Week 2: The Esophagus

what is the position of the esophagus when inactive?

collapsed

how long is the esophagus?

10 inches long

What is the upper 1/3 of the esophagus made of?

striated/skeletal muscle

what is the middle 1/3rd of the esophagus made of?

Mix of smooth and skeletal muscle

what is the lower 1/3rd of the esophagus made of?

Smooth muscle

primary peristalsis is the continuation of the __________ stage

pharyngeal

when does secondary peristalsis occur?

If bolus is still present after primary peristalsis (occurs from the distention of the esophagus)

the esophageal stage of swallowing is stimulated by the...

myenteric nervous system and by reflexes travelling from the vagal afferent fibers

the lower esophageal sphincter (LES) is aka

gastroesophageal sphincter

is the LES normally open or constricted? what purpose does this serve?

constricted; prevents reflux

atresia

absence of a normal body opening; occlusion/closure

characteristics of an atresia

regurgitation, excessive salivation

fistula

abnormal connection of esophagus and trachea

types of fistulas

1) Upper esophageal fistula

2) Lower esophageal fistula

3) H-type fistula

which type of fistula is most common?

lower esophageal

what is typical of an upper esophageal fistula?

choking & cyanosis

what is typical of a lower esophageal fistula?

distended abdomen (bloating)

what is typical of a H-type fistua?

choking, cyanosis AND distention of the abdomen

the most common type of fistula occurs near what part of the trachea?

the carina (bifurcation)

what procedure can be done to repair an esophageal atresia and close the fistula?

a thoracotomy

esophageal diverticula

outpouching of the wall of the esophagus

a diverticula may also occur in what part of the GI tract?

large intestine

diverticula is caused by...

motor disturbances (abnormal contractions)

3 types of diverticula

1) Zenker diverticulum

2) Traction diverticulum

3) Epiphrenic diverticulum

Zenker diverticulum

Diverticulum located high on the esophagus (upper 1/3rd)

symptoms of a Zenker diverticulum

regurgitation of food in ABSENCE of dysphagia

dysphagia

difficulty swallowing

traction diverticulum

outpouchings occurring in the middle of esophagus

traction diverticulum symptoms

asymptomatic!

epiphrenic diverticulum

immediately above the diaphragm/phrenic nerve

achalasia

failure of the lower esophagus sphincter muscle to relax in response to swallowing + absence of peristalsis

achalasia is associated with...

Loss of inhibitory ganglion cells in the myenteric plexus of esophagus

achalasia is a complication of what disease?

Chaga's disease

Chaga's disease destroys what type of cells?

inhibitory ganglion cells in the myenteric plexus of the esophagus

symptoms of achalasia

dysphagia, odynophagia, regurgitation (especially nocturnal)

odynophagia

painful swallowing

what type of injections can help with achalasia?

botox

signs vs symptoms

symptoms - subjective

signs - objective

esophagitis

inflammation of the esophagus

types of esophagitis

- reflux

- Barret

- chemical

what is the most common type of esophagitis?

Reflux Esophagitis

reflux esophagitis is aka

GERD (gastro-esopheal reflux disease)

what factors lead to GERD?

- alcohol, caffeine, chocolate

- fatty foods or foods high in protein

- nicotine, CNS depressants, pregnancy, estrogen therapy

alcohol, caffeine, and chocolate stimulate...

gastric disease

what type of foods slow down gastric emptying?

fatty or high-protein foods

what effect do nicotine, CNS depressants, pregnancy, and estrogen therapy have on GERD?

decrease LES activity

signs/symptoms of reflux esophagitis

dysphagia, odynophagia, dyspepsia, pyrosis, excessive saliva

dyspepsia

indigestion

pyrosis

heart burn

excessive saliva is aka

water brash

with a ________ hernia, you could have GERD-like symptoms

hiatal

Barrett esophagitis

Metaplastic replacement of squamous epithelium with columnar epithelium (which is normally found in the intestine) in the lower 1/3rd of the esophagus as a result of chronic reflux

there is an increased risk of what type of esophagitis with smoking?

