Esophageal Diseases and Anatomy

Vocabulary flashcards covering esophageal anatomy, constrictions, motility disorders, foreign bodies, perforations, GORD, Barrett's esophagus, and surgical treatments based interventions.

Esophagus

A muscular tube $25\,cm$ long occupying mainly the posterior mediastinum, lined throughout with non-keratinized stratified squamous epithelium.

Striated Esophageal Muscle

The muscle type present in the upper $2-6\,cm$ of the esophagus, innervated by voluntary lower motor neurons carried in the vagus nerve.

Proximal 1/3 Lymphatic Drainage

The lymphatic pathway of the upper esophagus, which drains into the deep cervical lymph nodes and subsequently into the thoracic duct.

Middle 1/3 Lymphatic Drainage

The lymphatic pathway of the mid-esophagus, which drains into the superior and posterior mediastinal nodes.

Distal 1/3 Lymphatic Drainage

The lymphatic pathway of the lower esophagus, which drains into the gastric and celiac lymph nodes.

Pharyngo-esophageal Junction

The first anatomical esophageal constriction, located $15\,cm$ from the incisor teeth.

Aortobronchial Constriction

The second anatomical esophageal constriction, located $25\,cm$ from the incisor teeth where the aortic arch and left main bronchus cross anteriorly.

Diaphragmatic Constriction

The third anatomical esophageal constriction located at the esophageal hiatus, $38-40\,cm$ from the incisor teeth.

Esophageal Foreign Body

An ingested object, most commonly a food bolus indicating underlying disease, best evaluated and removed using flexible endoscopy without contrast studies.

Esophageal Perforation

A full-thickness tear of the esophageal wall, most commonly caused by iatrogenic procedures ($\sim 60\%$) and presenting with chest pain, dyspnea, fever, and subcutaneous emphysema.

Hamman's Sign

A mediastinal crunch heard on auscultation in patients with esophageal perforation caused by mediastinal air.

Boerhaave's Syndrome

Spontaneous transmural perforation of the esophagus caused by forceful vomiting against a closed glottis, leading to high pressure buildup.

Mallory-Weiss Syndrome

A condition caused by vigorous vomiting that produces a non-transmural vertical mucosal split immediately below the squamocolumnar junction at the cardia ($90\%$) or esophagus ($10\%$).

Gastro-Oesophageal Reflux Disease (GORD)

A condition resulting from loss of lower esophageal sphincter (LOS) competence, presenting classically with retrosternal burning pain (heartburn), epigastric pain, and regurgitation.

Transient Lower Esophageal Sphincter Relaxations (TLOSRs)

Postprandial coordinated sphincter relaxations that account for most physiological reflux episodes and early-stage GORD.

Collis Gastroplasty

A surgical procedure (Collis-Nissen operation) performed to manage esophageal shortening caused by severe chronic reflux.

Barrett's Esophagus

Metaplastic replacement of normal esophageal mucosa with specialized columnar epithelium containing mucus-secreting goblet cells (intestinal metaplasia) due to chronic reflux.

Classic Barrett's Esophagus

Barrett's esophagus characterized by $\ge 3\,cm$ of columnar epithelial replacement in the lower esophagus.

Short-Segment Barrett's Esophagus

Barrett's esophagus characterized by $< 3\,cm$ of columnar epithelial replacement in the lower esophagus.

Paraoesophageal ('Rolling') Hiatus Hernia

A hernia where the greater curve of the stomach rolls into the mediastinum alongside the esophagus, classically presenting with dysphagia and chest pain relieved by a loud belch.

Achalasia

A primary esophageal motility disorder characterized by failure of lower esophageal sphincter relaxation, absence of normal peristalsis, and progressive esophageal dilation due to loss of inhibitory neurons in the myenteric plexus.

Bird-Beak Appearance

The characteristic radiological finding on a barium swallow study showing smooth distal esophageal tapering in achalasia.

Heller Myotomy

A surgical procedure for achalasia that involves cutting the muscle fibers of the lower esophageal sphincter, typically accompanied by a partial fundoplication.

POEM

Peroral Endoscopic Myotomy, a minimally invasive endoscopic procedure used to treat achalasia.