Esophageal Pathology Flashcards
(32 cards)
Achalasia results from the failure of what process to occur?
Relaxation of the lower esophageal sphincter
In a man with high lower esophageal sphincter resting pressure/uncoordinated peristalsis, you see innervation loss from which plexus?
The myenteric (Auerbach) plexus, which innervates the LES
What is the most common presenting symptom of achalasia?
Progressive dysphagia to both solids and liquids (vs. obstruction, which presents as dysphagia to solids only)
After you diagnose a man with achalasia, you should advise him that he has increased risk for what malignancy?
Esophageal squamous cell carcinoma
A man is diagnosed with new achalasia. He recently traveled to South America. What parasitic disease did he likely contract while there?
Chagas disease (associated with secondary achalasia)
What is the etymology of the word achalasia?
A = absence of, and chalasia = relaxation
What is the underlying pathophysiology of dysphagia associated with CREST?
Esophageal dysmotility (poor peristalsis) and low esophageal pressure proximal to the lower esophageal sphincter
A man has dysphagia. Work-up shows esophageal smooth muscle atrophy, poor peristalsis, low LES pressure, reflux, and a stricture. Diagnosis?
Sclerodermal esophageal dysmotility (part of CREST syndrome)
A man complains of dry cough and chest pain not associated with activity and worse when supine. If not treated, he is at risk for what?
Barrett esophagus (a complication of GERD)
A man has increasing asthma frequency, as well as nocturnal cough and mild chest discomfort before falling asleep. What might you prescribe?
Proton pump inhibitor or H2 receptor blocker (GERD can cause adult-onset asthma, and nocturnal cough and dyspnea are common)
A 45-year-old woman comes to the ED with vomiting. Her vomitus becomes bloody and painful. What is the cause of her hematemesis?
Mallory-Weiss tears, which often result from vomiting associated with alcoholics and bulimics (cause painful bleeding)
Ingestion of what compound classically causes esophageal strictures?
Lye (strictures are also seen with gastroesophageal reflux disease)
Esophagitis is commonly caused along with what three etiologies?
Reflux, infection, and chemical ingestion
Which of these infectious agents is least likely to be associated with esophagitis: HSV-1, cytomegalovirus, Candida, Helicobacter pylori?
H. pylori (this bacterium is associated with peptic ulcer disease but rarely with esophagitis)
Esophagitis associated with HSV-1 shows ____ ulcers on endoscopy, whereas esophagitis associated with cytomegalovirus shows ____ ulcers.
Punched-out; linear
Endoscopy performed on a patient with esophagitis shows white pseudomembranes. Is the patient immunocompromised?
Yes, as this is Candida esophagitis, which often occurs in immunocompromised patients
Plummer-Vinson syndrome has what symptom triad?
Dysphagia due to esophageal webs, Iron deficiency anemia, and Esophageal webs (plumbers DIE)
A patient has a food allergy that causes dysphagia, heartburn, and strictures. Does it respond to GERD therapy?
No, as this is eosinophilic esophagitis, which does not respond to typical GERD therapies
A patient with numerous allergies and GERD unresponsive to therapy has an esophageal biopsy. What is it likely to show?
Eosinophilic infiltration (this is eosinophilic esophagitis, common in patients with atopy)
Is Barrett esophagus an example of dysplasia, hyperplasia, neoplasia, or metaplasia?
Metaplasia
In patients with Barrett esophagus, there is a replacement of ____ epithelium with ____ epithelium.
Nonkeratinized squamous; intestinal (columnar)
What causes Barrett esophagus?
Chronic acid reflux resulting in glandular metaplasia
What specific malignancy is associated with Barrett esophagus?
Adenocarcinoma (Barrett = Becomes adenocarcinoma, results from reflux)
Name at least six risk factors associated with esophageal cancer.
Achalasia, Alcohol, Barrett esophagus, Cigarette smoking, Diverticula, Esophageal web, Familial, Fat, GERD, Hot liquids (AABCDEFFGH)