Barrett

there is a serious risk of malignant transformation to _________ in Barrett esophagitis

adenocarcinoma

chemical esophagitis

accidental poisoning of children or attempted suicide in adults by consuming alkaline agents or strong acids found in cleaners

esophageal varices

dilated/enlarged veins beneath the mucosa in the lower 1/3rd of the esophagus, which are prone to rupture and hemorrhage

what is the most likely cause of esophageal varices?

hepatic portal hypertension

what is the most common cause of hepatic portal hypertension?

cirrhosis of the liver

portal vein

large vein bringing blood to the liver from the intestines

when pressure rises in the portal system, the esophageal veins can _______ and ________

engorge; rupture

liver cirrhosis

Fibrosis of the liver. chronic liver disease characterized by replacement of liver tissue by fibrosis caused by alcoholism, hepatitis B and hepatitis C, and fatty liver disease. Low serum albumin and high serum Immunoglobuins (IgA). β-γ "bridge" is seen in SPE.

can esophageal varices cause death?

yes! :(

signs and symptoms of esophageal varices

blood in vomit, black tarry stool, and shock

hematemesis

blood in vomit

melena

Black tarry stool

Types of hiatal hernias (2)

sliding and paraesophageal (rolling)

hiatal hernia

herniation of the stomach through an enlarged esophageal hiatus in the diaphragm

symptoms of hiatal hernia

-Heartburn

-Regurgitation

symptoms of hiatal hernia are exacerbated when the patient is in what position?

recumbent

causes of hiatal hernia

- relaxation of the LES when the stomach is full

- tight clotting around mid & upper abdomen

- lying down after a big meal

- large amount of abdominal adipose

- hard coughing/sneezing

what type of hernia is the most common?

sliding hernia

sliding hernia

laxity of the hiatus which allows the cardia of the stomach and LES to pass above the diaphragm

is a sliding hernia usually symptomatic or asymptomatic?

asymptomatic

parts of the stomach

cardia, fundus, body, pylorus/antrum

cardia

where esophagus contacts medial surface of stomach, near heart

fundus

rounded upper portion of the stomach

atrum/pylorus

most inferior portion of the stomach

paraoesophageal hernia is aka

rolling hernia

paraoesophageal hernia

when a portion of the gastric fundus moves above the diaphragm, which can continue to enlarge

extreme cases of a paraoesophageal hernia

the stomach herniates into the thorax

a paraoesophageal hernia requires what type of intervention?

surgery

scleroderma

an autoimmune disorder in which the connective tissues become thickened and hardened, causing the skin to become hard and swollen

what type of scleroderma affects the esophagus?

systemic sclerosis

systemic sclerosis

sclerosis/fibrosis of the lower 1/3rd of the esophagus & LES, which can cause a lack of peristalsis

1/3rd of patients who have scleroderma will also exhibit what condition?

Barret's metaplasia

plummer-vinson syndrome is aka

paterson-kelly syndrome

plummer-vinson syndome is characterized by...

- cervical esophageal web

- mucosal lesions (mouth & pharynx)

- iron-deficiency anemia

esophageal web

mucosal tissue that extends into the lumen

a cervical esophageal web causes ________

dysphagia

what can be a complication of plummer-vinson syndrome?

carcinoma of the oropharynx and upper esophagus

90% of plummer-vinson cases occur in what population?

women

treatments/interventions for plummer-vinson syndrome

treat anemia and dilation of web

mallory-weiss syndrome

laceration of the lower esophagus

laceration

longitudinal slit caused by severe retching

a patient with mallory-weiss syndrome may vomit what substance?

blood (hematamesis)

mallory-weiss syndrome is associated with...

alcoholism

mallory-weiss syndrome can lead to...

peritonitis or pleurisy due to contents leaking out

peritonitis

inflammation of the peritoneum (membrane lining the abdominal cavity and surrounding the organs within it)

pleurisy

An inflammation of the pleura, the membranes that cover the lungs and line the pleural cavity

mallory-weiss syndrome usually occurs in what age category?

>40yrs