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esophagus Flashcards

robbins (83 cards)

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1
Q

what is the purpose of manometry

A

differentiate between the different types of esophageal dysmotility by checking LES tone and peristalsis

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2
Q

what are the three types of esophageal dysmotility

A
  1. nutcracker syndrome= high amplitude contractions of distal esophagus with loss of normal coordination
  2. diffuse esophageal spasm with repetitive, simultaneous contractions of the distal sm m.
  3. hypertensive lower esophageal sphincter- LES high resting pressure/incomplete relaxation
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3
Q

because wall stress is increased, esophageal dysmotility may result in development of ______, primarily the ___ ____

A

small diverticulae

epiphrenic diverticulum

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4
Q

spasm of the ____ M after swallowing can result in increased P within the ____ ____ and thus the development of ___ ____, which is located directly above the __ ____ ____

A

cricopharyngeus

distal pharynx

Zenker diverticulum

upper esophageal sphincter

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5
Q

what population is zenker diverticulum most likely to present in

A

age > 50 y.o

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6
Q

Sx of Zenker’s Diverticulum

A

regurge and halitosis because food gets stuck in the diverticulum

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7
Q

mechanical esophageal obstruction, such as _____, starts with inability to ______ and progress to _______

A

strictures of CA

swallow solids

liquids

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8
Q

describe benign esophageal stenosis

A

narrowing of the lumen due to fibrous thickening of the submucosa, associated with atrophy of the muscularis propria and secondary epithelial damage

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9
Q

benign esophageal strictures often maintain their ___ and ___, while malignant strictures are often associated with ______

A

appetite, weight

weightloss

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10
Q

what are esophageal mucosal webs

A

idiopathic, ledge-like protrusions of the mucosa that may cause obstruction

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11
Q

in what population are you most likely going to see esophageal mucosal webs

A

women older than the age of 40, associated with GERD, graft-vs-host ds

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12
Q

upper esophagus webs may be accompanied by what other conditions

A

iron deficiency anemia, glossitis, cheilosis =Plummer-Vinson syndrome

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13
Q

in esophagus, semi-circumferential lesions that protrude less than 5 mm, made of fibrovascular CT and overlying epithelium

A

esophageal webs

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14
Q

what is the clinical presentation of esophageal webs

A

nonprogressive dysphagia associated with incompletely chewed food

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15
Q

in esophagus, circumferential, thicker than 2-4 mm, includes mucosa, submucosa, and sometimes hypertrophic muscularis propria

A

schatzki rings

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16
Q

schatzki rings: differentiate between A rings and B rings

A

A rings= above the gastroesophageal junction in the distal esophagus, covered by squamous mucosa

B rings= at the squamocolumnar junction of the lower esophagus, with gastric cardia-type mucosa

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17
Q

achalasia is characterized by this triad

A

incomplete LES relaxation

increased LES tone

aperistalsis of the esophagus

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18
Q

What are the sx of achalasia?

A

dysphagia for solids and liquids, difficulty in belching, and CP

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19
Q

what is the etiology of achalasia

A

distal esophageal inhibitory neuronal (ganglion cell) degeneration

x vagus N/ dorsal motor nucleus of vagus

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20
Q

what is the etiology of secondary achalasia

A

happens in Chagas Ds (trypanosoma cruzi infection–> destruction of myentric plexus, failure of peristalsis, and esophageal dilation)

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21
Q

association of achalasia with these three etiologies suggests that achalasia may be driven by immune-mediated destruction of esophageal neurons

A

HSV1 infection
sjögren syndrome
autoimmune thyroid disease

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22
Q

what is the treatment of achalasia

A

laproscopic myotomy, pneumatic balloon dilatation, botox injection

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23
Q

longitudinal esophageal tears near the gastroesophageal junction, most often associated with sever retching or vomiting secondary to acute alcohol intoxication

A

mallory-weiss tears

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24
Q

describe the etiology of mallory weiss teras

A

esophageal relaxation fails during prolonged vomiting.. gastric contents overwhelm the gastric inlet and cause the esophageal wall to stretch and tear

