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.
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
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)
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.
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
