2 ESOPHAGUS Flashcards
(117 cards)
1
Q
What is Achalasia? (Cardiospasm)
A
An esophageal motility disorder involving the smooth muscle layer of the esophagus, and the lower esophageal sphincter (LES)
2
Q
What is Achalasia characterized by?
A
- Incomplete relaxation of LES - It’s increased tone - Lack of peristalsis of esophagus
3
Q
What is Primary Achalasia?
A
MC** Characterized by failure of distal esophageal inhibitory neurons - The Auerbach’s plexus (myenteric plexus)
4
Q
What does the Auerbach’s plexus (or myenteric plexus) provide?
A
Motor innervation to both layers of the muscular layer, having both para and sympathetic output
5
Q
What is special about Meissner’s plexus?
A
It has ONLY parasympathetic fibers and provides secretor innervation to the mucosa nearest the lumen of the gut
6
Q
What could secondary Achalasia result from?
A
Cancer of esophagus or upper stomach
7
Q
What else could Secondary Achalasia result from?
A
Infection with Protozoa (Trypanosoma Cruzi) which causes destruction of the myenteric plexus of the esophagus with its dilation
8
Q
Achalasia caused by Tripansoma cruzi is known as _____
A
***Chaga’s Disease SECONDARY ACHALASIA
9
Q
What are the signs and symptoms of Achalasia?
A
- Dysphasia 2. Regurgitation 3. Chest pain 4. Coughing 5. Aspiration of food or liquid
10
Q
What is “Dysphagia” associated with Achalasia?
A
Difficulty in swallowing of solid or liquid food
11
Q
What is “Regurgitation” associated with Achalasia?
A
Backflow of undigested food
12
Q
Why would you have chest pain with Achalasia?
A
BEHIND THE STERNUM With radiation to the neck or armS* (NOT JUST ONE ARM) Can be extremely painful and gets worse AFTER eating
13
Q
Why would there be “Coughing” with Achalasia ?
A
Cough when you’re in a HORIZONTAL position especially at night
14
Q
What will you see on X- Ray with Achalasia?
A
Use contrast liquid swallowing shows the narrowing of the distal part of esophagus
15
Q
What is the radiographic sign apparent with Achalasia?
A
“Bird’s Beak” or “Rat’s Tail” sign** Along with dilation above
16
Q
How is there a diagnosis of Achalasia?
A
Upper Endoscopy (Gastroscopy)
17
Q
What are the 3 complications of Achalasia?
A
- Aspiration pneumonia or airway obstruction 2. Lower esophageal diverticulum 3. Esophageal Cancer (in 5% of patients)
18
Q
What do you recommend to patients with Achalasia ?
A
- Eat slowly - Avoid eating near bed time - Avoid ketchup, citrus, chocolate, caffeine - Physician consultation
19
Q
What is a Hiatal Hernia of the esophagus?
A
Protrusion of the upper part of stomach into thorax through the space between the muscular Curran’s of the diaphragm (hiatus)
20
Q
What are the different forms of Hiatal Hernia?
A
- Sliding MC* 2. Rolling or Paraesophageal
21
Q
What happens during a Sliding Hernia?
A
Where the gastroesophageal junction together with the stomach move above the diaphragm
22
Q
What type of dilation do you see with a sliding hernia?
A
Bell Shaped* MC form of hiatal hernia
23
Q
What is a rolling or paraesophageal hernia?
A
When a separate portion of the stomach, usually along the greater curvature, enters the thorax through the widening foremen
24
Q
What is condition can be an etiology of Hiatal Hernia?
A
Kyphoscoliosis
25
What are the etiologies associated with Hiatal Hernia?
- Increased pressure within the abdominal cavity - Congenital diaphragmatic weakness - Obesity, trauma
26
Hiatal Hernia is known as
Great mimic disease
27
What do most cases of Hiatal Hernia do?
Does not cause any symptoms or specific symptoms
28
Signs and Symptoms of the Hiatal hernia:
- Dull pain in chest - Shortness of breath - Heartburn (typical for sliding hernia) - Heart Palpitation (tachycardia)
29
How do you diagnose Hiatal Hernia?
X ray with liquid Barium salt, or upper endoscopy
30
What are the differential diagnosis of the Hiatal Hernia?
- Ischemic heart disease (chest pain) - GERD because of heartburn - Lung disease (short breath)
31
Ulcer in the esophagus is a complication of what disease?
Hiatal Hernia
32
What is there a stricture of in the complication of a Hiatal Hernia?
Stricture of esophagus
33
What can the complication of Rolling Hernia be?
Development of venous infarction due to its possible strangulation by the diaphragm \*\*\* EMERGENCY \*\*\*
34
What are the recommendations by the chiropractor with Hiatal hernia?
- Restrict activities that raise intra abdominal pressure - Avoid eating near bed time - Diet modification: small frequent bland food
35
What is Gastroesophageal Reflux Disease (GERD)?
A chronic syndrome resulting in mucosal damage caused by stomach acid coming up from the stomach into the esophagus
36
Why does GERD usually happen?
