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GI/Liver > Lec 2 > Flashcards

Lec 2 Flashcards

1
Q

What is the order of layers from in to out of esophagus?

A
  • mucosa
  • muscularis mucosa / submucosa
  • muscularis propria
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2
Q

What structures are in esophagus submucosa?

A

veins, nerves [meissner’s plexus], salivary glands, elastic fibers

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3
Q

What is the z line?

A

the line demarcating esophagus from stomach

esophagus = shinier, lighter color
stomach = not shiny, not squamous
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4
Q

What is an especially dangerous cause of chemical esophagitis

A

alkalis = odorless and tasteless + rapid injury

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5
Q

What is effect of akalis on esophagus short and long term?

A

immediately = necrosis, saponification, perforation

long term = chronic ulcer, stricture, squamous cell carcinoma

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6
Q

How do pills cause esophagitis?

A

during sleep pill sandwiched in collapsed esophagus w/ no secretions

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7
Q

What are “kissing ulcers” a sign of?

A

sign of esophagitis due to pill

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8
Q

What are some chemical causes of esophagitis?

A
  • alkalis
  • pills taken at night
  • bisphosphonates
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9
Q

What does candida esophagitis suggest?

A

early sign of immunocompromised states

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10
Q

What do you see on endoscopy with candida esophagitis?

A

whitish plaques

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11
Q

What does CMV esophagitis indicate?

A
  • immunocompromised state

- indicates viremia [esophagus not usually involved alone]

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12
Q

What cells does CMV infect?

A

mesenchymal cells [endothelial, fibroblasts, myocytes]

NOT squamous cells

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13
Q

What cells does herpes infect?

A

squamous cells

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14
Q

What is the mucosal lining of the esophagus?

A

stratified squamous not normally keratinized

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15
Q

Who gets esophageal varices?

A

patients with portal hypertension

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16
Q

What is structure of muscularis propria?

A

2 muscle layers with myenteric nerve plexus sandwiched between

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17
Q

Is esophagus smooth or skeletal?

A

upper 1/3 skeletal; bottom 2/3 smooth

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18
Q

What 3 things do you see microscopically with HSV esophagitis?

A
  • cell cell detachment
  • multinucleation
  • ground glass nuclei
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19
Q

What are symptoms of infectious esophagitis?

A

odynophagia = painful swallowing

20
Q

Should you biopsy from ulcer or squamous epithelium to find CMV? What about herpes?

A

ulcer to find CMV

normal squamous epithelium to find herpes

21
Q

What are risk factors for reflux esophagitis?

A
  • LES incompetence [due to hernia, drug, food, scleroderma]
  • high ab pressure [obesity, pregnancy]
  • reduced saliva [smoking]
  • bulimia
22
Q

What substance cause injury to esophagus in reflux esophagitis?

A
  • gastric acid
  • pepsin
  • duodenal contents [trypsin, bile]
23
Q

What do you see under microscope in reflux esophagitis?

A
  • dilated capillaries
  • edema
  • ballooning of squmaous cells
  • eosinophils, neutrophils
  • increased height of basal cell zone
24
Q

What is eosinophilic esophagitis? treat?

A

infiltration of eosinophils in esophagus in person w/ allergy

treat by dietary restriction and steroids –> GERD therapies won’t work

25
Q

What are symptoms of eosinophilic esophagitis?

A

dysphagia, food impaction

26
Q

What is pathogenesis of eosinophilic esophagitis?

A

IgE and cell mediated injury

27
Q

Where in esophagus can you get eosinophilic esophagitis? GERD?

A

EoE = pan esophageal

GERD = distal esophagus usually

28
Q

What age group gets EoE? GERD?

A

children and adults get EoE

usually just adults get GERD

29
Q

What stain can you use to pick up goblet cells?

A

alcian blue

30
Q

How fast is progression of barrett’s to cancer?

A

very slow progression takes many years

31
Q

How do you diagnose barrett’s esophagus?

A

do endoscopy + biopsy –> can’t visualize dysplasia just by endoscopy need to do biopsy

32
Q

What factors increase risk of barrett adenocarcinoma?

A
  • duration of BE
  • length of Barrett segment
  • dysplasia
  • genetics
33
Q

What is treatment of barretts esophagus?

A

surgical or by local ablation

34
Q

Who usually gets barretts adenocarcinoma?

A

middle age white males

35
Q

What are symptoms of barretts adenocarcinoma?

A

progressive dysphagia + weight loss

36
Q

What is 5 year survival of barretts adenocarcinoma?

A

15-20%

37
Q

Is squamous or adenocarcinoma of esophagus more common?

A

squamous is more common world wide

adenocarcinoma is more common in the US

38
Q

Who is at risk for squamous cell carcinoma of esophagus?

A

in underdeveloped regions: dietary deficiencies, indoor coal burning

industrialized: alcohol, smoking
other: achalasia, lye stricture, celiac

39
Q

Who gets squamous cell carcinoma?

A 
males > females
age > 50
smoking + alcohol
urban environments
more in african americans
40
Q

What does squamous cell esophageal carcinoma look like grossly?

A

mid or distal esophagus
invades surrounding organs and lymph nodes
tumor tissue grey and cheesy due to keratin content

41
Q

What are micro features of squamous cell esophageal carcinoma?

A
  • vaguely resembles normal squamous epithelium
  • invasive pattern
  • polygonal cells arranged in sheets
  • lots of pink cytoplasm
  • if well differentiated have intercellular bridges and keratin pearls
42
Q

Is sliding or rolling hiatal hernia more common?

A

sliding ?90%

43
Q

What are esophageal webs and rings?

A
  • fibromucosal membranes that project into lumen

upper esophagus = web
lower esophagus = ring

44
Q

What is plummer-vinson syndrome?

A

triad of dysphagia [due to esophageal webs], iron deficiency anemia], and glossitis

45
Q

What is mallory weis syndrome?

A

longitudinal tear across esophagogastric junction due to severe vomitting; leads to hematemesis

usuually in bulemia and alcoholics

GI/Liver (36 decks)

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