Colon Cancer and Polyps Quiz

Esophageal Disorders

• Esophageal disorders encompass a range of conditions affecting the esophagus, the tube connecting the mouth to the stomach.

• Gastroesophageal Reflux Disease (GERD) is characterized by gastric juice flowing back into the esophagus. This is linked to a weakened lower esophageal sphincter (LES) and decreased LES tone.

• Reflux Esophagitis involves inflammation of the esophageal lining (epithelial layer) and mucosa and can lead damage and erosions (loss of the epithelial layer).

• Histopathology in reflux esophagitis may display basal zone epithelial hyperplasia, elongated papillae in the lamina propria, and an increase in eosinophils and neutrophils.

• Pediatric GERD presents with symptoms like vomiting or crying frequently. This is due to an immature lower esophageal sphincter (LES) in infants.

• Alcohol, smoking, obesity, fatty foods, and caffeine are identified as risk factors for GERD

• Symptoms of GERD include heartburn, retrosternal burning, dysphagia, and painful esophagitis, often worsening when lying down. Reflux may also enter the respiratory tract, potentially causing asthma in adults. Tooth enamel damage can also be a consequence of GERD.

• Weight loss and dietary modification are treatments. Refractory cases may necessitate Nissen fundoplication surgery.

• Medical therapies include histamine (H2) blockers such as famotidine, ranitidine, and others, and proton pump inhibitors like omeprazole, pantoprazole, Lansoprazole, andesomeprazole.

• Long-standing GERD may contribute to ulcers, fibrosis, and strictures leading to dysphagia.

• Lye ingestion can precipitate serious esophageal damage, potentially leading to strictures.

• Barrett's Esophagus results from long-standing GERD, leading to metaplasia of the esophageal lining, transforming from squamous epithelium to intestinal epithelium.

• Regular endoscopy and biopsies are crucial for surveillance.

• Esophageal cancer often arises from squamous cell or adenocarcinoma.

• Increased risk in smokers and manifesting with advanced disease/metastasis often late.

• Patients sometimes experience progressive dysphagia, starting with solids and progressing to liquids as the tumor grows. Additional symptoms include weight loss and hematemesis.

• Adenocarcinoma is more common in the US.

• Squamous cell cancer is often discovered in the mid to upper esophagus, and can originate from conditions that harm the upper esophagus (e.g., food/alcohol).

• Zenker's diverticulum and esophageal webs can impair food passage and result in esophageal discomfort.

• Lymph nodes critical in esophageal cancer diagnosis and treatment include cervical (neck), mediastinal (chest), tracheobronchial (chest) nodes and celiac/gastric nodes (abdomen).

• Infectious esophagitis can be caused by Candida (white membranes, pseudohyphae), HSV-1 (oral herpes, punched-out ulcers), CMV, or AIDS (linear ulcers).

• Eosinophilic esophagitis is an allergic/immune-mediated condition characterized by eosinophil-predominant inflammation in the esophagus. Diagnosing it involves ruling out other causes like GERD.

• Achalasia is an esophageal motility disorder causing failure to relax the lower esophageal sphincter (LES). It's often idiopathic, or linked to Chagas disease.

• Symptoms of achalasia include difficulty swallowing (dysphagia) with solids and liquids, closed LES, contrast obstruction (solids), bad breath, and food accumulation in the esophagus.

• Diagnosis involves esophageal dilation on barium swallow and esophageal manometry.

• Esophageal varices are dilated veins in the esophagus, often caused by portal hypertension related to cirrhosis.

• Malloy-Weiss syndrome relates to esophageal mucosal damage at the gastroesophageal junction, frequently resulting from prolonged vomiting or alcohol abuse - characterized by painful hematemesis (vomited blood).

• Boerhaave syndrome is characterized by a tear in the esophageal wall, frequently after severe vomiting or retching characterized by air in the mediastinum on chest X-rays, subcutaneous emphysema of the neck, and pain.

• Schatzki's ring, a fibrous ring at the gastroesophageal junction, can cause dysphagia, particularly for solid foods.

