Tutorial title - Esophagus
18 important questions on Tutorial title - Esophagus
What are the characteristics of eosinophilic disorders related to food?
- Hypersensitivity to food
- Chronic immunologically mediated disorder to food
- Self-limiting
- GERD-like symptoms in children
- Food impaction and dysphagia
- Epithelial infiltration by large numbers of eosinophils at sites far from gastroesophageal junction
- Their abundance is different from GERD
What are Mallory-Weiss tears and their causes?
- Longitudinal esophageal mucosal tears
- Confined tear of epithelium
- Symptoms include odynophagia and hematemesis
What defines esophageal tumors and their types?
- Infiltrative lesion/metaplasia within the esophageal squamous mucosa
- Types include adenocarcinoma and squamous cell carcinoma
- Adenocarcinoma is linked to lower 1/3 and Barrett esophagus
- Squamous cell carcinoma is associated with HPV (high-risk strains) and affects the middle 1/3
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What are the diagnostic methods and treatments for achalasia?
- Diagnosis:
- CXR: barium swallow, rat-tail deformity
- Endoscopy
- Treatment:
- Cause dependent
Describe Boerhaave syndrome and its symptoms.
- Retrosternal chest pain
- Dyspnea
- Odynophagia
- Vomiting
- Subcutaneous emphysema (accumulation of air under the skin, especially in the bumble rib area)
What are the clinical features of esophageal tumors?
- Weight loss due to food consumption (progressive)
- Epigastric pain/chest pain
- Food impaction,
- regurgitation,
- dysphagia
- Chronic hoarseness,
- frequent heartburns,
- persistent hiccups
What are the developmental origins and types of epithelium in the esophagus?
The esophagus develops from the cranial portion of the foregut.
It has two types of epithelium:
- Abrasive force: Non-Keratinized stratified Squamous epithelium
- Corrosive force: Simple Columnar epithelium
How is esophageal tear confirmed and what are the complications?
- Leakage causing the immune system to attack particles of food
- Inflamed heart muscle release
What are the symptoms and signs of upper gastrointestinal tract problems related to the esophagus?
Upper GIT problems related to the esophagus and stomach include:
- Hematemesis
- Heartburn
- Odynophagia
- Dysphagia
- Dark red blood in stool (melena) due to reflux iron
- Fresh red blood in stool (hematochezia)
What are the primary and secondary causes of achalasia?
- Primary:
- Idiopathic (failure of distal esophageal inhibitory neurons)
- Secondary:
- Chagas disease (Trypanosoma cruzi)
- Chagall-like disease caused by diabetic autonomic neuropathy, vagal nerve lesions, amyloidosis, sarcoidosis, eosinophilic gastroenteritis, lesions of dorsal motor nuclei
Describe the causes of esophageal obstruction.
- Mechanical/Dynamic Obstruction: Increased frequency and force of peristalsis
- Functional Obstruction: No peristalsis due to permanently constricted or relaxed muscle
Explain the pathogenesis and management of esophageal varices.
- Pathogenesis:
- Portal hypertension causes collateral channels that allow portal blood to shunt into the cava system
- These collaterals enlarge the subepithelial and submucosal venous plexi within distal esophagus
- Vessels termed as varices
- Management:
- Blood pressure control
- Banding
- Treat underlying causes
What are the characteristics of chemically induced esophagitis?
- Pain (odynophagia)
- Self-limiting, except due to corrosive chemicals
- Severe cases cause fibrosis
- Esophageal atrophy and lumen narrowing
- Progressive narrowing from middle 2/3 of the lower esophagus
What are the potential causes of mechanical esophageal obstruction?
- Intraluminal: Object blockage (foreign), food impaction, strictures, diverticula
- Mural: Tumor blockage (from esophagus), esophageal diverticulum
- Extramural: External compression of esophagus i.e. mediastinal masses, other tumors, aortic aneurysm, cardiomegaly (left atrium)
What are the causes and features of esophageal varices?
- Causes:
- Portal hypertension
- Liver cirrhosis (alcohol, liver disease)
- Schistosomiasis
- CHF
- Thromboembolic events
- Features:
- Often asymptomatic
- Rupture leads to massive hematemesis and death
Describe the causes and effects of reflux esophagitis (GERD).
- Reverse flow of gastric contents into the esophagus causing heartburn, dysphagia
- Acid reflux causing damage
- Severe recurrent reflux leads to metaplasia (dysplasia) or perforation, potentially causing esophageal adenocarcinoma
What are some functional potential causes of esophageal obstruction?
- Chagas' disease: Ganglions damaged by parasites causing permanent constriction
- Diabetic autonomic neuropathy: Permanent relaxation
- Malignancy, amyloidosis, sarcoidosis (infiltrative disorders)
- Lesions of dorsal motor nuclei: Produced by polio or surgical ablation
What are the clinical features and complications of esophageal obstruction?
- Dysphagia
- Vomiting
- Regurgitation of food
- Aspiration pneumonia (early)
- Fluid and electrolyte imbalances (late)
- Hypoglycemia (late)
- Malnutrition (late)
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