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What are the 4 hystological layers in the GI track?
- Mucosa--- Squamus, Non keratinized
- Submucosa-- BV, Nerves, Lymph, glands
- Muscularis
- Serosa
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What are the congenital Anomalies in the Esophagus?
- Ectopic Tissue
- Diaphragmatic herniation
- Atresia and fistulas
- Congenital fore gut cysts
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What is the most common Esophageal atresia?
Blind Upper segment, fistula between blind lower segment and trachea.
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What is Oropharyngeal Disphagia?
What is Esophageal Dyspha
- - difficulty in transfering food to the esophagus. Trouble INITIATING swollow.
- - Difficulty in transporting down esophagus.
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What is:
Pyrosis
Odynophagia
Atypical Chest Pain
- Heart burn
- Pain associated wit h swollowing
- Atypical chest pain
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 What is this? Who does it occur in the most?
This is a SCHATZKI RING
Seen in Women over 40 years old
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95% of Hiatal Hernias are ?
Sliding Hernias
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Name these
- Achalasis
- Hiatal Hernia (slidding
- Paraesophageal Hernia
- zenker diverticulum (propulsion)
- Epiphrenic diverticulum
- Mallory-weis-- due to alcohol
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What is Achalasia?
IS it common in the US?
What is it associated with?
Age?
What are you at increase risk for?
- •Failure of lower esophageal sphincter to relax
- •Degeneration of neural plexus
- •Aperistaltic contractions of the esophagus
- Rare in the US
- Associated with Chagas Disease
- YOung adults
- At increased risk for SCC (5%)
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What is Mallory Weiss Laceration?
What causes it?
Does it bleed?
What kind of lascerations?
- •Severe retching or violent vomiting
- •Usually alcoholics
- •5-10% of UGI bleeds, but usually not profuse
- •Heals promptly
- •Longitudinal Lacerations
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- This is Mallory Weiss syndrome
- see longitudinal lasceration
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Esophageal Varices
Related to:
Schistosomiasis world wide
- •Asymptomatic, until rupture causes massive hematemesis
- •40-50% fatality rate per episode
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What is esophagitis?
What causes it?
what is it associated with?
- It is infection of the Esophagus
- - caused by Lye strictures
- -associated with: Altered immune sustem. Candidiasis, herpes, CMV
- - Bacterial infection is RARE
- - reflex esophagitis = GERD
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What is this and what caused it?
Punched out lesion on the esophagus due to Herpes = Herpes Esophagius
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What do you see?
See Cowdry Type A incranuclear inclusions = Herpes Esophagitis
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What is GERD?
WHat age and sex affected?
Symptoms?
Complications?
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–> 40 years old, M>F
- –Heartburn
- –Regurgitation of gastric contents into pharynx
- –Dysphagia (suggests complication of stricture)
- –Complications
- •Esophageal ulceration
- •Barrett Mucosa (Esophagus)
- •Stricture with stenosis (narrowing)
- •Long-term risk adenocarcinoma
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IF you see alot of Epsinophils in the esophagus, what might be going on?
Reflux Esophagitis (GERD)
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What is Barrets esophagus?
What age and sex effected?
What is it a complication of?
What is it a risk factor for?
Replacement of Squamus cells of the esophagus with Glandular mucosa with GOBET CELLS
- seen in 40-60 White males
- Complication of GERD
- It is a riskfactor for ADCA---30-40X increase if greater than 3cm
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What is Plummer Vinson Syndrome?
- esophageal webs
- glossitis--- Thick tongue
- iron deficiency anemia
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What are the Malignant tumors of the Esophagus?
- –Adenocarcinoma
- –Squamous Cell Carcinoma
- –Rare tumors (Leiomyosarcoma, GIST)
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Adenocarcinoma
Sex and age?
Associated with?
Risk factors?
Prog?
- Old White Males
- GERD and Barrets
- Tobacco, Obesity
- Poor
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SCC of the Esophagus
Sex and age?
% in world, in US
BLACK 50 year old Male
- - World 90% of malignant Esophageal cancers
- - US: 50%
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- SCC
- Seen in the MID esophagus 50% of the time
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