upper GIT Flashcards
describe the esophagus?
hollow muscular tube
Extends from the epiglottis to the gastroesophageal junction
25 cm
has 2 physiological sphincters ( UES , LES )
mucosa/ submucosa / muscularis/ adventitia
non-keratinized stratified squamous epithelium
what is a heartburn?
burning pain in the chest
what is dysphagia?
difficulty swallowing
non specific word ( Could be due to any reason ) , very generic term
what is hematemesis ?
vomiting of blood
what are the two types of obstruction?
mechanical —> congenital anomaly for example
functional —> problem in contraction
what are examples of mechanical obstruction?
ectopic tissue ( abnormal tissue ) –> gastric tissue , sebaceous , pancreatic
atresia / fistula / stenosis / webs
Schiatzki ring –> lower esophagus ( leads to narrowing )
what is atresia?
failure of canalization –> the tube stops before reaching the place it is supposed to be at
it is a congenital anomaly
what is a fistula?
abnormal connection —> tube connects somewhere abnormal
also congenital anomaly
what is the most common place for atresia/fistula of esophagus?
most commonly near tracheal bifurcation and usually it is associated with a fistula connecting upper or or lower esophageal pouches to a bronchus or trachea
what is the result of atreisa/fistula?
aspiration
suffocation
pneumonia ( food goes to lung )
severe fluid and electrolyte imbalances
what is stenosis ?
narrowing of the esophagus due to inflammation and scarring
what are the causes of stenosis ?
chronic gastroesophageal reflux
irradiation
caustic injury
what is esophageal ring / web?
folds that block your esophagus either partially or completely
describe the rings?
bands of normal esophageal tissue that form constrictions AROUND the inside of esophagus ( surround the whole lumen )
different types depending on the location
Esophagus ring —> type A ring ( muscular )
lower esophageal sphincter ring –> Type B ring ( schatzki ring )
what is the commonest location for rings?
distal esophagus ( lower ? )
describe webs?
thin layers of cells that grow across the inside of esophagus
what is the commonest location for webs?
upper esophagus
what are the causes for webs/rings?
iron deficiency anemia
plummer vinson syndrome
what are the triads of plummer vinson syndrome ?
upper esophageal web
dysphagia
iron deficiency anemia ( carcinoma of oropharynx and upper esophagus )
what is functional obstruction ?
esophageal dysmotiltiy that interferes with the coordinated waves of peristaltic contractions responsible for delivering food and fluid to stomach
what are examples of functional obstruction?
Achalasia
hiatal hernia
zenker diverticulum
esophagophrenic diverticulum
mallory weiss tear
what is achalasia?
esophagospasm –> motiltiy disorder involving smooth muscle layer of esophagus in the absence of other explanations like cancer or fibrosis
( SO MOTILITY DISORDER WITHOUT AN EXPLANAING CAUSE )
what are the characteristics of achalasia?
difficulty swallowing
Regurgitation
chest pain
what are 3 triads of of achalasia ( failure to relax )
esophageal aperistalsis –>
inability of smooth muscles to move food down the esophagus
incomplete relaxation of the LES
Increased LES tone
what is primary achalasia?
idopathic unknown
what is secondary achalasia?
arise due to diseases :
chagas disease ( typanosoma cruzi infection )
Achalasia like disease :
diabetic autonomic neuropathy
infiltrative disorder such as malignancy , amyloidosis , sarcoidosis
describe hiatal hernia?
protrusion of the stomach into the thorax due to diaphragmatic crura defects ( diaphragmatic muscular defect )
widening of space which of the lower esophagus passes through
what are the 2 types of hiatal hernia?
sliding 95% of cases
paraesophageal 5% of cases
in all cases the stomach is above the diaphragm
describe sliding hiatus hernia?
both cardia and fundus of the stomach will be above
describe the paraesophageal hiatus hernia?
only the fundus will go above the diaphragm not the cardia junction
what is hiatal hernia usually associated with ?
associated with reflux
Very common and increase with age
what are the complications of hiatal hernia?
ulceration
bleeding
perforation
Strangulation
when does congenital hernia appear?
infants and children who has congenital hiatal hernias only appear later in life
what is esophageal diverticulum?
outpouching of mucosa through the muscular layer of esophagus
what are the classifications of epsophageal diverticulum?
true diverticulum —> outpouching through all 4 layers
false diverticulum —-> only through mucosa and submucosa layers
where is zenker esophageal diverticulum located?
high
describe zenker diverticulum?
posterior outpouching of mucosa and submucosa ( psuedo diverticulum ) through cricopharyngeal muscle
it is pseudo /false diverticulum
what are the causes of zenker diverticulum?
incoordination between pharyngeal propulsion and cricopharyngeal relaxation and tightness of cricopharyngeus muscle
what are the characteristics of esophageal diverticulum?
bad breath ( severe halitosis )
regurgitation of food
zenker smells bad
what is traction diverticulum?
traction from mediastinal inflammatory lesions
what is the location of traction?