Because the LES opens at the wrong time or does not close properly
37
Failure of the lower esophageal sphincter can be due to:
- CNS depressants - Hypothyroidism - Pregnancy - Alcohol or Tobacco exposure
38
Sliding hernia might be etiology for:
GERD
39
What are some visceral things that are an etiology of GERD?
SLE, asthma, gallbladder stones, and laryngitis
40
What infection is an etiology of GERD?
Helicobacter Pylori
41
Does obesity cause GERD?
YES
42
What are the signs and symptoms of GERD?
- Heartburn - Regurgitation - Dysphagia - Increased salivation - Nausea - Chest pain (radiates to arms and neck)
43
How do you diagnose GERD?
- X-ray with liquid Barium salt - Upper endoscopy
44
What is a differential diagnosis of GERD?
- Heart diseases (chest pain) - Hiatal Hernia
45
What is a major complication of GERD?
Reflux esophagitis necrosis (ulcer near the junction between stomach and esophagus)
46
Is esophageal stricture complication of GERD?
YES
47
What are the 3 complications of GERD?
- Barrett Esophagus - Aspiration Pneumonia - Esophageal Cancer
48
What are life style modifications for GERD?
- Eating not later than 3-4 hours before going to bed - Avoid coffee, alcohol, chocolate, sour, and spicy food - Increased fluid intake - Ginger tea
49
What is Barrett Esophagus?
An abnormal change (metaplasia) in the cells of the lower portion of esophagus
50
What happens to the cells in Barrett Esophagus?
The squamous epithelial cells of the esophageal mucosa are replaced by columnar epithelial cells with \*\*Goblet mucus producing cells
51
What is the etiology of Barrett Esophagus?
- GERD - Central Obesity - Smoking
52
What are the signs and symptoms with Barrett Esophagus?
- Heartburn - Hematemesis - Painful eating - Dysphagia (in case of complication by stricture)
53
How do you diagnose Barrett Esophagus?
Upper endoscopy with biopsy
54
What are complications of Barrett Esophagus?
Bleeding, stricture, and frank esophageal adenocarcinoma
55
How is treatment done with Barrett Esophagus ?
ONLY MEDICAL
56
What is Mallory Weiss Syndrome?
Lacerations - Bleeding from longitudinal tears in the mucosa (not muscular layer) at the esophagogastric junction
57
5-10% of Mallory-Weiss Syndrome have:
Upper GI bleeding episodes
58
What is the pathogenesis of Mallory Weiss Syndrome?
Inadequate relaxation of the musculature of the lower esophageal sphincter during vomiting, with stretching and tearing of the esophageal junction during propulsive expulsion of gastric contents
59
What is the MC etiology of Mallory Weiss Syndrome?
Alcoholism, after frequent severe retching and vomiting
60
What are the different etiologies of Mallory-Weiss Syndrome?
- Hiatal Hernia - Overdose of NSAIDs - Severe vomiting in pregnancy
61
What are signs and symptoms of Mallory Weiss Syndrome?
Episodes of vomiting with bright blood
62
What is the Diagnosis method for Mallory Weiss Syndrome?
Upper Endoscopy
63
What are the complications of Mallory Weiss Syndrome?
- Severe bleeding - Esophageal Rupture (known as BOERHAAVE SYNDROME\*\*\*)
64
Action of Mallory Weiss Syndrome in an office =
CALL 911
65
What is an esophageal Varicies?
Extremely dilated submucosa veins in the low 1/3rd of the esophagus
66
What is the Etiology of Esophageal Varicies?
Portal Hypertension
67
What does Portal Hypertension cause?
1. Posthepatic (suprahepatic) 2. Hepatic (Intrahepatic) 3. Prehepatic (Infrahepatic)
68
What is Post Hepatic (suprahepatic) associated with?
- Chronic right sided heart failure - Budd-Chiari Syndrome
69
What is Budd Chiari Syndrome?
Endophlebitis of the liver veins, or obstruction of the hepatic vein
70
What is Hepatic (Intrahepatic) associated with?
- Liver cirrhosis (MC) - Liver tumors - Amyloidosis
71
Prehaptic (infrahepatic) is associated with,
- Portal vein thrombosis - Portal vein sclerosis - Portal vein congenital stenosis or atresia
72
Esophageal Varicies appear in 65% of patients with \_\_\_\_\_\_
Liver cirrhosis
73
What are manifestations of Esophageal Varicies?
- Varicies produce no symptoms until they rupture, and the hemorrhage develops (hematemesis)
74
What is the diagnosis of Esophageal Varicies?
Upper Endoscopy and CT scan
75
What is the treatment for Esophageal Varicies?
This is life threatening situation and requires immediate hospitalization
76
What is an esophageal diverticuli?
A Diverticulum is an outpouching of the alimentary tract organ wall that contains all visceral layers
77
What are the forms of Esophageal Diverticulum?
1. Zenker’s Diverticulum aka Pharyngoesophageal Diverticulum 2. Midesophageal, aka Traction Diverticulum 3. Epiphrenic Diverticulum
78
What is Zenker’s Diverticulum aka Pharyngoesophageal Diverticulum?