• Plummer-Vinson syndrome is a rare condition involving iron deficiency anemia, a beefy red tongue, and an esophageal web.

• Zenker's diverticulum is a pouch that forms in the pharynx leading to difficulty swallowing (dysphagia) or bad breath (halitosis), commonly occurring at the junction of the esophagus and pharynx.

• Liver disease encompasses conditions like alcoholic fatty liver disease, acute hepatitis, cirrhosis, non-alcoholic fatty liver disease (NAFLD), and related issues like Budd-Chiari syndrome or right heart failure, impacting the liver's normal function.

• Liver tests include measures of liver enzymes like aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), and gamma-glutamyl transferase (GGT), along with synthetic tests for albumin, PT/PTT, and glucose levels.

• Alcoholic liver disease presents in three stages: fatty liver, hepatitis, and cirrhosis. NAFLD, similarly, can progress to cirrhosis.

• Budd-Chiari syndrome involves hepatic vein thrombosis, causing symptoms like abdominal pain, ascites (fluid buildup in the abdomen), and hepatomegaly (liver enlargement).

• Right heart failure can result in a nutmeg liver appearance, marked by a mottled pattern due to congestion.

• Reye's syndrome is a severe childhood disease from viral infection (especially chicken pox) that is linked to aspirin use. This condition may cause liver damage and encephalopathy.

• a1-antitrypsin deficiency leads to abnormal accumulation of the protein in the liver and lungs, contributing to conditions like emphysema (lungs) and cirrhosis (liver).

• Liver abscesses are walled-off infections that may be caused by bacteria or protozoa (Entamoeba histolytica) or helminths (Echinococcus).

• Viruses like hepatitis (A, B, C, D, E) can cause hepatitis, an inflammatory condition of the liver, potentially leading to further complications. Autoimmune hepatitis is an immune-system driven disease affecting the liver.

• Tylenol overdose causes acute liver failure (hepatic necrosis) due to the formation of a toxic metabolite, NAPQI. Activated charcoal and N-acetylcysteine are crucial treatments for such cases.

• Shock liver, an ischemic type of hepatitis, is characterized by diffuse liver injury from hypoperfusion commonly seen in ICU patients with shock of various causes.

• Cirrhosis is an irreversible, end-stage liver disease resulting from various chronic diseases or conditions like hepatitis or alcohol abuse and non-alcoholic fatty liver disease.

• Cirrhosis manifests with symptoms such as shrunken liver, formation of nodular tissue replacing liver tissue, smoother surface of the liver replaced by nodules. Other clinical features include elevated ammonia, leading to confusion and coma (hyperammonemia), jaundice, hypoglycemia, coagulopathy related to loss of clotting factors resulting in elevated PT/PTT, and hypoalbuminemia.

• Treatment for hyperammonemia usually involves a low-protein diet and a synthetic disaccharide (lactulose) to lower colonic pH and trap ammonia.

• Portal hypertension, a consequence of liver damage, leads to high pressure in portal veins, and elevated levels of estrogen. This can result in conditions like esophageal/gastric varices, spleen enlargement, ascites and edema, which can result from high pressure that forces fluid into the space between the visceral layers.

• Venous collaterals develop as an effect of portal hypertension, abnormal connections between portal and systemic veins. Caput medusa is a key finding in portal hypertension, where dilated veins are visible around the umbilicus.

• Hypersplenism from portal hypertension is identified by splenic enlargement and results in low platelet counts.

• Portal vein thrombosis presents with acute abdominal pain and splenomegaly (a palpable or enlarged spleen); it's often an unusual cause of portal hypertension.

• Ascites is fluid accumulation in the peritoneal cavity, often associated with lower albumin levels and portal hypertension arising from disorders such as cirrhosis. SAAG is a helpful diagnostic test that measures serum albumin minus ascites albumin.

• Common treatments for ascites include sodium restriction, diuretics (like spironolactone), large-volume paracentesis (fluid removal), or a transjugular intrahepatic portosystemic shunt (TIPS) procedure.

