Note: esophagus doesn’t have serosa; narrows at UES, Left mainstem bronchus and Aortic arch, and LES
- What: solids vs liquids
- When: intermittent, unremitting
- Where: does it feel like the food is getting stuck
- Associated symptoms: voice change, difficulty speaking/breathing heartburn, weight loss, fevers, night sweats
- Risk factors: irradiation, smoking
Physical exam: Virchow’s node, liver enlargement
- Remember to feel inside mouth
- Do a concentrated exam on neck, thorax (think of where esophagus goes!) and abdomen
Motor causes: achalasia (atrophy/loss of ganglions, non progressive, manometry, Barium swallow shows bird’s beak esophagus), DES
Non-Motor causes: benign (strictures – caustic injuries, Schatzki’s rings; webs) vs malignant (esophageal cancer: adenocarcinoma and squamous cell)
Imaging – Barium swallow first – check for a Zenker’s, then safe to scope
- Most common types of esophageal cancer are squamous cell carcinoma and adenocarcinoma.
- Approximately 60% of squamous cell carcinomas develop in the middle third of the organ, 30% occur in the lower third, and 10% occur in the upper third.
- Adenocarcinoma develops in the lining of the esophagus and is associated with a condition called Barrett’s esophagus. This type usually occurs in the lower third of the esophagus.