Immediately above the upper esophageal sphincter (FALSE Diverticulum)
79
Midesophageal aka Traction Diverticulum =
Near the midpoint of the esophagus
80
What does Midesophageal aka Traction Diverticulum results from:
Mediastinal Lymphadenitis (as from TB)
81
Where is Epiphrenic Diverticulum?
Immediately above the lower esophageal sphincter
82
What are the signs and symptoms of Esophageal Diverticuli ?
1. Zenker’s diverticulum 2. Traction diverticulum 3. Epiphrenic diverticulum
83
What is Zenker’s Diverticulum?
Food regurgitation in the absence of Dysphagia, can be complicated by aspiration pneumonia
84
What is Traction Diverticulum?
Usually asymptomatic
85
What is Epiphrenic Diverticulum?
Gives rise to nocturnal regurgitation
86
How do you diagnose Esophageal Diverticuli?
- X-ray with contrast liquid - Upper endoscopy
87
What is the treatment of Esophageal Diverticuli?
Surgery
88
What are the different types of Benign tumors of Esophagus?
1. Leiomyomas 2. Polyps 3. Fibromas 4. Lipomas 5. Hemangiomas 6. Neurofibromas 7. Squamous Papillomas
89
What are benign tumors of esophagus?
Mostly mesenchymal in origin and usually lie within the esophageal wall
90
What is a leiomyoma?
MC benign tumor of esophagus, originates from smooth muscle cells
91
Where do Benign tumors most commonly locate ?
Distal 2/3rd of the esophagus, usually they are multiple
92
What are Polyps?
Usually composed of a combination of fibrous, vascular, or adipose tissue, covered by an intact mucosa
93
What age/gender do Benign tumor of esophagus occur?
Occur between 20-50, and have NO gender preference \*\*The potential for malignancy for these tumors is very low
94
What is the rule for signs and symptoms of benign tumors of esophagus?
They are usually asymptomatic, silent, and undetected - Their size is more than 5 cm in diameter, they can come to the clinical attention
95
What are the signs and symptoms of Benign tumors of the Esophagus?
1. Dysphagia (meat and bread) 2. Pain while swallowing (less common) 3. Food regurgitation 4. Bleeding or hematemesis
96
When does bleeding or hematemesis of Benign tumor result from?
Bleeding or hematemesis result from ulceration or necrosis of benign tumors (These manifestations are very rare)
97
What is the diagnosis for Benign tumor of esophagus ?
- Upper endoscopy with biopsy - Ultrasound endoscopy - CT scan - X-ray with Barium liquid
98
How do you treat Benign tumors of Esophagus?
- Removal of polyps through endoscopy - Surgery
99
What are the MC malignant esophageal tumors?
Squamous cell carcinoma and adenocarcinoma
100
Squamous cell Carcinoma represents ______ of esophageal cancer world wide
90-95%
101
Where does squamous cell carcinoma arise from?
The squamous epithelium
102
Adenocarcinoma represents ______ of esophageal cancer in the US?
50-80%
103
What does Adenocarcinoma arise from?
Metaplastic columnar epithelium
104
Where does squamous cell carcinoma usually occur?
In the proximal 2/3rd of esophagus
105
Where does Adenocarcinoma usually occur?
In the distal 1/3rd of esophagus or gastroesophageal junction
106
What is squamous cell carcinoma in direct correlation with?
- Celiac disease - Hot tea with increased concentration of tannins - Tylosis (palmar/plantar hyperkeratosis)
107
What is adenocarcinoma in direct correlation with?
- GERD - Barrett Esophagus - Scleroderma - Zollinger-Ellison syndrome
108
What are the risk factors for both cancers of esophagus ?
- Tobacco smoking and chewing - Alcohol overconsumption - Age after 60-65 y/o - male:female 5:1
109
What are the clinical manifestations for both cancers of esophagus?
- Dysphagia - Weight loss
110
Why is there pain with Malignant tumors of esophagus?
Usually more late symptom, the pain locates behind sternum or epigastrium, could be severe, and is worsened by swallowing of any food
111
Why is there coughing with Malignant esophageal tumors?
Unusual hoarseness, due to involving of the recurrent laryngeal nerve
112
Why are there hiccups of Malignant tumors of esophagus?
Phrenic nerve involvement
113
What are the more severe manifestations of malignant tumors of esophagus?
- Nausea, vomiting, regurgitation of food - due to disruption of normal peristalsis - Bleeding, hematemesis
114
How do you diagnose malignant tumors of esophagus?
Endoscopy with biopsies - Ultrasound endoscopy
115
What are the 3 special imaging choices for Malignant tumors of esophagus?
1. CT scan of chest, abdomen and pelvis, especially if looking for METS 2. PET (Positron Emission Tomography) for estimation of stage, Mets of the cancer 3. Xrays with Barium liquid for esophageal motility studies
116
Where do malignant tumors of the esophagus metastasize to?
- Regional lymph nodes - Aorta - Liver and lungs - Mediastinum
117
What is the treatment for Malignant tumors of the esophagus?
- Surgery - Chemotherapy - Radiotherapy
