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GI II > Pathology of the GI Tract- SI and Colon (2) > Flashcards

Pathology of the GI Tract- SI and Colon (2) Flashcards

1
Q

the esophagus develops from what and is recognizable at what point?

A

develops from the cranial portion of the foregut and is recognizable by the third week of gestation

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2
Q

what is the blood supply of the esophagus?

A

upper 1/3: inferior thyroid artery middle 1/3: branches of thoracic aorta; lower 1/3: left gastric artery

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3
Q

what is the nerve supply to the esophagus?

A

sympathetic trunks; parasympathetic nerve: vagus

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4
Q

what is the epithelium of the esophagus?

A

it is a continuation of the squamous epithelium from the oral cavity

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5
Q

what are 3 functional causes of obstruction in the esophagus?

A

nutcracker esophagus, diffuse esophageal spasm, and systemic sclerosis- CREST syndrome

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6
Q

what does it mean to have a function cause of obstruction in the esophagus?

A

there is a disruption in coordinated peristalsis

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7
Q

what is an example of a complication due to increased intraesophageal pressure?

A

Zenker diverticulum

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8
Q

what is Zenker diverticulum associated with?

A

the upper pharyngo constrictor muscle

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9
Q

what are four non-cancer causes of strictures/stenosis in the esophagus?

A

esophageal web, esophageal ring, achalasia, and inflammation and scarring (esophagitis)

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10
Q

what is an esophageal web?

A

a partial shelf like occlusion

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11
Q

what is an esophageal ring?

A

circumferential abnormality

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12
Q

what is achalasia characterized by?

A

the triad of incomplete LES relaxation, increased LES tone, and peristalsis of the esophagus

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13
Q

what is the etiology of primary achalasia?

A

ganglion cell degeneration (rare)

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14
Q

what are the etiologies of secondary achalasia?

A

Chagas, achalasia-like disease, infiltrative disorders, lesions of DMN

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15
Q

which is more common, UGIB or LGIB?

A

UGIB is 4 times more common than LGIB

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16
Q

how is an UGIB defined?

A

pharynx to ligament of Treitz

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17
Q

what are the signs/symptoms associated with an UGIB?

A

hematemesis and melena (tarry stools)

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18
Q

what are the signs/symptoms associated with a LGIB?

A

hematochezia (bright red blood)

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19
Q

What are three examples of esophageal causes of hematemesis?

A

mallory-weiss syndrome, boerhaave’s syndrome, and esophageal varices

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20
Q

what is Mallory-weiss syndrome?

A

a tear on the gastric side of the gastroesophageal junction; it is superficial as it only affects the mucosa and submucosa; it is associated with binge drinking; resolves on its own

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21
Q

what is Boerhaave’s syndrome?

A

a catastrophic event; complete rupture at the lower thoracic esophagus; bleeding associated with arterial blood supply

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22
Q

what are some signs/symptoms associated with boerhaave’s syndrome?

A

Hamman’s sign, chest pain, shock, subcutaneous emphysema

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23
Q

what is hamman’s sign?

A

crunching sound upon auscultation of the heart due to pneumomediastinum

24
Q

how can esophageal varices be treated?

A

medically by inducing splanchnic vasoconstriction or endoscopically by sclerotherapy (injection of thrombotic agents), balloon tamponade, or variceal ligation

25
Q

who is at risk for developing esophageal varices?

A

cirrhotics

26
Q

what is the outcome of variceal hemorrhage?

A

variceal hemorrhage is a medical emergency; 30% die initially, 50% recur within a year

27
Q

what is the most common cause of varices?

A

hepatic schistosomiasis

28
Q

what type of obstruction does esophagitis cause?

A

structural/mechanical

29
Q

what are the symptoms associated with esophagitis?

A

symptoms range from self-limited pain, particularly on swallowing, to hemorrhage, stricture, or perforation in severe cases

30
Q

what are 5 potential causes of esophagitis?

A

radiation, chemical, infectious, eosinophilic, and reflux esophagitis

31
Q

what is associated with esophagitis?

A

most patients have food or seasonal allergies–> asthma, allergic rhinitis, atopic dermatitis

32
Q

what are the morphological changes that occur in esophagitis?

A

there is trachialization of the esophagus- it has these multiple ridges or furrows that are circumferentially extending the length of the esophagus

33
Q

what would a biopsy look like in a patient with esophagitis?

A

squamous epithelium infiltrated by numerous eosinophils

34
Q

what is atopy?

A

it refers to the genetic tendency to develop allergic diseases such as allergic rhinitis, asthma, and atopic dermatitis

35
Q

what is the most frequent cause of esophagitis?

A

reflux of gastric contents into the lower esophagus

36
Q

what are some causes of LES relaxation associated with GERD?

A

vagal mediated pathways, increased intra-abdominal pressure, alcohol and tobacco, obesity, hiatal hernia, gastroparesis

37
Q

when is GERD most common?

A

in individuals older than age 40, but it does occur in infants and children occasionally

38
Q

what are some complications associated with GERD>

A

ulceration, hematemesis, melena, stricture development, and metaplasia

39
Q

why is tissue biopsy of barrett mucosa important?

A

metaplasia can be associated with malignancy–> adenocarcinoma

40
Q

benign neoplasms of the esophagus usually arise from what layer?

A

the submucosal layer

41
Q

what are the most common type of benign neoplasms of the esophagus?

A

most are mesenchymal, with smooth muscle tumors being the most common

42
Q

what geographical area has the highest risk for squamous cell carcinoma of the esophagus?

A

iran, central china, hong kong

43
Q

which population has the highest group from squamous cell carcinoma of the esophagus?

A

> 45 years, Males 4:1; african americans 8x more common

44
Q

what are some risk factors associated with squamous cell carcinoma of the esophagus?

A

alcohol and tobaccos use, poverty, caustic esophageal injury, achalasia, tylosis, radiation, plummer-vinson syndrome, frequent consumption of very hot beverages, mursik (Kenya)

45
Q

where do most squamous cell carcinoma of the esophagus occur?

A

50% occur in the middle third of the esophagus

46
Q

what are the histologic features of a squamous cell carcinoma of the esophagus?

A

formation of keratin pearls and intercellular bridges

47
Q

what are three additional risks for esophageal SCC?

A

tylosis, HPV (maybe), and HIV

48
Q

what is tylosis and what is it caused by?

A

hyperkeratosis of palms and soles; caused by a RHBDF2 mutation)

49
Q

occasionally, what are the first symptoms of esophageal squamous cell carcinoma caused by?

A

aspiration of food via a tracheoesophageal fistula

50
Q

could a T-E fistula be acquired later in life?

A

yes- in the setting of esophageal squamous cell carcinoma

51
Q

which geographic area is at risk for adenocarcinoma of the esophagus?

A

US, UK, Canada, and Australia

52
Q

what is the highest risk groups for adenocarcinoma of the esophagus?

A

caucasians, 7x more common in men

53
Q

what are the risk factors for adenocarcinoma of the esophagus?

A

barrett esophagus, tobacco, radiation, and H. pylori

54
Q

what is the most likely location in the esophagus for adenocarcinoma of the esophagus?

A

the distal esophagus

55
Q

how might an adenocarcinoma of the esophagus present?

A

with pain or difficulty in swallowing, progressive weight loss, hematemesis, chest pain, or vomiting

GI II (20 decks)

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