7- esophagus diseases

what type of epithelium lines the esophagus

non-keratinizing squamous (SSNKE)

2 types of esophageal obstruction

1. mechanical

2. functional

2 types of mechanical esophageal obstruction

1. atresia

2. stenosis

what’s atresia mechanical esophageal obstruction

• birth defect where thin, non-canalized cord replaces part of esophagus usually near tracheal bifurcation → aspiration, suffocation, pneumonia

• associated w/ fistula-connects esophageal pouch to bronchus or trachea

what’s stenosis mechanical esophageal obstruction

congenital/acquired (common) narrowing of esophagus → fibrous thickening of submucosa + atrophy of muscularis propria

2 common causes of stenosis mechanical esophageal obstruction

chronic GERD or irradiation

2 types of functional esophageal obstruction

achalasia: incomplete relaxation of LES, increased LES tone, esophageal aperistalsis

1. primary: unknown cause, failure of distal esophageal inhibitory neurons, can affect CN X

2. secondary: Chagas disease caused by Trypanosoma cruzi bacteria → failure of LES to relax, esophageal dilation, destruction of myenteric plexus

what’s esophageal varices

portal HTN → enlarged vessels that protrude in lumen of distal esophagus → can rupture + cause massive bleeding

esophageal varices is seen in 50% of which pts

pts w/ cirrhosis

what’s the first pass effect

venous blood from GI tract goes to liver via portal vein

2 causes of esophageal lacerations

1. Mallory-Weiss syndrome: acute alcohol intoxication w/ severe vomiting → linear + superficial esophageal tears into GI junction

2. Boerhaave syndrome: rupture of distal esophagus → can affect mediastinum + result in mediastinitis

which cause of esophageal laceration is most common

Mallory-Weiss syndrome

which cause of esophageal laceration requires surgery

Boerhaave syndrome

what’s esophagitis

inflammation of esophagus

3 types of esophagitis

1. infectious

2. eosinophilic

3. reflux (GERD)

3 common infections that cause infectious esophagitis

1. fungal (Candidiasis)

2. cytomegalovirus: presents w/ shallow ulcers + nuclear/cytoplasmic inclusions histologically

3. herpes simplex: presents w/ “punched out” uclers

symptoms of eosinophilic esophagitis in adults vs. children

• adults: experience food impaction + dysphagia

• children: experience food intolerance or GERD-like symptoms

what’s the histopathology that indicates eosinophilic esophagitis

infiltration of eosinophils in superficial aspect of lamina propria + epithelium, distinguishing it from GERD or Crohn’s

what’s the most common type of esophagitis

reflux esophagitis (GERD)

4 things that contribute to reflux esophagitis (GERD)

1. increased abdominal pressure

2. alcohol/tobacco use

3. pregnancy

4. hiatal hernia

3 symptoms of reflux esophagitis (GERD)

1. heartburn

2. dysphagia

3. regurgitation of sour tasting content

4 complications of reflux esophagitis (GERD)

1. esophageal ulcerations

2. hematemesis (vomiting blood)

3. stricture development

4. Barrett esophagus

what are hiatal hernias

separation of diaphragmatic crura w/ protrusion of stomach into the thorax → can cause LES incompetence

2 symptoms of hiatal hernias

1. heartburn

2. regurgitation of gastric juices

2 types of hiatal hernias

1. sliding: stomach herniates through diaphragmatic hiatus

2. paraesophageal (rolling): stomach protrudes through separate defect alongside esophagus

Barrett’s esophagus involves metaplasia of what cells

lower 1/3 esophagus columnar squamous cells → tall, columnar glandular epithelium, resembling intestinal epithelium

Barrett’s esophagus increases risk for what

adenocarcinoma

esophageal adenocarcinoma can arise from which 2 conditions

1. Barrett’s esophagus

2. GERD

esophageal adenocarcinoma affects which part of the esophagus

distal/lower 1/3 of esophagus, can invade stomach

esophageal squamous cell carcinoma affects which part of the esophagus

middle 1/3

4 risk factors of esophageal squamous cell carcinoma

1. alcohol/tobacco use

2. achalasia

3. frequent consumption of very hot beverages

4. Plummer-Vinson syndrome

what’s Plummer-Vinson syndrome

severe iron deficiency → esophageal squamous cell carcinoma in upper 1/3 of posterior cricoid area

Plummer-Vinson syndrome usually affects what type of people

middle aged + elderly women of Scandinavian origin