esophageal abnormalities Flashcards
Esophageal web: definition, presentation, complications
thin protrusion of the MUCOSA that causes a partial obstruction. presents with dysphagia for poorly chewed food. incresaes risk of esophageal squamous cell carcinoma.
What is plummer vinson syndrome?
severe iron deficiency anemia, esophageal web, and beefy red tongue from atrophic glossitis
zenker diverticulum definition, cuases, location, and presentation.
outpouching of pharyngeal mucosa through acquired defect in the mucosal wall. usually related to disordered swallowing. arises above the upper esophageal sphinctera at the junction of the esophagus and pharynx. it presents with dysphagia, obstruction and halitosis (bad breath- food is trapped and rotting). may also be asymptomatic.
this is a false diverticulum- only the mucosa has protruded.
Mallory weis syndrome: definition, location, presentation, causes
longitudinal laceration of mucosa at the gastroesophageal junction. caused by severe vomiting, often due to alcoholism or bulimia. presents with PAINFUL hematemesis.
complications of mallory weis syndrome
boerhaave syndrome: rupture of the esophagus leading to air in the mediastinum and subcutaneous emphysema (air bubbles beneath the skin- crackling sound when you push on them). surgical emergency.
esophageal venous drainage
most drains by azygous vein to the SVC. some drains from the left gastric vein to the portal vein.
achalasia: definition, causes, pathophysiology
disordered esophageal motility and inability to relax LES which can cause progressive dysphagia to solids and liquids. looks like a bird beak on barium swallow and high LES pressure on esophageal manometry. caused by damaged ganglion cells in the myenteric plexus (which is located in between the inner circular layer and the outer longitudinal layer of the muscularis propria). may be idiopathic or secondary to an insult like Chagas disease.
risk factors for GERD; discuss hiatal hernias.
hiatal hernia: stomach hernaites into the thorax. sliding hiatal hernia- stomach herniates into the stomach. cardia of stomach is in the esophagus (no sphincter = incr. GERD risk). causes an hourglass appearance of the stomach.
(remember that you could also have a paraesophageal hernia where the stomach herniates next to the esophagus. you will have bowel sounds in the lung fields and lung hypoplasia.
(EtOH, tobacco, obesity, caffeine, fat-rich diet)
presentation of GERD; complications
heartburn, ASTHMA (adult-onset) and cough. damage to tooth enamel. may cause ulceration with stricture (ulcers must heal with fibrosis if you’ve knocked out the stem cells). you can also get Barrett’s esophagus
classes of esophageal carcinoma
adenocarcinoma or squamous cell carcinoma. barrett’s causes adenocarcinoma and
adenocarcinoma if esophagus: location, causes
comes from barrett’s in the lower 1/3 of the esophagus. malignant prolif of glands. most common in the west
squamous cell carcinoma: esophagus. location, cuases
malignant prolif of squamous cells. most common esophageal cancer worldwide. usually arises as a result of irritation in the upper or middle thirds of the esophagus. (alcohol/tobacco, hot tea, achalasia, esophageal webs, esophageal injury like lye ingestion)
What is the presentation of squamous cell carcinoma?
progressive dysphagia (starts with dysphagia for solids, then progresses to dysphagia for liquids), weight loss, pain, and hematemesis. patients can present with hoarse voice (invasion into the recurrent laryngeal nerve) and cough (invasion into the trachea)
where do esophageal cancers spread (node wise)
upper 1/3 of the esophagus: spreads to cervical nodes
middle 1/3: mediastinal or tracheobronchial nodes
lower 1/3: celiac and gastric nodes
eosinophilic esophagitis
infiltration of eosinophils in the esophagus in atopic pts. food allergens cause dyphagia, heartburn, and strictures. unresponsive to GERD therapy