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25
transmural tearing and rupture of the distal esophagus
boerhaave syndrome
26
describe the prognosis and treatment of boerhaave syndrome
=an emergency that results in severe mediastinitis and requires surgical intervention
27
what is the clinical presentation of boerhaave syndrome
CP, tachycardia, shock
28
common irritants of the mucosa of the esophagus
alcohol, corrosive acids or alkalis, hot fluids, heavy smoking
29
describe the presentation of esophageal chemical injury
in children, due to accidental ingestion of household cleaning in adults, often after attempted suicide
30
esophageal infections in otherwise healthy people are uncommon and often due to ____. infections in immunosuppressed patients is more common and can be caused by ___
herpes simplex virus herpes simplex virus, CMV, fungal organisms, candidiasis
31
what is the most common fungal infection of the esophagus
candida
32
pill induced esophagitis frequently occurs at the site of ____. ulceration, when present, is accompanied by ________ and eventually _____
strictures superficial necrosis with granulation fibrosis
33
nonpathogenic oral bacteria are frequently found in _________, which pathogenic organisms may invade the ___ ____ and cause _____ or overlying mucosa
ulcer beds lamina propria, necrosis
34
_____ virus usually causes punched-out ulcers (in esophagus)
herpes
35
_______ causes shallower ulcerations and characteristic nuclear and cytoplasmic inclusions within capillary endothelium (in esophagus)
CMV
36
submucosal glands in the ___ and ____ esophagus secrete ____ and _____
proximal and distal mucin and bicarb
37
what is the most frequent cause of esophagitis
reflux of gastric contents into the lower esophagus, most commonly caused by transient LES relaxation
38
what is the most common outpatient GI complaint in the US
esophagitis
39
what factors and conditions can cause LES relaxation and gastric reflux
normally mediated by vagus N can be triggered by gastric distension, gas or food, mild pharyngeal stimulation, stress, swallow-induced relaxation of LES abrupt increase in intra-abdominal P alc and tobacco use, obesity, CNS depressants, pregnancy, hiatal hernia, delayed gastric emptying, increased gastric volume
40
(esophagus) basal zone hyperplasia exceeding 20% of total epithelial thickness and elongation of lamina propria papillae extending into the upper third
extensive GERD
41
in what population is GERD most common
older than 40, infants and children
42
describe the clinical presentation of GERD
heartburn, dysphagia, regurge of sour-tasting gastric contents in chronic GERD--> attacks of severe CP
43
what is the treatment for GERD and what are some complications of reflux esophagitis
PPIs for symptomatic relief complications--> ulceration, hematemesis, melena, stricture development, Barrett esophagus
44
"separation of diaphragmatic crura and protrusion of the stomach into the thorax through the resulting gap"
hiatal hernia
45
what is the clinical presentation of hiatal hernia
heartburn and regurge
46
in what population will you see hiatal hernia
can have congenital in infants and children mostly acquired later in life
47
what are the sx of eosinophilic esophagitis
food impaction and dysphagia in adults and feeding intolerance in children majority of patients are atopic- atopic dermatitis, allergic rhinitis, asthma, modest peripheral eosinophils
48
(esophagus) large number of intraepithelial eosinophils, particularly superficially
eosinophilic esophagitis
49
differentiate the sx and trx of GERD vs eosinophilic esophagitis
unlike GERD, acid reflux is not prominent in eosinophilic esophagitis and high doses of PPIs usually do not provide relief in e.e., give dietary restrictions (no milk or soy), and topical or systemic corticosteroids for atopic sx
50
"tortuous dilated veins lying primary within the submucosa of the distal esophagus and proximal stomach"
esophageal varices
51
what are the two most common causes of esophageal varices (the portal HTN that precedes them)
first- alcoholic cirrhosis second- hepatic schistosomiasiss
52
what is the risk of untreated varices
rupture--> hemorrhage into the lumen of the esophageal wall--> overlying mucosa appears ulcerated and necrotc
53
(esophagus) squamous cells with nuclear inclusions = __ | - seen in the setting of ___
HSV, immunocompromised (infectious esophagitis)
54
what two viral infectious should come to mind with infectious esophagitis
HSV-1 and CMV
55
vascular ectasia- what is he?
in the antrum of the stomach =watermelon stomach- = ectatic mucosal vessels producing stripes of edematous erythematous mucosa alternating with less severely injured paler mucosa associated with cirrhosis and systemic sclerosis
