What is achalasia?
a failure of smooth musclefibers to relax, which can cause a sphincter to remain closed and fail to open when needed.
While priamry achalasia is primarily due to neuronal abnormalities, secondary achalasia is seen in ______
Chagas disease, in which T. cruzi destroys the myenteric plexus, which normally inhibits uninhibited LES contraction. Like Hirschsprung disease, proximal dilation follows
Diseases that impede flow of venous blood through the liver can cause what?
portal HTN leading to the development of esophageal varices, extremely dilated sub-mucosal veins in the lower third of the esophagus
Why are esophageal varices common in the lower 1/3rd?
The upper two thirds of the esophagus is drained via the esophageal veins, which carry deoxygenated blood from the esophagus to the azygos vein, which in turn drains directly into the superior vena cava. These veins have no part in the development of esophageal varices.
The lower one third of the esophagus is drained into the superficial veins lining the esophageal mucosa, which drain into the left gastric vein(coronary vein), which in turn drains directly into the portal vein. These superficial veins (normally only approximately 1 mm in diameter) become distended up to 1–2 cm in diameter in association with portal hypertension.
Eosphageal varices develop in up to 90% of what pts.?
How do esophageal varices present?
typically asymptomatic, but can rupture when thinned and lead to massive hematemesis and death in ~50% of pts.
What are Mallory-Weiss tears?
these are esophageal lacerations associated with severe retching or vomiting, as may occur with acute alcohol intoxication (normally the esophageal relaxation that nromally occurs with vomitng is thought to fail during prolonged vomoting)
How should Mallory-Weiss tears be managed?
they are superficial and do not generally require surgical intervention.
What is Boerhaave syndrome?
Boerhaave's syndrome is reserved for the 10% of esophageal perforations which occur due to vomiting
What are some habits that increase the likelihood of GERD developing (either by decreasing LES tone or increasing intraabdominal pressure)?
alcohol and tobacco use
How does GERD present?
-heartburn and dysphagia
Describe eosinophilic esophagitis
An allergic esophagitis marked by symptoms similar to GERD but a higher density of eosinophils on biopsy
What is the typical pt to get Barrett's esophagus from GERD?
old, fat, white men
T or F. GERD and Barrett's Esophagus increase the risk of esophageal adenocarcinoma
T. Epithelial dysplasia occurs in about 1 of every 300 patient-years (so most pts with Barrett's will NOT develop esophageal cancer)
T or F. Diagnosis of Barrett Esophagus requires endoscopy and biopsy
T. Usually prompted by GERD symptoms
What are the main types of esophageal cancers?
SCC and adenocarcinoma
Describe esophageal adenocarcinoma
This typically arises in a background of barrett's esophagus and in those who chronically use tobacco and/or are obese
What diets prevent esophageal adenocarcinoma?
fruits and veggies
What pts typically get esophageal adenocarcinoma?
white men (men 7:1 to women)
What mutations occur in progression of Barrett's to adenocarcinoma?
Esophageal adenocarcinomas are more likely to occur in what part?
How do esophageal adenocarcinomas present?
most commonly with symptoms including dysphagia, progressive weight loss, chest pain, or vomitin. By the time symptoms occur, METs are likely to have occurred, leading to a poor prognosis in most
Describe esophageal SCCs
These typically occur in adults 45+ in AA males mostly
What are the risk factors for esophageal SCCs?
at least partially atributable to use of alcohol and tobacco, the effects of which are synergistic
- nutritional deficiencies
Where do esophageal SCCs most commonly occur?
middle 1/3rd of the esophagus