Esophagus Path II Flashcards by Matt Stanton

esophageal webs

thin membranes in midline of upper esophagus

pain and difficult swallowing

congeintal/acquired

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plummer vinson syndrome

iron deficient anemia - esophageal webs

often progress to SCC of esophagus

also with bullous disease

tx - correct iron deficiency

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schatzki ring

narrowing of esophagus
-dysphagia

-ring of mucosal tissue

upper - A rings
lower - B rings

seen wit barium swallow

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postcricoid dysphagia, esophageal webs, iron deficient anemia

triad of plummer vinson

aka paterson-brown-kelly

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most common hiatal hernia

sliding - GE junction above diaphragm

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rolling hiatal hernia

part of stomach herniates esophagus hiatus

paraesophageal

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hiatal hernia clinical

50yo or older

95% sliding

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risk fx hiatal hernia

heavy lifting
cough, sneezing, vomiting
pregnancy
constipation
obesity
heredity
soking
cocaine
stress

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dull pain in chest, SOB, heart palpitation, dysphagia

hiatal hernia

irritate vagal nerve
acid reflux occurs

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zenker diverticulum

pressure in lower pharynx - weak portion of pharyngeal wall forms diverticulum

cricopharyngeus muscle spasm

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killians triangle

point of ballooning in zenkers diverticulum

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halitosis

smelly breath
-with zenker diverticulum

also dysphagia, regurg, feeling of lump in neck, can get food stuck

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achalasia

incomplete LES relaxation, increased LES tone, aperistalsis of esophagus

risk for SCC

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achalasia path

failure of smooth m to relax -
-referring to esophagus

failur eof distla esophageal inhibitor neurons during swallowing

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chagas disease

trypanosoma cruzi

with achalasia**

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diagnosis of achalasia

manometry and barium swallow

heller myotomy

cleave of smooth m in tx of achalasia

nifedipine

sublingual - improves achalasia disease

CREST syndrome

calcinosis
raynauds
esophageal dysfunction
sclerodactylyl
telangiectasias

unknown etiology
no tx

anti-Scl 70

lower 2/3 esophagus fibrotic changes**

rubber hose like tube

severe retching/vomiting in alcoholics

mallory-weiss lacerations

not full thickness
of esophagus

tx - supportive

cauterize or epi to stop bleeding

boerhaave syndrome

rupture of esophagus
-excessive vomiting/ eating disorder

full thickness - transmural

air in mediastinum - crepitus

majority of esophageal rupture

iatrogenic

-endoscopic procedure or feeding tube

esophageal varices

with portal HTN - alcoholics

also schistosomiasis mansoni or laponicum

massive bleeding can occur

dilated submucosal veins

esophagitis

lye strictures - suicide attempt

also with infection - candida, herpes, bacterial uncommon

and GERD

herpesvirus esophagitis

punched out lesion ulcers

punched out lesion in esophagus

herpesvirus intranuclear inclusions -multinucleated cells

GERD

mucosal damage from stomach acid tx - PPIs, H2 receptor blockers, antacids statins - reduce barrets and adenocarcinoma

GERD clinical

40yo, M, obese -heartburn, dysphagia barret mucosa -long term risk for adenocarcinoma

barrets esophagus

intestinal metaplasia with GERD

eosinophilic esophagitis

allergic condition -dysphagia, heartburn, food impaction food allergy dx - reflux not responsive to PPIs of pH rules out GERD biopsy - eosinos in superficial epithelium - minimum of 14 per high power field

NERD

non-erosive reflux disease | -thought to have GERD, but don't respond to PPIs and no erosion present on EGD

barret esophagus

complication of GERD ->3cm - 30-40x increased risk for aenocarcinoma squamous metaplasia to glandular - goblet cells** need biopsy

GIST

gastrointestinal stromal tumor malignant in esophagus

adenocarcinoma of esophagus

more in male hispanic HERD and barrets mucosa increase risk tobacco and obesity prognosis poor h. pylori - reduced risk**

distal third esophagus

common site of adenocarcinoma

SCC of esophagus

90% of malignant esophageal tumors worldwide 50% in US age 50 hx of heavy smoking/ethanol males AAs poor prognosis HPV - high risk regions

keratin pearl

squamous cell carcinoma

middle third esophagus

SCC