Esophagus/Stomach Flashcards by Nathan Hansen

Esophageal structure- derived

Tracheo bronchial diverticulum

UES at C5/C6

Intraabdominal esophagus
crura arise from

Phrenoesopgeal membrane

Foregut

Separation of esophagus/trachea at weeks 4-6

Cricophayngeus muscle attaches, muscle fibers run to T10

Lumbar vert and Anterior long lig

Inserts around esoph, above/below diaphragm

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Esophageal layers

Mucosa
Submucosa
Muscularis propria
Adventitia

No serosa, tumors metastasize readily

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Esophageal duplication cysts

May cause dysphagia
Cancers have been reported

Tx is surgical

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Schatki’s ring

Possible

Treat

Thin membranous ring at squamo-columnar jxn

GERD

Dilation

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Zenker’s Diverticulum

Older male

Aspiration/halitosis

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GER/GERD

Reflux esophagitis

GER- regurg gastric content
GERD- sx of tissue damage

Inflamm/evidence of injury

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Patho of GER/GERD

Dec LES tone caused by

Others

Transiet LES relaxation and reflux of stomach content

Drugs, Alcohol, caff, CNS dep, Tobacco

Hiatal hernia, inc ab pressure, delayed gastric emptying, inc gastric volume

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Reflux esophagitis Esophageal

Extra-esophageal

Heartburn, dysphagia, odynophagia, regurg, hematemesis, CP

Cough/wheeze/sore throat/ear pain

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Gold standard to confrim GERD

Ambulatory pH monitoring

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Endoscopy parameters

Failure to respond to PPI after 4-8 wks
Weight loss
dysphagia
Older men
Fam history of esoph ca
Tobacco
Hematemesis

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Treatment of RE

Weight loss
PPI (relapse off therapy)
take 30/60 min before meal
H2 blocker
Surgery (erosive)

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Eosinophilic esophagitis sx

Peds

Biopsy finding

Food impaction/dysphagia

Feed intol/failure to thrive/reflux refractory to tx

Furrows/rings in esoph, red eosinophils

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EE Associated features

Therapy

Atopy, peripheral eosinophila, failure to respond to PPI

PPi, topical steroids, allergen id, Elim diet

No eggs/milk/soy/nuts/seafood/gluten

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Infectious esophagitis

Common pt

Org

Look for

Candida (colonizes esoph)

Yeast/hyphae
Inherent IC
Meds/steroids

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Herpes esophagitis
Appearance
Biopsy location

CMV esophagitis
Biopsy location

IC/competent
Multinucleated cells, ground glass appearance of nucleus/vacuoles
Edge of ulcer

Giant cells w intranuclear inclusions
Ulcer bed

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Pill induced esoph injury

Doxy- young person, acne
Emepromium Bromide
KCl
Quinidine
Iron sulphate
NSAIDs
Alendronate

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Barrett Esoph

Metaplastic columnar epithelium- intest metaplasia/goblet cells replaces squamous epithelium

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BE complication of

Abnormal mucosa above

Inc risk of
Surveillance

Therapy for

GERD

GEJ/goblet cells

Adenocarcinoma
3-5 yrs no dysplasia
Annually for low grade dys

High grade

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BE dx

Biopsy findings

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Endoscopy, directed biopsy

Esophageal sparing tx
endoscopic mucosal resec, RF ablation

Goblet cells, nuclei not neat

Treatment for HGD

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Ablation- RF, photodynamic, cryo

Endoscopic mucosal resec
Esophagectomy

Carcinomas of esoph

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SCC most common

Adenocarcinoma (think BE, obesity, GERD, tob, low H pylori)

SCC Geographic
Characteristic

Dietary risk
Vitamins

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Central China, Iran, South Af
Male, black

Mutagenic compound in fungus contaminated foods
VE, betacarotene, selenium, FE, VD

