1. Upper GI Pathology Flashcards
Congenital abnormalities
• Ageneis (absence) of the esophagus is extremely ____
• ____, incomplete development, is more common
• In esophageal atresia, a thin, noncanalized cord replaces a segment of the esophagus causing ____ obstruction
• Most common, esophageal atresia with a ____ between the lower portion of the esophagus and the respiratory tree.
• Fistulas can lead to aspiration and ____
• Developmental abnormalities of the esophagus are associated with ____ defects, genitourinary malformations, and neurologic disease
rare atresia mechanical fistula suffocation congenital heart
VACTERL association
• VACTERL association is a disorder that affects many body systems
• VACTERL stands for ____ defects, anal atresia, ____ defects,
trachea-esophageal fistula, ____ anomalies, and limb abnormalities
• People diagnosed with VACTERL association typically have at least ____ of these characteristics
• Occurs in 1 in 10,000 to 40,000 newborns
vertebral
cardiac
renal
three
Obstruction
• Esophagus can be impeded by structural obstruction or functional obstruction
• Functional obstruction results from disruption of the coordinated waves of ____ contractions that follow swallowing
• Dysmotility may result in the development of ____ diverticulae
• Diverticulae are small pouches that form and push outward through weak spots in wall of ____
• For example, epiphrenic (diaphragm) diverticulum located immediately above the ____
• ____ diverticulum
peristaltic small esophagus lower esophageal sphincter zenker
Zenker diverticulae
• Impaired relaxation and spasm of the ____ muscle after swallowing can result in increased pressure within the ____ pharynx and development of a diverticulum
• Zenker diverticulae is located immediately above the ____
• Occurs at this point because of the weakness between the ____ muscle as they descend on the posterior wall of the esophagus to become ____
• Uncommon, but typically develop after age ____
• Larger Zenker diverticulae may accumulate significant amounts of food, producing a mass and symptoms that include regurgitation and ____
cricopharyngeus distal UES inferior constrictor longitudial 50 halitosis
Structural obstruction
• Structural obstruction can be caused by ____ or cancer
• Presents as progressive ____ that begins with inability to swallow solids
• Over time, ingestion of liquids is also affected
• Types
• Benign esophageal stenosis is narrowing of the lumen caused by fibrous
thickening of the ____
• Most often due to inflammation and scarring that may be caused by chronic ____, irradiation, or injury
• Esophageal mucosal ____
strictures
dysphagia
submucosa
GER
Esophageal mucosal webs
• Ledge like protrusions of mucosa that can cause obstruction; ____ lesions that protrude less than ____ mm
• Esophageal rings or Schatzki rings are similar to webs, but are ____, and ____
• Typically occur in women older than age ____
• In the upper esophagus, esophageal webs seen with ____-deficiency anemia, glossitis, and cheilosis are part of ____ syndrome
semi circumferential 5 circumferential thicker 40 iron plummer-vinson
Plummer Vinson syndrome
- Rare condition characterized by iron-deficiency anemia, seen in conjunction with glossitis and ____, and esophageal mucosal webs
- Condition has been associated with high frequency of both oral and esophageal ____
- Most reported patients have been ____ of Northern European background between age 30 and 50 years
- ____ is often present, marked atrophy of the tongue, and ____ sensations are common clinical presentations
dysphagia squamous carcinoma women angular cheilitis burning
Achalasia
• Failure of relaxation of the ____ while peristaltic waves moving food through; food bolus is not propulsed into the stomach
• In early stages, achalasia is ____. However, longstanding achalasia has a risk of developing ____ (16 to 33 fold increased risk)
• Overtime esophagus ____ to accommodate the swallowed food
• Chronic inflammation and ulceration persist and fibrotic stricture results
• Symptoms include ____ for solids and liquids, difficulty in belching, and chest pain
LES reversible SCC dilates dysphagia
Pathophysiology
• A nearly complete loss of ____ganglion cells in the ____ esophagus and ____
• Initiation of neuronal degeneration may be an ____ process triggered by indolent viral infection with a genetically susceptible host
• ____ infiltrate that destroys ganglion cells
• Patients with achalasia are more likely to have concomitant ____
diseases
• Primary achalasia is the result of ____ esophageal degeneration
• Secondary achalasia may arise in ____ disease
• Chagas disease is an ____ parasitosis of South America, infection by ____
myenteric plexus distal LES autoimmune T cell autoimune distal chagas endemic trypansoma cruzi
Chemical and infectious esophagitis
- The stratified squamous mucosa of the esophagus may be damaged by a variety of irritants including alcohol, corrosive acids, excessively hot fluids, and heavy smoking
- Symptoms range from pain upon swallowing (____) to hemorrhage, stricture, or perforation
