Flashcards in Esophagus Deck (23):
What type of muscle is esophagus made up of?
Upper 1/3: striated only. Middle 1/3: striated/smooth. Inferior 1/3: smooth only.
Causes of mechanical dysphagia (solids > liquids)
Foreign body, inflammation (infectious esophagitis, caustic exposure), strictures, neoplasms, extrinsic compression (aortic aneurysm, retropharyngeal abscess, thyromegaly)
Causes of neuromuscular dysphagia (solids = liquids)
Tongue paralysis, lesions of CN 9 and/or 10, MG, poly or dermatomyositis, esophageal smooth muscle d/o (scleroderma, achalasia, diffuse esophageal spasm)
Result of derangement of the myenteric plexus -> nonpersistalsis, incomplete LES relaxation after swallowing, increased LES tone at rest
Tx of achalasia
Meds: CCBs or nitrates. Surgery: endoscopic dilation (less successful, higher risk of perf) or esophagomyotomy with fundoplication
Complications of achalasia
Increased risk of SCC. Pulmonary complications from aspiration
Diffuse esophageal spasm (DES)
Primary or secondary to reflux esophagitis, esophageal obstruction, CTD, diabetic neuropathy. Spasm is in distal 2/3. Dysfunction of myenteric plexus -> large uncoordinated contractions of smooth muscle
Unlike achalasia, no regurg. Can present with chest pain that is mistaken for ACS. Barium swallow may show corkscrew or be normal if not in spasm
Meds: nitrates, CCB decrease LES pressure. Esophagomyotomy not as successful as for achalasia so only use if totally debilitating
Mortality of esophageal rupture
Full thickness esophageal tear. Due to forceful vomiting, cough, labor, lifting, trauma. Most common site of rupture is L lateral wall just above esophageal hiatus. Needs surgical repair.
Partial thickness esophageal tear. Due to forceful vomiting. Bleeding gen resolves spontaneously. 90% can be medically managed with NG tube and gastric lavage.
What are the three anatomic narrowings of the esophagus?
Above the UES. Near the aortic arch. Above the LES (which is not an anatomic sphincter btw)
Mediastinal emphysema heard as "crunching" sound with heartbreat, finding in esophageal perf
Esophageal webs from chronic iron deficiency
Risk factors for esophageal carcinoma
Alcohol, tobcco, diet high in nitrates, achalasia, chronic esophagitis, Plummer-Vinson
Prognosis of esophageal carcinoma
Poor; dysphagia doesn't develop until esophagus is more than half occluded, so by the time of presentation most patients have mets. Tx is mostly palliative and has many complications. 5 yrs survival 5%. Radiation can shrink and provide some palliation.
True vs. false esophageal diverticulum
True = all three layers of esophagus. False = only mucosa and submucosa
Three types of esophageal diverticula
Pharyngoesophageal (Zenker's), midesophageal, epiphrenic
Pharyngoesophageal and epiphrenic diverticular are caused by what?
Pulsion diverticula, meaning caused by increased pressure. These are false diverticula
Midesophageal diverticular are caused by what?
Traction. They are true diverticula
Dx of esophageal diverticula