Esophageal Atresia = a congenital birth defect which causes the esophagus to end in a blind ended pouch instead of connecting

normally to the stomach *Trachea-esophageal fistula = a connection between the esophagus and the trachea (usually occurs with an atresia where either the upper or lower pouch is connected to the trachea) VATERL = a non random association of birth defects V vertebral defects A anal atresia C cardiovascular anomalies T tracheoesophageal fistula E esophageal atresia R renal/kidney anomalies L Limb defects Esophageal Stenosis = A narrowing or tightening of the esophagus which causes swallowing difficulties. (fibrous thickening of the esophageal wall usually in the submucosa) Stenosis vs. Atresia = a stenosis is a narrowing of the esophagus which still allows a small amount of food to pass where as an atresia is a complete closure of the esophagus so there is no passage of food to the stomach. CREST = A systemic inflammatory rheumatic disease associated with antibodies against centromeres C carcinoma R Raynauds syndrome E Esophageal Dysmotility S Sclerodactyly T Telangiectasias Mucosal Webs = A semicircumferential protusion of the mucosa into the esophageal lumen (MC in upper esophagus) *Plummer-Vinson Syndrome = A condition that sometimes occurs in people with iron deficiency anemia. Includes: upper esophageal webs, glossitis, and iron deficiency anemia. MC in females. HIGH RISK FOR ESOPHAGEAL CANCER.

Schatzki rings = a narrowing of the lower part of the esophagus caused by a ring of mucosal/muscular tissue. This can result in dysphagia. Stricture = a gradual narrowing of the esophagus which can lead to difficulty swallowing. This is caused by scar (fibrous) tissue that builds up in the esophagus. Achalasia = failure of the esophageal muscles/sphincters to relax. Characterized by: aperistalsis; partial or incomplete relaxation of the LES; increased resting tone of the LES. (i.e. progressive dilatation of the esophagus above the level of the LES) 2 types: primary (MC and of uncertain etiology) and secondary. PRIMARY: problems are associated with muscle-failure of the distal esophageal inhibitory neurons and there are also degenerative changes in neural innervation SECONDARY: this is extremely rare and is associated with chagas disease (T. cruzi). This causes destruction of the myenteric plexus via dilatation of certain viscera. Can also be thru diseases of the dorsal motor nuclei (eg Polio, surgical ablation; amyloidosis) APPEARS AS A BIRDS BEAK ON CXR Diverticula: TRUE an outpouching of the alimentary tract that contains all visceral layers FALSE (aka pulsion) due to weakness of the underlying wall resulting in outpouching of mucosa and submucosa into area of weakness. ZENKER pulsion diverticulum immediately above the UES ( can be several cm in size and accumulate a lot of food) symptoms: dysphagia, food regurgitation and mass in neck; PNEUMONIA Hiatal hernia: the seperation of the diaphragmatic crura and widening of the space b/w the muscular crura and the esophageal wall 2 types: Sliding hernia (95%) and Paraesophageal hiatal hernia Mallory-Weiss Syndrome: (lacerations) longitudinal nontransmural tears in the esophagus at the esophagogastric junctionconsequence of severe retching; seen in alcoholics; CAUSES PAINLESS BLEEDING (=HEMATEMESIS)

Boerhaaves Syndrome: rupture of distal esophagus and mediastinus. Caused by endoscopy, retching, and bulimia Reflux Gastritis/GERD: Reflux of gastric contents into the lower esophagus. MCC OF ESOPHAGITIS. Is caused by decreased LES tone (alcohol; tobacco; pregnancy; scleroderma) and presence of a sliding hiatal hernia. HISTOLOGICALLY: basal zone hyperplasia; elongated papillae; intraepithelial neutrophils and/or eosinophils. CLINICAL: heartburn; regurgitation of sour brash; dysphagia; attacks of chest pain CONSEQUENCES: development of stricture; tendency to develop Barrett esophagus Barrett Esophagus: the distal squamous mucosa is replaced by metaplastic columnar epithelium, as a response to prolonged injury. RISK FACTOR FOR ESOPHAGEAL CANCER. Diagnosed thru endoscopic and histologic means grossly appears as RED VELVETY mucosa extending upwards from the gastroesophageal junction which alternates with pale squamous mucosa of remaining oesophagus. MUST SEARCH FOR DYSPLASIA Know a little bit about Candida esophagitis (monliasis) and Herpetic esophagitis even though they are rare conditions Esophageal Varices: MC is PORTAL HTN. Varices appear as DILATED VEINS LYING WITHIN THE SUBMUCOSA of the distal esophagus and proximal stomach. No symptoms until rupture then massive hematemesis occurs. (usually heavy alcoholics) congestion of subepithelial and submucosal venous plexus in distal esophagus REVIEW THE 4 AREAS OF PORTAL SYSTEMIC SHUNTS Benign tumors: mostly mesenchymal in origin and lie w/in the esophageal wall. MC are of smooth muscle origin = leiomyomas Malignant tumors: squamous cell carcinoma; Adenocarcinoma

Squamous cell carcinoma: adults >45. Male to female ratio 4:1. Risk factors include alcohol, tobacco, plummer-vinson syndrome, achalasia caustic esophageal injury first appear as lesions in situ MC location is middle third of the esophagus* CLINICAL: dysphagia, odynophagia and obstruction; adjustment in diet from solid to more liquid foods; weight loss; hemorrhage Adenocarcinoma: occurs in the background of barretts esophagus and GERD. Increased risk with tobacco use, obesity, and prior radiation therapy. (a stepwise acquisition of genetic changes) Occurs in the distal third; microscopically most are mucin producing glandular tumors exhibiting intestinal like features. adults >40. Men>women and in Caucasians Symptoms: DYSPHAGIA, progressive weight loss, vomiting, chest pain, bleeding