Mid
whats assoicated with epiphrenic diverticulum?
motor dysfunction like achalasia/diffuse esophageal spasm
what is the location of epiphrenic diverticulum?
low
what is laceration?
longitudinal tears of the lower esophagus
what is the most common esophageal laceration?
mallory weiss tears?
what is the most common cause of mallort weiss tears?
alcoholics
laceration are usually secondary to what?
severe vomiting
what are the general characteristics of lacerations?
usually in alcoholics
usually in mucosal tears
describe the process of laceration?
normally a reflex relaxation of the gastroesophageal musculature follows the contractile waves associated with the vomiting
this relaxation reflex fails during prolonged vomiting , with the result that reflux gastric contents —> cause esophageal wall to stretch and tear and the patient will present with hematemesis
what are the 3 common areas of portal /caval anastomoses ?
esophageal
umbilical
Hemorrhoidal
describe varices ?
100% related to portal hypertension
Found in 90% of cirrhotic – alcoholic liver disease
hepatic schistomomiasis
what is the most feared complication of varices?
massive sudden fatal hemorrhage
how can varices be detected?
angiography and appear as tortuous dilated veins lying primarily within the submucosa of the distal esophagus and proximal stomach
what are the chemicals that could damage the stratified squamous mucosa of the esophagus?
LYE –> suicide attempts with strictures
alcohol
Extremely HOT drinks
Chemo (harmful to all high turnover mucosas)
all lead to esophagitis
what are infections that could to esophagitis ?
HSV
CMV
fungus –> especially candida ( usually in HIV )
what are other causes of esophagitis ?
GERD /reflux
barretts esophagus
what are the risk factors for esophagitis?
decreased LES tone
increased abdominal pressure
obesity
hiatal hernia
slowed reflux clearing
Delayed gastric emptying
alcohol , tobacco
in which population is GERD more common in?
adults older than 40 years
infants and children ( less likely )
what is the typical clinical presentation of GERD?
heartburn
dysphagia
regurgitation
chest pain
excessive salivation
Gas
Bloating
Trouble sleeping
sensitivity to some foods and liquids
what are the atypical presentation of GERD?
persistent cough
chronic sore throat
frequent and or difficulty swallowing
Asthma
hoarseness
excessive throat cleaning
bad breath
dental erosions
gum disease
Ear and nose discomfort
what are the histological changes in Mild GERD?
mild gerd –> unremarkable
what are the histological changes in significant GERD?
hyperemia
inflammatory cells in the squamous mucosa :
eosinophils
neutrophils
lymphocytes
basal zone hyperplasia
lamina propria papillae elongated and congested due to regeneration
what is barretts esophagus?
complication of chronic GERD that is characterized by intestinal metaplasia within the esophageal squamous mucosa
10% of gerd patients get it
white males 40-60 years of age
what is the diagnostic criteria for barrets esophagus?
Goblet cells present in esophageal mucosa
what is significance of barretts esophagus ?
single most common risk factor for esophageal adenocarcinoma
any part of mucosa that becomes barretts is at risk
search for dysplasia when you see barrets ( periodic endoscopy with biopsy )
what happens to G-E junction in barretts?
breached G-E junction
how is barretts esophagus recognized?
endoscopically as patches of red , velvety mucosa extending upward from the gastroesophageal junction
alternates with residual smooth pale squamous mucosa and proximally interferes with light brown columnar gastric mucosa distally
Diagnosis requires endoscopy and biopsy
what are the benign tumors of esophagus?
leiomyomas
fibrovascular polyps
condylomas HPV
lipomas
what are the malignant tumors of esophagus ?
squamous cell carcinoma
adenocarcinoma
what are the risk factors of squamous carcinoma?
tobacco —> most imp
Alcohol –> most imp
polycyclic hydrocarbons
nitrites / nitrosamines
fungi in food ( nitrosamines )
esophagitis
HPV infection
what is the most location for squamous carcinoma ?
50% of cases are in middle third of esophagus
what is the location of adenocarcinomas?
distal third esophagus
describe the process of developing squamous carcinoma?
dysplasia —-> in-situ —-> infiltration
adenocarcinoma no in situ form
what are the risk factors of adenocarcinoma?
Barret esophagus, long standing GERD
Tobacco
obesity
previous radiation therapy
heterotopic gastric or submucosal glands
whites 7 times more in men than women
describe the process of developing adenocarcinoma?
squamous epithelium —> esophagitis —-> barret esophagus —> dysplasia —-> carcinoma
what are the features of adenocarcinoma?
invade adjacent gastric cardia
barret esophagus adjacent to the tumor
tumor produce mucin and form glands
