Gastrointestinal Disorders: Esophagus

These flashcards contain key vocabulary and definitions related to gastrointestinal disorders, specifically focusing on the esophagus.

Gastroesophageal Reflux Disease (GERD)

1. Cause: Decreased lower esophageal sphincter (LES) tone, hiatal hernia, or obesity.

   • Pathogenesis: Chronic retrograde flow of gastric acid and pepsin leads to esophageal mucosal injury.

   • Symptoms: Heartburn (pyrosis), regurgitation, dysphagia, and chronic cough.

   • Treatment: Lifestyle changes (weight loss), PPIs (H^+/K^{+} ATPase inhibitors), and H2 receptor antagonists.

Barrett's Esophagus

1. Cause: Long-standing, untreated chronic GERD.

   • Pathogenesis: Intestinal metaplasia where stratified squamous epithelium is replaced by nonciliated columnar epithelium with goblet cells.

   • Symptoms: Often reflects underlying GERD (heartburn); may be asymptomatic until progression.

   • Treatment: Aggressive acid suppression (high-dose PPIs) and endoscopic surveillance to monitor for dysplasia.

Esophageal Varices

1. Cause: Portal hypertension, most commonly due to liver cirrhosis.

   • Pathogenesis: Increased pressure in the portal vein forces blood into collateral systemic circulation (left gastric vein to esophageal veins), causing dilation.

   • Symptoms: Typically asymptomatic until rupture, which presents as massive hematemesis and melena.

   • Treatment: Endoscopic variceal ligation (banding), octreotide, and non-selective beta-blockers (e.g., Propranolol) for prevention.

Esophageal Strictures

1. Cause: Chronic inflammation from GERD, ingestion of caustic substances, or radiotherapy.

   • Pathogenesis: Healing of deep circumferential ulcers leads to fibrous tissue deposition and collagen contraction.

   • Symptoms: Progressive dysphagia, first with solids then with liquids, and food impaction.

   • Treatment: Endoscopic balloon dilation and long-term acid suppression to prevent recurrence.

Esophagitis

1. Cause: GERD, infections (Candida, HSV-1, CMV), or chemical/pill-induced injury.

   • Pathogenesis: Direct mucosal damage or infiltration by inflammatory cells (e.g., eosinophils in EoE).

   • Symptoms: Odynophagia (painful swallowing), retrosternal chest pain, and heartburn.

   • Treatment: Addressing the underlying cause (e.g., Fluconazole for Candida; PPIs for reflux; food elimination for eosinophilic esophagitis).

Portal Hypertension

1. Cause: Pre-hepatic (secondary to portal vein thrombosis), intra-hepatic (cirrhosis), or post-hepatic (Budd-Chiari syndrome).

   • Pathogenesis: Increased resistance to blood flow through the liver leading to a pressure gradient (> 5-10 \text{ mmHg}) in the portal system.

   • Symptoms: Ascites, splenomegaly, and portosystemic shunts (varices).

   • Treatment: Diuretics, sodium restriction, and TIPS (Transjugular Intrahepatic Portosystemic Shunt).

Adenocarcinoma

1. Cause: Chronic GERD, Barrett’s Esophagus, obesity, and tobacco use.

   • Pathogenesis: Progresses through the metaplasia-dysplasia-carcinoma sequence (chronic inflamation, dysplasia →malingancy →cancer), usually in the lower third of the esophagus.

   • Symptoms: Progressive weight loss, dysphagia, and retrosternal pain.

   • Treatment: Surgical resection (esophagectomy), chemotherapy, and radiation. high mortality rate due to mets

Squamous Cell Carcinoma

1. Cause: Alcohol consumption, tobacco use, achalasia, and consumption of very hot liquids.

   • Pathogenesis: Malignant transformation of squamous epithelial cells(chronic inflamation, dysplasia →malingancy →cancer),, typically occurring in the upper or middle third of the esophagus.

   • Symptoms: Dysphagia, hoarseness (if recurrent laryngeal nerve is involved), and unintentional weight loss.

   • Treatment: Combination of chemoradiotherapy and surgical resection.

pathogenisis for esphogeal stricture

chronic inflamation→fribrin/scar tissue formation→ narrowing of the esophagus

pathogenisis for esphogeal varices

reduced BF to liver →increased pressure in portal vein pressure→risk for rupture

leads to life-threatening bleeding and complications →hypovolemic shock