Esophagus

Esophagus

congenital
1. Atresia
  1. disruption of elongation and separation of esophagus and trachea
  2. Associated with
    1. VACTERL
    2. Trisomies
    3. George
    4. maternal polyhydramnios
    5. Single umbilical artery
  3. choking & cyanosis & drooling after infant’s first feeding
2. Esophageal Web
  1. protrusion of mucosa - upper
  2. dysphagia of poorly chewed food
  3. PLummer-Vinson Syndrome
    1. dysphagia due to webs
    2. Glotitis
    3. iron deficiency anemia
    4. Koilonychia, Splenomegaly
    5. SQUAMOUS CELL CARCINOMA OF ESOPHAGUS
      2. smoking
      3. Alcohol
      4. P53, P16, Rb
      5. Melena
      6. Mediastinitis
      7. TE fistula
      8. Aspiration Pneumonia
      9. Lung Abscess
      10. Spread to Cervical (top 1/3), mediastinal (middle 1/3), gastric and celiac (lower(1/3)
      11. most common Globally
    6. Treatment: Iron, Endoscopic dilation
Neoplastic
Non-Neoplastic
1. Mallory Weiss Tears
  1. inadequate relaxation during vomitting
    1. Longitudinal MUCOSAL tear at the esophageal junction
      1. Hematemesis (PAINFUL!!)
  2. Alcoholics & bulemics
    1. history of vomiting
2. Esophageal Varices
  1. portal hypertension
    1. Cirrhosis
  2. Splenomegaly + ascites
  3. RUPTURE
    1. MCCOD in Cirrhosis
    2. Painless hematemesis
      1. COD: Hypovolemic shock
3. Achalasia (Cardiospasm)
  1. Incomplete relaxation in LES after swallowing
    1. peristalsis, incomplete relaxation of LES, increased resting tone of LES dysphagia, odynophagia. reflux of contents, vomiting, aspiration pneumonia
      1. Complication
        PROGRESSIVE dilation of esophagus above LES
        Squamous Cell Carcinoma
  2. Primary cause
    1. Loss of intrinsic inhibitory nerves of LES and smooth muscle
    2. Loss of ganglion in myenteric plexus
  3. Secondary cause
    1. Chagas
      1. T.cruzi polio paraneoplastic syndromes sarcoidosis,,
  4. Monometry
4. Hiatal Hernia
  1. Paraesophageal (rolling type): volvulus strangulation and perforation
  2. Sliding Type: epigastric pain, heart burn
  3. Reflux
    1. GERD
      2. Alcohol
      3. Tobaco
      4. Obesity
      5. Caffiene
      6. Heartburn & ashtma
      7. Ulceration with stricture
      8. Barrett's Esophagus
        CREST Syndrome
        Anti-centromere (+)
        Decrease tone of LES
        stem cell reprogramming in lower 1/3
        Intestinal metaplasia: Stratified squamous non-keratinized to tall columnar epithelium with goblet cells
        heart,burn (water brush), metallic taste dyspepsia, epigastric pain substernal discomfort relieved w/ antacids
        # 1 cause of dysplasia
        Adocarcinoma
        Progressive dysphagia, odynophagia, Melena, iron deficiency anemia
        Most common in US
      9. Esophagitis
        REFLUX
        Endoscopy: irregular area of hyperemia (vascular congesion)
        Dyspepsia, burning, water brush, nocturnal cough (night), worse when laying down or after a large meal
        Basal zone HYPERPLASIA + elongation of lamina propria
        Eosinophilic
        Trachealization, furrow, white plaque, , micro abscess, does NOT respond to medication Children: GERD sx, Adult: impactation
        Also due to HSV, CMV, Candida, Uremia, Anticancer therapy,

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	Erstellt von Nazik Al-Hashimi vor mehr als 9 Jahre