DSA17 - Pathology of Motility and Dysphagia

Mechanical Obstruction d/t Esophageal Cancer

Define Condition:

Resulting from cancerous mass of esophagus protruding into lumen

-Sx: Dysphagia

Mechanical Obstruction d/t External Mass (ex: Thyroid Cancer)

Define Condition:

Mechanical external compression by a benign or malignant mass

-Sx:

> Dysphagia

> Choking on food

> Progressive DOE

Esophageal Stenosis/Stricture

Define Condition:

Fibrous thickening of the submucosa and atrophy of the muscularis propria​

-Hx:

> MCC = Chronic GERD

> Irradiation

> Ingestion of Caustic Agents

-Sx:

> Progressive Dysphagia of Solids --> Liquids

-Dx: ALWAYS BIOPSY (may result from infiltrating carcinoma - may be malignant)

Esophageal Atresia (EA)

Define Condition:

Congenital defect where the esophagus is closed at the bottom where it’s supposed to connect to the stomach

-Hx: A/w fistula connecting upper or lower esophageal pouches to bronchus or trachea

-Path: MC near Tracheal Bifurcation

-Dx: Type C (TEF-EA) is MC

-Prog:

> Aspiration

> Suffocation

> Pneumonia

> Fluid/Electrolye Imbalance

Esophageal Diverticulum

Define Condition:

An outpouching of esophageal tissue - from all layers (TRUE) or only mucosa and submucosa (FALSE)

-Path: (types)

> Pulsion = secondary to increased intraluminal pressure (ex: Zenker)

> Traction = secondary to pulling forces on outer aspect of esophaugs (TRUE)

-Sx:

> Asx

> Sx = Dysphagia, Regurgiation, Halitosis

-Dx: Barium Swallow

Zenker's Diverticulum

Define Diverticulum Type:

FALSE Diverticulum (only mucosa + submucosa) - occurs at esophagus-pharynx junction

-Hx:

> Elderly

> D/t Chronic Swallowing problem

-Path: Located at Killian's Triangle/dehiscence (focal weakness in hypopharynx) btwn cricopharyngeal muscle and thyropharyngeal muscle

> Failure to relax → difficulty swallowing → chronic high pressure in pharynx to force food down ==> OUTPOUCHING

-Sx:

> Dysphagia

> Haltosis

> Regurgitation

> Gurgling

> Aspiration

-Dx: Barium Swallow

Plummer-Vinson Syndrome

Define Condition:

-Hx:

> Rare

> MC in Women

> A/w Glossitis (inflamed tongue)

-Path: Lack of iron to act as co-factors to enzymes specific to the esophagus affects epithelial turnover and leads to webs​

-Sx/PE: NON-PROGRESSIVE Dysphagia + IDA + Esophageal Webs (thin mucosal membrane that grows across the lumen & found in proximal esophagus)

-Dx: Barium Swallow

-Tx:

> Correct IDA

> Dilatation of Web (relieve dysphagia)

-Prog: Risk of SCC of Pharynx and Esophagus

Schatzki's Ring

Define Condition:

2 to 4 mm mucosal stricture (no muscular layer involved) that causes a ring-like narrowing of the distal esophagus by the squamocolumnar junction

-Hx: GERD

-Sx: Sporadic & Intermittent Sx (DYSPHAGIA)

-Tx: Dilation Therapy

proximal; distal

Esophageal webs are usually found in the (proximal/distal) esophagus and have a covering of squamous epithelium, while Esophageal rings are usually located in the (proximal/distal) esophagus and can be covered with squamous epithelium, columnar epithelium, or both depending on their location to the squamocolumnar junction.

Primary Achalasia

Define Condition:

Type of Dysmotility disorder (process that interferes w/ coordinated waves of peristaltic contractions) characterized by certain Sx

-Hx: IDIOPATHIC

> Develops slowly over weeks to years (Sx increase as disease progresses)

-Path: D/t failure of distal esophageal inhibitory neurons in Myenteric (Auerbach) plexus (Neurodegenerative Disorder) ==> Less relaxation of LES/MORE CONTRACTION

-Sx/Dx: (Dx Triad)

> Esophageal Aperistalsis

> Impaired LES relaxation

> Increased LES tone

> Other Sx =

>> PROGRESSIVE Dysphagia (Food --> Liquid)

>> Heartburn (d/t retention of acid/noxious food contents)

>> Bad breath/Foul-Smelling Burp (d/t undigested retained food in esophagus)

>> Chest Pain/Wt Loss/Regurgitation/Nocturnal Cough (d/t stasis and retention of food & liquids)

>> Pulm Issues (Recurrent aspiration, tracheal compression from dilated eosphagus)

-Dx:

> Esophageal Manometry (HIGHEST SENSITIVTY)

>> Pressure change w/ contraction

>> Shows Increase LES Tone

> Barium swallow study = Dilated Esophagus

>> "Bird's beak" deformity

Secondary Achalasia

Define Condition:

Type Dysmotility disorder (process that interferes w/ coordinated waves of peristaltic contractions) characterized by certain Sx

-Hx: Chagas Disease (Trypanosoma cruzi)

-Path: Infex destroying Myenteric Plexus (Neurodegenerative Disorder)

-Sx/Dx: (Dx Triad)

> Esophageal Aperistalsis

> Impaired LES relaxation

> Increased LES tone

> Other Sx =

>> PROGRESSIVE Dysphagia (Food --> Liquid)

>> Heartburn (d/t retention of acid/noxious food contents)

>> Bad breath/Foul-Smelling Burp (d/t undigested retained food in esophagus)

>> Chest Pain/Wt Loss/Regurgitation/Nocturnal Cough (d/t stasis and retention of food & liquids)

>> Pulm Issues (Recurrent aspiration, tracheal compression from dilated eosphagus)

-Dx:

> Esophageal Manometry (HIGHEST SENSITIVTY)

>> Pressure change w/ contraction

>> Shows Increase LES Tone

> Barium swallow study = Dilated Esophagus

>> "Bird's beak" deformity

Achalasia-LIKE Disease

Define Condition:

-Hx:

> MG

> ALS

> Stroke

> Diabetic Autonomic Neuropathy

> Amyloidosis

> Sarcoidosis

> Scleroderma

> Parkinson's

-Path: Affect NM function, esp of swallowing

-Sx:

> Dysphagia

> Heartburn

>Chest Pain

Scleroderma associated Esophageal Dysmotility

Define Condition:

Systemic disorder characterized by vasculitis and upregulated collagen deposition --> Hard thickening or tight skin ==> Achalasia-type of Sx​

-Hx:

> 90% pts experience this issue

-Path: Esophageal smooth muscle atrophy and fibrosis​ --> ↓LES pressure and distal esophageal dysmotility --> acid reflux and dysphagia -> stricture

-Sx/PE:

> Dysphagia

> GERD

> Assoc Sx = (think "CREST")

>> Calcinosis

>> Raynaud's Phenomenon

>> Esophageal Issues

>> Sclerodactyly

>> Telangiectasias

-Dx: Barium Swallow

> May see Stricture

Inlet Patch

Define Condition:

Ectopic gastric mucosa is frequently seen in the upper third of the esophagus

-Associated Hx: (may develop next to these d/t peptic injury)

> Barrett's esophagus (usually in DISTAL Esophagus)

> Esophagitis

> Adenocarcinoma

-Dx: MUST Biopsy if see Velvety Salmon Mucosa (to r/o dysplastic changes)