SCC genetics

chronic mucosal injury

Area/appearanc

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SOX2, cyclin D1, TP53

Lye, achalasia, HPV

Dysphagia, grad obst, aspiration PNA

Middle esoph, fungating

Lacerations

Syndrome

MC
Causes

Boerhaave syndrome

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longtiudinal tears in GEJ

Mallory-weis tears

alcoholics
excessive vomiting, retching

transmural tear

Esophageal innervation Motor PNS SNS ENS

Vagus Bagus various SM and LES

Achalasia Primary Secondary Tx

LES fails to relax in response to swallowing Dec/absent peristalsis- progressive esophageal dilation and hypertrophy Idio- deg of nerves Inflamm destruct MP, chagas Laparoscopic myotomy, pBD, botox

Cardia Funds Antrum Cells

Mucous Parietal/chief Mucous/G

Damaging Protective Injury mechanism Factors for stomach dz

Gastric acids, peptic enzymes Mucus, bicarb, blood flow, regen H pylori, NSAID, T/A, reflux, ischemia, shock

H pylori Location Not in

Spiral/curled Urease +. gram neg Gastric mucosa location Intestinal mucosa

H pylori factors for survival

Motility via flagellin Urease- forms bicarb/ammonium Adhesins Cag A toxin

H pylori epid Transmission

Prev high in developing Inverse with SES Fecal/oral

Dx of H pylori Non invasive Invasive

N- serologic test for AB, urea breath/stool antigen I= requires endoscopy Rapid urease, histology, culture, bacterial detec by PCR

H pylori causative of Neutrophils with gastritis

Chronic gastritis, PUD, gastric carcinoma, MALT Always H pylori

Urea breath test Test of choice Sensitivity affected by

Carbon isotope labeled urea Metabolized to NH4 and labeled HCO3 Excreted as labeled CO2 Confirming eradification Ab (off 28 days) PPI (off 14 days)

Treat PUD

PPI, ab 2 weeks Eradicate and avoid NSAIDs

PUD Exudates Complication MC cause of ulcer death

deep ulcer, into muscularis propria PMN and fibrin (think HP) Necrosis, granulation tissue, scar Bleeding Perforation

Acute gastric erosion Causes

Acute gastritis, acute hemorrhagic gastritis, erosive gastritis, stress ulcers ``` NSAIDs/Aspirin Alcohol/Tobacoo Stress- trauma/burn/surgery Uremia, food poisonng Chemo ```

AGE patho Impaired local defense Hypersecretion of GA

Mucosal hypoperfusion- shock/sepsis Dec mucus (aspirin), PG def (NSAIDs) Stimulate vagal nuclei w inc ICP

AGE presentation treat

superficial, coagulative necrosis, no inflamm Often asymptom Correct underlying cx

Chronic gastritis causes

H pylori, Atrophic (autoimmune/HP) | Chemical- NSAIDs/bile reflux

Autoimmune type A AB against Location in the stomach Presentation inc risk of

Diffuse, atrophy, metaplasia parietal cells, IF Body Achlorhydria, hypergastrinemia PA (loss of IF) Carcinoid tumor, gastric cancer

Multifocal atrophic gastritis type B Causes Location in stomach MC precursor to Presen

Multifocal, Atrophy, metaplasia HP, diet, enviro Antrum AdenoCa (intestinal) normal gastrin, no PA

Gastric carcinoma\ Geo Gastric cancer typical population Etio

2nd mc East Asia, C/S America, EE lack Refrigeratiors, fresh fruits/veggies/inc salt/smoke Diet/enviro/HP for intestinal

RF for CG Potential genes

Autoimmune Gastrits Previous partial gastrectomy- bile reflux Adeomas Menetriers dz CDH1, Ecadherin, BRCA2, tp53

Gastric ca location presentation Signet cells indicate

mostly antrum polypoid, ulcerating Adenocarcinoma diffuse stomach cancer

Gastric cancer symptoms Metastasis

Asympt until late WL, ab pain, anorexia, NV Melena, hematemesis, anemia R/D LN duodenum, pancreas, liver etc

Lauren classification Intestinal Diffuse Gastric cancer Gross, micro, intestinal metaplasia, M:F, etiology

I- polypoid, fungating/ well differentiated, universal, more M, diet/HP D- ulcerative, infiltrative, signet cells, less, even, unknown

Esophagus/Stomach Flashcards

(47 cards)