- In children, esophageal chemical injury is often secondary to accidental ingestion of ____ products
- Esophageal injury may be caused by ____, radiation therapy, or ____ disease
- Esophageal infections in healthy individuals are ____, but are most often due to ____
odynophagia household cleaning chemotherapy GVHD uncommon herpes simplex
Candida esophagitis and herpes esophagitis
• Characterized by adherent, ____ pseudomembranes composed of densely matted fungal ____ and ____ cells covering the esophageal mucosa
• Candida esophagitis can complicate the ulcers of herpes or appear in the ____ of viral infection, usually seen in immunosuppressed individuals
• Herpes virus typically cause ____ out ulcers
• Can arise in both ____ and immunocompetent
individuals
• May present with ____, retrosternal chest pain, and fever
gray-white hyphae inflammatory absence punched immunosuppressed odynophagia
Reflux esophagitis
• Reflux of gastric contents into the ____ is the most frequent cause of esophagitis; the associated clinical condition is termed ____
• GERD is accompanied by regurgitation, heartburn, pain, and dysphagia
• Reflux esophagitis may progress to superficial ____ and circumferential fibrosis and stricture formation and ____ to the surrounding structures
lower esophagus
GERD
ulceration
fixation
Pathogenesis
• Most common cause of GERD is transient ____ relaxation
• Conditions that can contribute to GERD include ____ and tobacco use, obesity, central nervous system ____, pregnancy, hiatal hernia, ____ gastric emptying, and increased gastric volume
• Hiatal hernia is the protrusion of the ____ into the thorax and can give rise to symptoms, such as ____ and regurgitation of gastric juices
• Reflux ____ are central to the development of mucosal injury
• In severe cases, reflux of bile from the ____ may exacerbate the
damage
• ____ of the mucosa may be the only alteration
LES alcohol depressants delayed stomach heartburn gastric juices duodenum redness
Clinical features
• GERD is most common in individuals older than age ____ but can occur in children and ____
• The most frequent clinical symptoms are ____, dysphagia, and regurgitation of sour-tasting gastric contents
• Rarely, chronic GERD is punctuated by attacks of severe chest pain that may be mistaken for ____
• Treatment is with ____, which reduces ____ and provides temporary relief
• Complications of reflux esophagitis include ____, stricture development, and ____
40 infants heartburn heart disease proton pump inhibitors gastric acidity ulceration barrett esophagus
Eosinophilic esophagitis
• An allergic ____ disorder that seems to be increasing in frequency
• Symptoms include ____ in adults or ____-like symptoms in children
• Thought to be a result of local ____ to food- or blood-borne allergens, and that ____ cells play an important role
• The characteristic histologic feature is large numbers of intraepithelial ____ in the superficial epithelium
• Unlike GERD, ____ is not prominent and high doses of proton pump inhibitors usually do not provide ____
eosinophilic dysphagia GERD hypersensitivity antigen-presenting eosinophils acid reflux relief
Esophageal varices
- Varices are tortuous dilated ____ lying primarily within the submucosa of the ____ and proximal stomach
- Varices develop in the vast majority of cirrhotic patients, most commonly in association with ____ disease
- Present in nearly half of patients with cirrhosis
- 25-40% develop variceal bleeding
- Patients with risk factors may be treated prophylactically with ____ to reduce portal blood flow
- Variceal hemorrhage is an emergency that can be treated ____; despite interventions, 30% or more patients die as a direct consequence of hemorrhage
- More than 50% of patient who survive a first variceal bleed have ____ hemorrhage within 1 year
veins distal esophagus alcoholic liver beta-blockers medically recurrent
Barrett esophagus
• Complication of chronic GERD where the esophageal squamous mucosa is replaced with ____
• May occur up to 10% of individuals with symptomatic GERD
• Most common in ____ males and presents between 40 and 60 years of
age
• Though has been reported in children with ____, a condition that can induce gastroesophageal reflux
- The greatest concern in Barrett esophagus is that there is an increased risk of esophageal ____
- Vast majority of esophageal adenocarcinomas are associated with Barrett, however, most individuals with Barrett esophagus do not develop cancer
- Usually occurs in the ____ of the esophagus and may invade the ____
metaplastic intestinal mucosa white males cystic fibrosis adenocarcinoma distal third gastric cardia
Clinical
• Esophageal adenocarcinomas discovered in evaluation of GERD or surveillance of Barrett esophagus
• Commonly present with pain or difficulty in ____, progressive weight loss, hematemesis, chest pain, or vomiting
• By the time symptoms appear, the tumor has usually spread to submucosal ____
• Prognosis of advanced stage adenocarcinoma in Barrett esophagus is ____ with a 5-year survival rate of less than 20%
swallowing
lymphatic vessels
poor
