Thiruvengadam-Dysphagia, Esophageal Cancer, Gastric Cancer
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| dysphagia | difficulty swallowing
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| odynophagia | painful swallowing
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| xerostomia | not enough saliva
can occur in patients on anticholinergic drugs
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| Sjogren's syndrome | auto-immune condition against exocrine glands that produce tears and saliva
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| achalasia | degeneration of neurons in myenteric plexus-->incomplete LES relaxation, increased LES tone, and lack of peristalsis of the esophagus
symptoms: difficulty swallowing, regurgitation, chest pain
*bird beak appearance with barium swallow
Tx: botox
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| radiation esophagitis | inflammation of esophagus from physical injury from radiation therapy
mucositis can occur followed by strictures
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| mucositis | painful inflammation and ulceration of the mucous membranes lining the digestive tract-->usually adverse effect of chemo and radiotherapy treatment for cancer
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| globus pharyngeus/hystericus | feeling of lump in lower neck that persists between swallowing but doesn't cause difficulty in swallowing
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| esophageal scleroderma | autoimmune disorder
primary defect: smooth muscle atrophy and fibrosis due to severe GERD secondary to distended LES and hypomotile esophagus
smooth muscle replaced by scar tissue-->loss of peristalsis and a weakening of LES
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| squamous cell carcinoma of esophagus risk factors | high incidence in China, Iran, and South Africa
African American
3-4x more common in men
smoking, alcohol, diet low in fruits/vegetables/fiber
low socio-economic status
achalasia, strictures, tylosis, other aero-digestive cancers
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| adenocarcinoma in lower esophagus risk factors | high incidence in USA and western countries
white
3-4x more common in men
smoking, obesity, alcohol may not be risk factor
GERD, Barrett's esophagus
*H. pylori might be protective
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| esophageal cancer clinical features | dysphagia, odynophagia, weight loss, chest pain, GI bleeding, voice hoarseness
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| diagnosis of esophageal cancer | EGD
EUS
CT
PET
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| rings and webs | can cause intermitted solid dysphagia and food impaction
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| intestinal type gastric cancer | high incidence in East Asia, Andean South America, Eastern Europe
older subjects
men>women
sequence: superficial gastritis-->atrophic gastritis-->intestinal metaplasia-->dysplasia-->invasive cancer
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| diffuse type gastric cancer | not common in high incidence countries
poorer prognosis
men=women even in younger age groups
*signet ring cells
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| gastric cancer risk factors | diet (fruit and vegetables are protective), pernicious anemia, atrophic gastritis, prior gastric surgery, gastric polyps, gastric mucosal hypertrophy
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| gastric cancer clinical features | weight loss, abdominal pain, early satiety, nausea, GI bleeding, dysphagia, pseudoachalasia, Virchow's node, Sister Mary Joseph's node, Krukenburg tumor, rectal shelf of Blumer, ascites, liver metastasis, Leser-Trelat, Trousseau's syndrome
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| Virchow's node | tumor extension to supraclavicular node
seen in patients with gastric cancer
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| Sister Mary Joseph's node | tumor extension to periumbilical nodules
seen in patients with gastric cancer
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| Krukenburg tumor | often (over 80%) found in both ovaries: malignancy that metastasized from a primary site--> classically GI tract but also from breast
*gastric adenocarcinoma the most common source
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| Leser-Trelat sign | explosive onset of multiple seborrheic keratoses (many pigmented skin lesions) often with an inflammatory base
ominous sign of internal malignancy part of paraneoplastic syndrome
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| Schatzki ring | narrowing of lower esophagus from mucosal or muscle (uncommon) tissue
can cause intermittent solid food dysphagia and impaction or complete esophageal blockage
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| Case: 51 yr old woman was started on a tricyclic antidepressants, she reports difficulty swallowing because of a very dry mouth | xerostomia
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| Case: 72 yr old woman with left LMN VII Palsy, food pools inside and drools | Bell's Palsy
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| Case: 76 yr old man with severe rigidity, tremor, bradykinesia and transfer dysphagia | Parkinsonism
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| Case: 61 yr old male Progressive Weakness of the legs (UMN defect in LE, LMN defect in the UE) and cranial nerve palsies | motor neuron disorder
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| Case: 50 yr old woman swallows her Ibuprofen with her saliva, lying flat on her bed | pill-induced esophagitis
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| Case: 47 yr old male with trouble swallowing liquids and solids. Regurgitates bland material | achalasia
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| Case: 54 yr old obese man with a long history of severe reflux symptoms and intermittent dysphagia who recently presented with a meat impaction | GERD and peptic esophagitis with a stricture
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| Case: 50 yr old with a hiatal hernia and a ring like narrowing at the SC junction | Schatzki ring
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| Case: 67 yr old man, with weight loss, solids sticking in the lower chest. Smoker, ETOH++ | Esophageal cancer
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| Case: 55 yr old male with NHL, complaints of dysphagia 4 months after Radiation Therapy | Radiation esophagitis
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| Case: 54 yr old male with dyspepsia, EGD shows a slightly elevated plaque, biopsy – monoclonal aggregation of lymphocytes. EUS lesion restricted to mucosa, anti H. pylori treatment resolved plaque | MALToma
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| Case: 47 yr old with HIV-AIDS with complaints of odynophagia | Candida esophagitis
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| Case: 65 yr old with weight loss, dyspepsia for 3 months. EGD found a 2 cm ulcer with rolled up edges | gastric adenocarcinoma
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