56
what does H. Pylori infection look on endoscopy
nodular lesions in the antrum
57
what population is associated with adenocarcinoma
white men
58
what is the treatment for esophageal variceal hemorrhage
an emergency ``` can be treated by inducing splanchnic vasoconstriction endoscopically by sclerotherapy balloon tamponade variceal ligation (banding is semi-permanent) ``` patient's with high risk for hemorrhage are treated prophylactically with B blockers to reduce portal blood flow and with endoscopic variceal ligation
59
what is the prognosis of esophageal varices hemorrhage
30% die from hypovolemic shock, hepatic coma, etc. 50% of those who survive will have a recurrent hemorrhage within 1 year
60
complication of GERD that is characterized by intestinal metaplasia within the squamous mucosa of the esophagus
barrett esophagus
61
in what population is Barrett esophagus most common
white males between 40-60
62
the greatest concern in Barrett esophagus is that it confers an increased risk of ___ ______
esophageal adenocarcinoma
63
"one or several tongues or patches of red, velvety mucosa extending upward from the gastroesophageal junction" "metaplasic mucosa alternates with residual smooth, pale squamous mucosa"
barrett esophagus
64
Barrett esophagus can only be identified through ___ and ___, which are usually prompted by _______
endoscopy and biopsy, GERD sx
65
what is the trx for Barrett esophagus
surgical resection, esophagectomy, photodynamic therapy, laser ablation, and endoscopic mucosectomy
66
the most common esophageal CA
squamous cell carcinoma
67
most esophageal adenocarcinomas arise from ___ ____
Barrett esophagus
68
risk factors for adenocarcinoma
``` obesity-related GERD barrett esophagus tobacco radiation H. ```
69
protective factors against adenocarcinoma of the esophagus
a diet full of fruit and vegetables H. pylori (decreased acid secretion secondary to gastric atropy)
70
in what population is adenocarcinoma most common
Caucasian, men in the US/UK/Australia/Netherlands
71
describe the genetic and epigenetic changes that cause the progression from Barrett's to adenocarcinoma
first mutation of TP53 and downregulation of CDKN2A, aka p16/NK4a later progression= amplification of EGFR, ERGBB2, MET, cyclin D1, and cyclin E
72
esophageal adenocarcinoma usually occurs in the ___ ____ of the esophagus and may invade the ___ ___ ____
distal third adjacent gastric cardia
73
esophageal adenocarcinomas most commonly produce ___ and form ___, with intestinal-type morphology
mucin | glands
74
describe the prognosis of adenocarcinomas
by the time they present, its usually already spread to the submucosal lymphatic vessels 5 year survival less than 25% in the few patients where it is limited to the mucosa or submucosa, the 5 year survival is about 80%
75
in what population are you most likely to see squamous cell carcinoma
adults older than 45, males, AAs also in patients in western kenya under 30 who consume traditional fermented milk
76
what are risk factors for squamous cell carcinoma
alcohol and tobacco use, poverty, caustic esophageal injury, achalasia, tylosis, plummer-vinson syndrome, diets without fruits or vegetables, previous radiation to the mediastinum
77
describe alcohol as a risk factor for squamous cell carcinoma
not a risk factor on its own, but is synergistically risky with tobacco use
78
what genetic abnormalities are associated with squamous cell carcinoma of the esophagys
amplification of SOX2, over-expression of cyclin D1 (cell cycle regulator), loss of function of TP53, E-cadherin, and NOTCH1
79
where in the esophagus are squamous cell carcinoma commonly found
middle third of the esophagus
80
describe the morphology of squamous cell carcinoma in the esophagus
begins as an in situ lesion called squamous dysplasia early lesions appear as small, gray-white, plaque-like thickenings
81
metastasis from the upper third of the esophagus will go to ____, from the middle third will go to ________,and from the lower third will go to the _________
1. cervical lymph nodes 2. mediastinal, paratracheal, and tracheobronchial nodes 3. gastric and celiac nodes
82
what is the clinical presentation associated with squamous cell carcinoma
dysphagia, odynophagia, obstruction causing to switch to liquid foods prominent weight loss, debilitation hemorrage and sepsis with tumor ulceration, iron deficiency sometimes the first sx are aspiration of food via a tracheoesophageal fistula
83
what is the prognosis of squamous cell carcinoma
5 year survival= 75% if superficial overall= 20%, and varies by stage, age, race and gender

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