• Spontaneous bacterial peritonitis is an infection of the ascitic fluid (fluid in the abdominal cavity), often caused by bacteria (like E. coli or Klebsiella).

• MELD score and Child-Pugh classification are important in evaluating chronic liver disease, helping predict mortality in these patients.

• In cases of cirrhosis or other chronic liver diseases, a liver biopsy remains the gold standard in diagnosing various liver pathology. Various other imaging studies and clinical assessments are helpful, including physical examination or imaging studies (e.g., CT or MRI scans).

• Stellate cells, perisinusoidal cells in the liver, contribute to fibrosis in liver disease through the production of TGF-β.

• Hepatocellular carcinoma frequently arises as a consequence of chronic liver disease, impacting organs such as the liver, but also in other locations potentially with metastasis.

• Aspergillus is a fungus that contaminates grains and can produce aflatoxins, which are linked to the development of hepatocellular carcinoma (HCC), a significant cancer of liver cells. Chronic exposure to aflatoxins from improperly stored food can pose an increased risk in non-industrialized countries with locally grown foodstuffs.

• Hepatic adenoma, a benign liver tumor most often found in young women and usually discovered incidentally, is frequently associated with oral contraceptive or anabolic steroid usage.

• Hepatic hemangioma and angiosarcoma are other possible benign and malignant liver cell tumors.

• Liver tumors such as metastatic colon cancer tumors can occur as a site of secondary cancer spread.

• Various types of gastric disorders affect the stomach. Gastritis describes inflammation of the stomach lining (mucosa), potentially due to acid damage (acute) or chronic inflammation (often from autoimmune causes or H. pylori infections). Symptoms of gastritis include dyspepsia (digestive discomfort), nausea and vomiting, and epigastric discomfort.

• NSAIDs (non-steroidal anti-inflammatory drugs) or chemotherapy can induce acute gastritis.

• Chronic gastritis, often categorized as type A or type B (linked respectively most often to autoimmune situations or H. pylori infections).

• Autoimmune gastritis, a type of chronic gastritis, frequently leads to pernicious anemia.

• H. Pylori infections commonly cause chronic gastritis, and may lead to ulcers and increased risk of malignancies like MALT lymphoma.

• Peptic ulcer disease often includes gastric ulcers or duodenal ulcers. Duodenal ulcers are frequently related to H. pylori in the antrum of the stomach leading to an increase in gastrin release. Gastric (or stomach) ulcers are usually fewer in number and more likely to be associated with NSAID use or other stomach abnormalities such as tumors.

• Curling's ulcers are lesions in the stomach lining that often develop in burn patients due to stress of the injury with dehydration.

• Cushing's ulcers typically result from increased intracranial pressure causing vagal stimulation and excess gastric acid production.

• Stress ulcers, related to shock, sepsis, or trauma, arise due to loss of the defensive mucous/bicarbonate barrier.

• Stress ulcers are treated with prophylactic therapy with proton pump inhibitors (e.g. Pantoprazole, Omeprazole).

• Intestinal disorders can manifest as malabsorption (failure to absorb nutrients), diarrhea (e.g., watery), or other symptoms that impair digestion. Celiac disease is an autoimmune response to gluten and may involve destruction of the villi in the small intestine, causing malabsorption and diarrhea.

• Tropical sprue from unknown infectious agent, most often found in warm, tropical climates. The small intestine may be affected; diarrhea is a key characteristic. There is often a striking difference between the affected intestinal part's location compared to celiac disease, which usually impacts the duodenum.

• Whipple's disease is a systemic infection involving small intestine, causing malabsorption.

• Lactose intolerance, due to a decline in lactase activity (either from decline with aging or from secondary mucosal harm), makes the digesting of lactose compounds difficult, potentially causing symptoms like stomachaches, bloating, and diarrhea.

• Other important intestinal conditions may include acute appendicitis, diverticular disease, intussusception, volvulus, or bowel obstruction arising from several causes (e.g., adhesions, hernias, or cancer).

• Intestinal conditions including celiac disease or tropical sprue, Whipple's disease or Crohn's disease may lead to malabsorption, and cause significant problems if untreated.