Esophagus Flashcards by Denisse Tiangco

Achalasia triad

Form of

incomplete LES relaxation
inc LES tone
esophageal aperistalsis

Functional esophageal obstruction

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Most frequent site of ectopic gastric mucosa

upper third of esophagus:

inlet patch

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Small patches of ectopic gastric mucosa in si and colon

Gastric heterotopia

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Dilated coronary veins in lower esophagus due to portal hypertension
(cirrhosis, schistosomiasis)

Develop in 90% of cirrhotic px esp alcoholic liver disease
Second most common cause is hepatic schistosomiasis

Detected by angiography tortuous dilated coronary veins lying within submucosa of distal esophagus

Most common complication: hematemesis and rupture

Commonly collapse postmortem

Esophageal varices

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Most common esophageal laceration assoc with severe retching and vomiting

Acute alcoholic intoxication

Failure of relaxation of esophagus preceding antiperistalsis leading to stretch and tear

Longitudinal lacerations across GEJ
superficial

Chronic vomiting with severe counter peristalsis

Mallory weiss tear

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Transmural esophageal tear and mediastinitis

Severe

Boerhaave syndrome

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Most common fungal pathogen in esophagitis

Candida

Mucormycosis
Aspergillosis

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Punched out ulcers

nuclear viral inclusion within a rim of degenerating epithelial cell at ulcer edge

Herpes virus

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Shallow ulcer with nuclear and cytoplasmic inclusion within capillary endothelium and stromal cell

CMV

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Most frequent reason for esophagitis
Central to mucosal injury
Most common outpatient GI diagnosis

Causative mechanism:
Dec LES and inc abdominal pressure

reflux of gastric content

Reflux esophagitis

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Hyperemia
Eosinophil in squamous mucosa followed by neutrophil
Basal zone hyperplasia exceeding 20%

GERD

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Complications of GERD

Melena
Hematemesis
Ulceration
Stricture
Barret’s

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Separation of diaphragmatic crura and protrusion of stomach into the thorax through gap

Asymp in 90%

Hiatal hernia

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Food impaction
Dysphagia 
Feeding intolerance
Epithelial infiltration of eosinophil superficially at sites far from GEJ 
Atopic associated

Tx: avoidance of allergen

Eosinophilic esophagitis

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Complication of GERD charac by intestinal metaplasia within the esophageal squamous mucosa
40-60 years
Confers greatest risk of esophageal adenocarcinoma
Premalignant
Preinvasive lesion:

Barrett’s esophagus

Dysplasia 0.2-1%

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Complication of chronic GERD
Intestinal metaplasia within the esophageal squamous mucosa
Confers an increased risk of esophageal carcinoma

Tongues or patches of red velvety mucosa extending upward from GEJ
Metaplastic mucosa alternates with residual smooth pale squamous (esophageal) mucosa proximally and interfaces with light brown columnar gastric mucosa distally
Esophageal mucosa becoming metaplastic mucosa with goblet cell (squamocolumnar metaplasia)

Barrett esophagus

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Invasion of neoplastic epithelial cell into lamina propria

Tx:

Intramucosal carcinoma

Surgical resection esophagectomy

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Barrett’s dx

Endoscopy

Biopsy

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Most common esophageal tumor worldwide

SCC

adeno in US

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Arises from background of Barrett’s and GERD

Occurs in the distal third

inc by tobacco use, obesity, radiation and documented dysplasia
Dec in diet rich in fruit and vegetable
M, 7x

Esophageal adenocarcinoma

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Associated with progression from dysplasia to invasive ca in esophageal adenocarcinoma

TP53 mutation

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Most common location of adenocarcinoma

distal third of esophagus invading adjacent gastric cardia

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Adults >45, M 4x
Alcohol, tobacco, poverty, caustic, achalasia, Plummer-Vinson, hot beverage, mediastinum radiation, polycyclic hydrocarbon, nitrosamine, HPV,tylosis

Occurs in middle third or the esophagus

6x in Africans

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SCC of esophagus

SCC of esophagus occurs

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Middle third

SCC begins as small gray plaquelike thickening | Invades respiratory tree, aorta, exsanguination

in situ squamous dysplasia

SCC metastasizes frequently bec of invasion of

submucosal lymphatic network promoting circumferential and longitudinal spread

Cancers on upper third metastasize to

cervical LN

Cancer in middle third metastasize to

mediastinal paratracheal tracheobronchial

Cancers in lower third metastasize to

gastric and celiac nodes

Thin, noncanalized cord replaces a segment of esophagus, causing a mechanical obstruction Most common at or near the tracheal bifurcation Usually associated with a tracheoesophageal fistula

Esophageal atresia

Occurs when incomplete formation of the diaphragm allows the abdominal viscera to herniate into the thoracic cavity Displaced viscera can cause pulmonary hypoplasia that is incompatible with life

Diaphragmatic hernia

Left posterolateral hernia

Bochdalek’s hernia

Anterior, right diaphragmatic hernia

Morgagni

Most common type of esophageal atresia and TEF

Type C then | A

Gives rise to central tendon of diaphragm

Septum transversum

Gives rise to muscular part of diaphragm

Pleuroperitoneal membrane

``` More common type of esophageal diverticula Esophago-pharyngeal junction Above cardia Unknown etiology Killian’s triangle ```

Pulsion type (Zenker’s)

Less common Lower 1/3, near hilum Rarely collect food Tuberculous lymphadenitis

Esophageal diverticula

``` Achalasia Idiopathic muscular hypertrophy Progressive systemic sclerosis Plummer-Vinson Syndrome Leiyomatosis ```

Esophageal dysmotility

Primary esophageal motility disorder Failure of LES smooth muscle relaxation leading to high pressure Absence of peristalsis Dysphagia Vomiting Regurgitation Heartburn

Achalasia | Megaesophagus

Achalasia/Megaesophagus

Primary: idiopathic Secondary: T cruzi (amastigotes damage the ganglion cells)

Vasculitis with muscle wall degeneration | Part of CREST syndrome

Progressive Systemic Sclerosis

``` Esophageal web Atrophic glossitis, dysphagia Hypochromic, microcytic anemia Esophagitis in upper 1/3 Most common in middle-aged females Increased risk of CA in upper 1/3 esophagus, oropharynx and tongue ```

Plummer-Vinson Syndrome

Adenoma of esophagus arises from

Barett’s esophagus

Associated with leiomyomas

GIST

Portal vein is formed by union of

SMV | Splenic vein

Presinusoidal block of portal vein

Schistosomiasis

Benign tumors of esophagus

Adenoma GIST Granular cell tumor Localized amyloidosis

``` 80-85% of all esophageal carcinomas 10% of all GIT cancers More common in blacks and males 12% upper 56% middle 32% lower portion ```

Squamous Cell Carcinoma of Esophagus

Tributaries of portal vein

Left gastric Periumbilical Superior Rectal Vein

The rectal veins that drain into inferior vena cava

Inferior rectal | Middle rectal

Secondary causes of Esophageal Motility Disorder

GERD Scleroderma Chagas disease Post-operative

Hypermotility disorder of esophagus

Achalasia

Hypermotility disorders of esophagus

Diffuse Esophageal Spasm Nutcracker esophagus Hypertensive LES

Antibody in CREST

anti centromere

Antibody in tropical sprue | Gluten enteropatht

Anti-gliadin

Esophagus Flashcards

(56 cards)