GIT I (Esophagus) Flashcards by Ibrahem Salem Rehiel

Clinical manifestations of GIT

Loss of appetite
Heartburn
Abdominal pain
Indigestion
Nausea and vomiting
Swollen belly

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The esophagus has been subdivided into 3 portions

The cervical portion
The thoracic portion
The abdominal portion

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Esophagus formed from:

Outer longitudinal layer and inner circular layer of smooth muscle
Between them, there is Auerbach’s plexus that responsible for **peristalsis

In the submucosa, there is Meissner’s plexus that is responsible for sensation

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The esophagus has four normal constrictions:

1st: at level of C6 (15cm from incisor teeth)
2nd: where the arch of aorta crosses it, at T3 (22.5 cm)
3rd: where the left bronchus crosses it, at T6 (27.5 cm)
4th: where it passes through the diaphragm, at T10 (40 com)

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The narrowest part of the esophagus

1st constriction

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The normal indentations of the esophagus

Aortic arch (22.5cm)
Left bronchus (27.5cm)

Enlarged left atrium (Abnormal)

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What is cardio-esophageal syndrome:

It happens when the left atrium is enlarged, it may compress in the esophagus and cause dysphagia.

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Symptoms of esophageal disorders

Dysphagia
Odynophagia
Regurgitations (esophangitis or esophageal ulcer)
Vomiting

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Related to the age, Achalasia most common in:

Young

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Related to age: Cancer most common in:

Elderly

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During reflux, some food regurge into the pulmonary system and causes aspiration pneumonia
Particularly in which age?

Pediatrics age

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Patients with esophageal anomaly that are susceptible to recurrent infections:

Tracheoesophageal fistula (TOF)

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Imaging modalities of esophagus:

Plain X-ray
Fluoroscopy (by Barium swallow)
Ultrasound
CT scan
MRI
Nuclear medicine

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Using of X-ray in esophagus

Dilated esophagus (achalasia)
Foreign bodies
Air fluid level
Mass

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What is the type of contrast used in barium swallow

Barium sulfate (45% weight/volume)

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Double vs single contrast:

Single: esophagus is full of barium and has a smooth outline
Double: Then emptying esophagus and barium lies b/w mucosal folds, it appears as three or four long, striaght parallel lines

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The normal indentations of the opacified esophagus are seen in which view during barium swallow?

Right anterior oblique

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The barium sulfate is the preferable contrast media using fluoroscopy because:

It provides a good coating of the internal part of lumen

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Barium sulfate is conisder as positive (bright) or negative (dark) contrast media:

Positive

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Stricture is the main cause of dysphagia:
It caused by:

Peptic (GERD)
Carcinoma
Achalasia
Corrosives
Surgery

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The stricture can be:

Tapering ends with smooth outline =benign
Overhanging edges or shouldering with irregular outline = malignant

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Peptic stricture:

• Found at lower end of the esophagus
• associated with hiatus hernia/GERD(reflux esophangitis)

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Signs of peptic stricture

Short
Smooth outline
Tapering ends
Ulcer may be seen close to the stricture

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What is Achalasia

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Rare swallowing disorder, which affects the esophagus
Primary: functional dt neuromascular abnormality (defect on **myenteric (Auerbach’s) plexus)
2ry: non-functional, may cause by malignancy

Features of achalasia:

Failure of organized esophageal peristalsis Impaired relaxation of LES Food stasis (marked dilation) Occurs at middle and late adulthood

Patients with achalasia may comes with

Dysphagia Chest pain Regurgitation

Complications of achalasia

Pneumonia and brochiectasis due to aspiration Esophageal carcinoma Candida esophangitis

Radiological findings of achalasia:

Markedly dilated esophagus Tapering in inferior esophagus Rat tail (bird beak)

CT rule in achalasia

It has little role in directly assessing patients with achalasia, but it is useful in assessing commin complications Used to identify any focal regions of **thickenning** (malignancy) Inspection of lungs for evidence of aspiration

A number of entities may mimic achalsia

Scleroderma Esophageal or gastric malignancy Esophageal stricture Chagas disease Anti-Hu antibodies from lung cancer (paraneoplastic syndrome)

Corrsive stricture

Long stricture, which begins at the level of aortic arch

Features of corrosive stricture

Smooth Tapered ends May be irregular

Esophageal carcinoma

Usually involves the full circumference to form stricture for several centimeters in length.

Features of malignant carcinoma stricture

Occur anywhere Irregular outline Shouldered edges Deep ulceration There is always dilatation before any stricture

If you suggest that the stricture from esophageal carcinoma What is the next step?

CT scan

Types of filling defects on barium swallow

Intraluminal Intramural: acute angle made with the wall Extramural: There is a shallow obtuse angle with the wall of the bowel

Ex of intramural filling defect

Leiomyoma esophageal carcinoma

Ex of extramural lesion

Carcinoma of the bronchus Enlarged mediastinal lymph node Aneurysm of aorta

Intra-luminal filling defects

Foreign body like coin/lump food

Esophageal varices:

Dilated submucosal veins dt ++ collateral blood flow from portal system to azygos system Mainly caused by **portal hypertension**

What is the next step if suggested on the esophageal varices

Endoscopy

How to describe the finding in case of esophageal varices

Multiple tortuous worms like filling defects Most likely esophageal varices

Other findings may you get them with esophageal varices:

Liver cirrhosis and splenomegaly (CT)

Esophageal web:

Thin, shelf-like projection arising from the anterior wall of **cervical portion of the esophagus** **not shouldering**

The combination of a web, dysphagia , and iron deficiency anemia that is usually found in middle-aged females is known as:

Plummer vinson syndrome

How to describe the esophageal web in the barium x-ray

Thin non circumferential defect arising from the anterior wall of the cervical esophagus

Esophageal diverticula

A pouch or sac that protrudes from the gastrointestinal wall and can derive from any tubular organ in the gastrointestinal wall

True vs. False esophageal diverticula

False: consists of mucosa, submucosa, and strands of muscle fibers True: contains all layers of the gastrointestinal wall

Which level of the esophagus can diverticula occur at?

At any level

Clinical features of diverticula

It is often **Asymptomatic**, may cause dysphagia, aspiration...

Diverticula more common in age and gender:

Older male

Common types of esophageal diverticula

Pharyngo-esophageal (Zenker's diverticulum) : most common Mid-esophageal (para-bronchial) Epiphrinic

Esophageal atresia

It is an absence in the continuity of the esophagus due to an inappropriate division of the primitive foregut into the trachea and esophagus.

Most common congenital anomaly of the esophagus

Atresia

Esophageal atresia may associated with :

Duodenal atresia Pyloric stenosis

Types of esophageal atresia :

1. Proximal atresia with distal fistula (85%) 2. Isolated esophageal atresia (8%) 3. Double fistula with esophageal atresia (1%) 4. Proximal fistula with distal atresia (1%)

X-ray finding of the proximal esophageal atresia with distal tracheoesophageal fistula

Non progression of an orogastric catheter in the blind esophagus pouch and the presence of air in the stomach

The non-progression radiopaque tube in the esophageal pouch with no air in the stomach

Esophageal atresia without tracheoesophageal fistula

GIT I (Esophagus) Flashcards

(58 cards)