Systems path 2 exam 1 -Esophageal Pathologies and abnormalities (pg 41-77)

lower pharyngeal outpouching due to increased pressure in pharynx

zenker's diverticulum

Symptoms of Zenker's diverticulum

halitosis, dysphagia, regurgitation, aspiration

Diagnosis for Zenker's Diverticulum

barium swallow and video fluoroscopy

difficulty swallowing

dysphagia

when upper and lower esophageal segments are separated (in infants)

atresia

functional esophageal obstruction where the lower esophageal sphincter fails to relax

achalasia

achalasia triad

Incomplete LES relaxation, Increased LES tone, esophageal aperistalsis

symptoms of achalasia

dysphagia, regurgitation, chest pain, weight loss

typical sign of achalasia

"bird beak" sign

achalasia where a co-morbitiy impairs LES function (chaga's, polio, diabetes)

secondary

MC type of achalasia which results from loss of inhibitory innervation to LES

primary

mechanical causes of dysphagia

congenital atresia, stenosis, esophageal diverticula, tumor

neurologic causes of dysphagia

achalasia, infection, stroke, brain damage

developmental anomaly in the form of an inlet patch, most likely in the upper 1/3 of the esophagus, frequent site of ectopic gastric mucosa and is typically asymptomatic

esophageal ectopia

backup of blood into esophageal veins from portal HTN

esophageal varices

why may someone get esophageal varicose?

cirrhosis (90% of cases) and hepatic schistosomiasis (MC worldwide)

procedure in which a balloon is inflated within the esophagus or stomach, to apply pressure on bleeding blood vessels, compress vessels, and stop bleeding. This is used to treat bleeding veins in esophagus and stomach

balloon tamponade

inflamed esophageal mucosa

esophagitis

2 or more episodes of acid reflux per week ; MC cause of esophagitis and the MC G.I. complaint

GERD

risks associated with developing GERD

obesity, smoking, hiatal hernia, pregnancy, age > 40

symptoms associated with GERD

dysphagia, heartburn, "sour brash"

what type of esophagitis is acute, self limited, and is caused by tobacco, alcohol, hot liquids, acidic foods, and irradiation

chemical

what type of esophagitis is MC following an ulcer and caused by microbes (fungal or viral)

infectious

longitudinal and superficial tear at G-E junction

mallory-weiss tear

signs and symptoms of a mallory-weiss tear

forceful vomiting, hematemesis, upper GI bleeds

complete rupture at the lower thoracic esophagus

Boerhaave's syndrome

signs and symptoms of boerhaave's syndrome

hamman's sign, chest pain and shock, subcutaneous emphysema

when the stomach protrudes into thorax/chest

hiatal hernia

what is the MC type of hiatal hernia characterized by a "bell-shaped" dilation?

axial (sliding)

what type of hiatal hernia is occurs when a separate portion of the stomach protrudes and is prone to strangulation or obstruction?

non-axial (rolling)

who is most likely to get a hiatal hernia?

adults >70 years

symptoms of hiatal hernia (if there is any)

mimics GERD (MC with non-axial type)

when normal squamous epithelium undergoes a cylindrical muciparous metaplasia-> columnar epithelium with intestinal goblet cells

Barrett esophagus

barrett esophagus is found in 10% of symptomatic ______ patients

GERD

risk associated with developing Barrett esophagus

caucasians, males, GERD, alcohol, age 40-60, smoking

appearance of Barrett esophagus

red, velvety mucosa (bands or tongues)

complications associated with barrett esophagus

esophageal adenocarcinoma, ulcerations and strictures

chronic esophagitis caused by high amounts of eosinophils, located far from G-E junction and is immunologically mediated

eosinophilic esophagitis

cardinal histological feature of eosinophilic esophagitis

superficial "epithelial infiltration" by large number of eosinophils

symptoms of eosinophilic esophagitis in children

GERD-like

symptoms of eosinophilic esophagitis in adults

dysphasia and impaction of food

MC benign tumor from smooth muscle

esophageal leiomyoma (mostly in distal esophagus)

MC esophageal tumor worldwide which accounts for 90% of all esophageal CA cases

esophageal squamous cell carcinoma

esophageal tumor which is common in the US and has the same symptoms as GERD

esophageal adenocarcinoma

risk associated with developing esophageal squamous cell carcinoma

>45 years, males, African Americans, irritation (HPV), achalasia

symptoms of esophageal squamous cell carcinoma

dysphagia, odynophagia, cachexia

what type of tumor follows Barrett's esophagus and starts out in glandular cells?

esophageal adenocarcinoma

signs and symptoms of esophageal adenocarcinoma when advanced

obstruction (dysphagia/odynophagia), vomiting, cachexia, fatigue

appearance of esophageal adenocarcinoma

diffuse, flat/raised, possible ulceration

appearance of esophageal squamous cell carcinoma

strictures, rigidity, hemorrhage, cardio-pulmonary invasion