Questions and Answers
Which of the following is NOT a clinical feature of esophageal varices?
What is the most common cause of portal hypertension?
What is the main characteristic of achalasia?
What is the term for the longitudinal lacerations at the gastroesophageal junction?
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What is the term for the veins that develop in the distal esophagus and proximal stomach as a result of portal hypertension?
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Study Notes
Anatomy of the Esophagus
- The esophagus is a muscular tube extending from the epiglottis to the gastroesophageal junction (GEJ).
- It is lined by stratified squamous epithelium.
Diseases Affecting the Esophagus
Mechanical Obstruction
- Causes: Congenital or Acquired, Atresia, Fistulas, Duplications, Agenesis (very rare), Stenosis
- Atresia: characterized by a thin, non-canalized cord replacing a segment of the esophagus, typically near the tracheal bifurcation
- Esophageal Stenosis: results from fibrous thickening of the submucosa and atrophy of the muscularis propria due to inflammation and scarring
- Clinical Presentation of Atresia: regurgitation during feeding shortly after birth, requires prompt surgical correction
- Complications of Atresia: aspiration, suffocation, pneumonia, and severe fluid and electrolyte imbalances
- Clinical Presentation of Esophageal Stenosis: progressive dysphagia, initially affecting solids and later liquids
Functional Obstruction
- Characterized by esophageal dysmotility, with discoordinated peristalsis or muscular spasms
- Achalasia: most significant cause, characterized by a triad of incomplete LES relaxation, increased LES tone, and esophageal aperistalsis
- Primary Achalasia: often idiopathic, involving degeneration of distal esophageal inhibitory neurons
- Secondary Achalasia: results from damage to the esophagus, vagus nerve, or dorsal motor nucleus of the vagus
- Clinical Presentation of Achalasia: difficulty swallowing (dysphagia), regurgitation, occasionally chest pain
Vascular Diseases
Esophageal Varices
- Tortuous dilated veins within the submucosa of the distal esophagus and proximal stomach
- Pathogenesis: portal hypertension leads to the development of collateral channels in the distal esophagus, creating varices
- Causes of Portal Hypertension: cirrhosis, hepatic schistosomiasis
- Clinical Features: often asymptomatic until rupture, massive hematemesis and death, first bleed has a 20% mortality rate, rebleeding occurs in 60% of cases
Esophagitis
- Types: Esophageal Lacerations (Mallory-Weiss tears), Chemical Esophagitis, Infectious Esophagitis
- Clinical Features and Morphology: ulceration and acute inflammation, symptoms include pain, odynophagia (painful swallowing), hemorrhage, stricture, or perforation in severe cases
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Description
Learn about the structure and diseases of the esophagus, including mechanical obstruction, atresia, and more. Understand the normal anatomy and abnormalities of the esophagus.