Diseases of the esophagus
Dysphagia and odynophgia = difficulty swallowing
Most of the time, there will be 5-6 clues per question. A pt has problem swallowing foods, is it
solids or liquids?
If the pt can take down liquids and not solids (difficulty in swallowing solids), it is due to
obstruction – can be due to esophageal web in Plummer Vinson syndrome, IDA with glossitis
and cheilosis and an esophageal web, esophageal cancer
If pt has problem swallowing solids AND liquids, it is a peristalsis problem, which is very bad. If
it’s the upper 1/3 of the esophagus (which is all striated muscle), it is due to myasthenia gravis
(b/c it affects striated muscle). If it’s the middle 1/3 (combo of smooth and striated muscle).
And if it’s the lower 1/3 (smooth muscle) it’s due to Scleroderma (aka progressive systemic
sclerosis and CREST syndrome) and achalasia. So, they will tell you immediately if they can
swallow liquids and/or solids, or neither (which is a peristalsis problem). How can you
distinguish PSS/CREST from achalasia? In achalasia, they vomit up the food they ate when they
go to bed at night; or they will tell you pt has Raynaud’s, indicating that it is CREST.
Odynophgia = PAINFUL swallowing; always abnormal
In HIV pt = Candida esophagitis – is it AIDs defining? Yes.
MC fungal infection in HIV = Candida
When it gets into the esophagus, it is AIDs defining
When it is a thrush, it is PRE AIDS lesion (not aids defining)
Helpful hints with other diseases:
Palpable purpura = immune HPY type III = Henoch Schonlein (MC)
Epistaxis = platelet problem (don’t think hemophilia)…they give clues!
Pansystolic murmur increases on inspiration = tricuspid regurg
Pansystolic murmur increases on expiration = mitral regurg
Blindly ending esophagus (prox esophagus ends blindly) – distal esophagus arrives from the
trachea. What does the mom have? Polyhydramnios – amniotic fluid is baby urine, so have to
recycle it, or mom will have big belly. So, the baby swallows it and it is reabsorbed in the small
intestine. So, if you have obstruction in the esophagus, or proximal portions of the duodenum,
mom will have polyhydramnios. So, there are 2 answers: 1) Tracheoesophageal fistula 2)
duodenal atresia in Down’s syndrome – these 2 are associated with polyhydramnios. They block
the ability to reabsorb amniotic fluid, leading to polyhydramnios. Also, when these kids eat,
food gets caught and kids cough and sputter b/c the distal esophagus arises from the trachea
and leads to distension of the stomach. This is very characteristic.
Area of weakness – cricopharyngeous muscle. It has a lil slit in between the fibers of it. Not the
whole area is cut (which would be a true diverticulum – this is a false diverticulum). It goes out
and gets a pouch. The pouch collects food and leads to halitosis. They have a tendency of
regurgitating undigested food out of the nose. Achalasia
Peristalsis prob – prob with relaxation of the LES, therefore it is in spasm all the time. Why? If
you bx that area, this means that the ganglion cells are missing. What dz does this remind you
of? Hirschsprung dz. What is in those ganglion cells? Vasointestina