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Flashcards in Esophagus Deck (25):
1

What type of cells line the esophagus?

Stratified non-keratinized squamous epithelium

2

Esophageal Atresia
and
Fistula

a thin cord like non canalized segment of the esophagus associated with a proximal blind pouch and lower pouch leading to the stomach

Fistula: congenital or acquired communication between the trachea and esophagus

*most common TE Fisual

3

What are the symptoms of esophageal atresia and associated health problems?

Symptoms:
-regurgitation shortly after birth
-aspiration, paroxysmal suffocation, pneumonia, fluid and electrolyte disturbances

Associations
-congenital heart disease (frequently the cause of death in these infants)
-neurologic and GU disease
-GI malformations
-Single umbilical artery

4

What is achalasia? What are some secondary causes of achalasia?

anti-peristalsis, relaxation of LES with swallowing, increased resting tone of LES
-progressive dysphagia
-nocturnal regurgitation and aspiration
-BIRDS BEAK

chagas disease
polio
surgical ablation
diabetes
sarcoid
malignancy
amyloidosis

5

What are complications of achalasia?

5% develop SCC

Complications:
candida, diverticula aspiration pneumonia

6

What is scleroderma?

connective tissue autoimmune disorder
-damage to small blood vessels
and progressive fibrosis in skin
-GI involvment (90%)
-esophageal dysfunction-acid reflux and decrease in motility


****
-difficulty swallowing, reflux symptoms
-atrophy of smooth muscle in lower 2/3 of esophagus
-LES injury (reflux, barrett's esophagus)

7

Hiatal hernia
Sliding and Paraesophageal

separation of diaphragmatic crura and widening of the space between the muscular crura and esophageal wall

Complications:
-ulceration, bleeding, perforation, strangulation and obstruction(paraesophageal), reflux esophagitis (sliding)

8

Mallory Weiss Tear

longitudinal tears at the esophageal junction or gastric cardia
-severe retching or vomiting
-seen in alcoholics
-hiatal hernia predisposing factor

Clinical:
hematemesis, mucosa and submucosa tear

9

boerhaave syndrome

transmural
usually distal esophageal rupture
-due severe vomiting
-high morbidity and mortality without surgical treatment

Clinical:
-retrosternal chest pain and upper abdominal pain with subsequent odynophagia, tachypnea, dyspnea, cyanosis, fever, shock
-subcutaneous emphysema pneumomediastinum

10

What reflux esophagitis caused by?

1. decreased efficacy of esophageal anti-reflux mechanisms (decreased LES tone)
2. sliding hiatal hernia
3. slowed esophageal clearance of reflux meateria
4. delayed gastric emptying and increased gastric volume
5. reduction in the reparative capacity of the esophageal mucosa

11

What are clinical presentations of reflux esophagitis? What are complications?

-infants to adults
-dysphagia, heartburn, regurgitation of sour brash, hematemesis
-severe chain mimicking a heart attack
-hyperemia on endoscopy

Complication: bleeding, ulceration, stricture, barrett's esophagus

12

CMV

owl eye

13

What is eosinophilic esophagitis?

Adult Symptoms
-dysphagia, food impaction
Children Symptoms
-feeding intolerance, GERD-like symptoms, dysphagia/food impaction
Treatment:
-dietary restrictions to prevent exposure to food allergens
-topical or systemic corticosteroids

14

What is chemical or pill induced esophagitis?

Mucosal irritants
-alcohol
-corrosive acids/alkalis
-excessive hot fluids
-heavy smoking
-medications (pil induced)
-cytotoxic anticancer therapy
-uremia

---see edema on histology

15

What are benign tumors of the esophagus?

leiomyomas
fibromas
lipomas
hemangiomas
neurofibromas
lymphangiomas
squamous papilloma
condyloma
inflammatory polyp

16

What is the single most important risk factor for adenocarcinoma?

Barrett's esophagus

17

What is Barrett's esophagus? What is the clinical presentation of Barrett's esophagus?

Complication of GERD
-considered a premalignant condition

Clinical Presentation:
40-60yrs
M>F
Secondary complications: ulceration, bleeding, stricture, malignancy
-30-40X rate of adenocarcinoma with long segment Barrett's esophagus
(long>3cm)
-salmon or red velvet covered mucosa

18

What is the histologically sign of barrett's esophagus?

intestinal metaplasia=presence of goblet cells

-classified as low and high grade dyplasia-50% of high may already have adenocarcinoma

19

What is the epidemiology of squamous cell carcinoma of the esophagus?

male more than female
most common worldwide
-iran, central china, hong kong, south africa, southern brazil
-more common in AA than white

20

What is the clinical presentation of squamous cell carcinoma?

insidious onset
patient subconsciously changes diet from solids to liquids
dysphagia and weight loss
9% overall 5 year survival

21

What are some causative factors of squamous cell carcinoma?

-dietary-hot tea
lifestyle-alcohol/smoking
-esophageal disorders
-achalasia, webs, injury

genetic predisposition
-p53 point mutation
-p16/ink4a mutation
-stepwise acquisition and accumulation of genetic alteratioson

22

Where does squamous cell carcinoma normally arise?

upper 1/3
ln spread depends on esophageal location
upper 1/3-cervical
middle-mediastinal or tracheobronchial
lower-celiac and gastric

23

Epidemiology of adenocarcinoma?

>40 yrs
M>F
White>AA
-associated with obesity and barrett's

24

WHat are the clinical symptoms of adenocarcinoma? Prognosis

Difficulty swallowing, progressive weight loss, bleeding, vomiting, chest pain with normal EKG

25

What are causative factors of adenocarcinoma?

-Barrett's
-p53 mutation
-amplification of c-ERB-B2, cyclin D1, cyclin E
-mutation in Rb suppressor gene
-allelic loss of p16/ink4
-increased expression of TNF and NFKB