Carlos Shared "Esophageal pathologies not in Picmonic" - 5 Picmonics

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Esophageal pathologies not in Picmonic

Eosinophilic esophagitis
Infiltration of eosinophils in the esophagus often in atopic patients.
Food allergens lead to dysphagia, food impaction.
Esophageal rings (trachea-like rings) and linear furrows (white arrows) often seen on endoscopy. Could also present with white papules that in histology are proved to be with microabscess (black arrows).
Unresponsive to GERD therapy.
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Esophageal varices and esophageal strictures
Esophageal varices
Dilated submucosal veins (red arrows) in lower 1 ⁄3 of esophagus (white arrow) 2° to portal hypertension.
Common in cirrhotics, may be source of life-threatening hematemesis.
Esophageal strictures
Associated with caustic ingestion and acid reflux
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Esophagitis
Associations
Reflux
Infection in immunocompromised (Candida: white pseudomembrane; HSV-1: punched-out ulcers; CMV: linear ulcers)
Caustic ingestion
Pill esophagitis (eg, bisphosphonates, tetracycline, NSAIDs, iron, and potassium chloride)
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Sclerodermal esophageal dysmotility
Esophageal smooth muscle atrophy leads to decreased LES pressure and dysmotility
Acid reflux and dysphagia leads to stricture, Barrett esophagus, and aspiration.
Part of CREST syndrome.
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Esophageal cancer
BOTH
Presents with progressive dysphagia (first solids, then liquids)
Weight loss
Poor prognosis: presents late
Lymph node spread: Upper 1/3 (cervical), Middle 1/3 (mediastinal and tracheobranchial), Lower 1/3 (celiac and gastric)
adenocarcinoma
Lower 1/3
Risk factors: Chronic GERD, Barret esophagus, obesity, smoking, achalasia
More common in America
Arises from grandular tissue
Ulcerative/exophytic
squamous cell carcinoma
Upper 2/3
Risk factors: Alcohol, hot liquids, caustic strictures, smoking, achalasia, esophageal web (Plummer-vinson), injury (Lye injestion)
N-NITRO containing foods, betel nuts
More common worldwide
May have hoarse voice (Recurrent laryngeal) and cough (tracheal involvement)
Can cause GI bleed and iron deficiency anemia
Histology: Eosinophilic cytoplasm, keratin pearls, intercellular bridging
Plaque like thickening, may become ulcerated
Usually occurs in men over 50
Retrosternal discomfort/burning
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