for uncontrolled or recurrent bleeds (stent to connect portal and hepatic veins bypassing the sinusoids)
What is the general definition of esophagitis?
What are the 5 types?
injury of the esophageal mucosa with subsequent inflammation.
- GERD
- infectious
- eosinophilic esophagitis
- “pill” esophagitis/irritant/corrosive
- chemoradiation esophagitis
What are the 3 main types of infective esophagitis?
- HSV (usually 1)
- CMV
- Candida
What is the usually presentation of someone with HSV esophagitis? Who does it usually effect and what is the treatment?
It presents with inflammation and ulcers causing dysphagia and odynophagia.
It affects mostly immunocompromised people
It is treated with acyclovir and famcyclovir
What are the classic endoscopic findings of HSV? Where should you take a biopsy from for definitive diagnosis?
What cells are infected?
What part of the cells are infected?
There are ulcers with exudate on the lower 1/3 of the esophagus
Take the biopsy from the edge of the ulcer where viable squamous epithelial cells are.
The nucleus is affected and is:
1. multi-nucleated
2. molding
3. muddy chromatin
4. margination
What are the 2 main manifestations of CMV in the GI system?
- colitis (most frequently)
2. esophagitis
How does someone with CMV esophagitis present? Who is most likely infected? What is the treatment?
CMV esophagitis presents with odynophagia and dysphagia along with systemic infection (eyes, liver, colon, lungs).
HIV infected patients are most likely to be infected.
Treat with famcyclovir.