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MODHIII - Unit 3 > Esophagus Pathology > Flashcards

Esophagus Pathology Flashcards

1
Q

Vascular diseases

A
  • esophageal varices
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2
Q

Infectious/inflammatory diseases

A
  • achalasia, chemical esophagitis, infectious esophagitis, reflux esophagitis
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3
Q

Traumatic diseases

A
  • mallory-weiss syndrome
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4
Q

Anatomic diseases (congenital/acquired)

A

C: atresia, diverticula, fistula, hiatal hernia, rings, stenosis, webs
A: diverticula, fistula, hiatal hernia, rings, stenosis, webs

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5
Q

Idiopathic diseases

A
  • achalasia
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6
Q

Neoplastic diseases

A
  • adenocarcinoma, barrett’s esophagus, benign tumors, squamous cell carcinoma
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7
Q

Squamocoloumnar junction (SCJ)

A

Z line

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8
Q

Anatomic gastroesophageal juction (GEJ)

A

defined as takeoff of gastric fold

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9
Q

Relation of SCJ to GEJ

A
  • normally SCJ approximates GEJ
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10
Q

Anatomic disease: atresia & fistula

A
  • congenital
  • choking, coughing, cyanosis w/ feeding
  • amenable to surgical correction
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11
Q

Anatomic disease: achalasia

A
  • failure of LES to relax: narrow distal segment, dilated proximal segment
  • progressive destruction of myenteric plexus
  • dysphagia
  • increased risk of carcinoma
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12
Q

Achalasia: primary vs. secondary

A
  • primary: idiopathic

- secondary: Chagas disease, scleroderma

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13
Q

Anatomic disease: hiatal hernia

A
  • protrusion of stomach above diaphragm
  • idiopathic and asymptomatic
  • two types: sliding (95%), paraesophageal (rolling-5%)
  • *PE hernia patients at risk for strangulation (infarction of incarcerated hernia)**
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14
Q

Anatomic diseases: diverticula-types

A
  • congenital vs. ACQUIRED
  • true (contain all gut layers) vs. FALSE
  • PULSION (peristalsis against a closed sphincter) vs. traction (extrinsic pull, secondary to inflammation)
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15
Q

Zenker diverticula

A
  • pulsion, from above UES
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16
Q

Mid esophageal diverticula

A

traction

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17
Q

Epiphrenic diverticula

A
  • pulsion, from above LES
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18
Q

Mallory-Weiss syndrome

A
  • hematemesis from lacerations of GEJ mucosa/submucosa
  • caused by forceful retching/coughing/vomiting
  • alcoholics, persons with eating disorders
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19
Q

Esophageal varices causes

A
  • consequence of portal hypertension
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20
Q

Stenosis, Webs, Rings

A

Web: shelf of tissue, congenital, post inflammation
Ring: circumfrential, example-Schatzki @ SCJ

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21
Q

Chemical and pill esophagitis cause

A
  • topical injury due to ingestion of alcohol, corrosive substances (acid,lye), hot liquids
  • cytotoxic chemotherapy (radiation, GVHD)
  • “stuck” pills: doxycycline (acne), aspirin, iron, alendronate
22
Q

Kissing ulcers

A
  • ulcers facing each other

- seen with doxycycline

23
Q

Infectious esophagitis: who gets it, presentation

A
  • seen in immunocompromised

- ODYNOPHAGIA

24
Q

Infectious esophagitis: causes & presentation

A
  • candida: white plaques
  • herpes: numerous punched out ulcers (3 Ms: multinucleation, margination, molding)
  • cytomegalovirus: single deep ulcer, “owl’s eye”
25
Q

GERD vs. reflux esophagitis (RE)

A
  • GERD: condition that develops when reflux of stomach contents causes troublesome symptoms and or complications
  • RE: endoscopic or histologic evidence of reflux associated injury
26
Q

GERD: prevalence, pathophysiology, symptoms

A
  • 10-20% in West,
27
Q

GERD: diagnosis, treatment, complications

A
  • diagnosis: clinical, further testing if not responding to treatment
  • treatment: antacids, anti secretory (PPIs), surgical (nissen fundoplication)
  • complications: stricture, barrett’s esophagus, adenocarcinoma
28
Q

Types of GERD

A
  • erosive: mucosal break (40%)

- non erosive (60%)

29
Q

Histologic features of reflux

A
  • epithelial hyperplasia: basal zone hyperplasia, papillary elongation
  • dilated intercellular spaces
  • intraepithelial eosinophils
30
Q

Epithelial hyperplasia

A
  • compare height of papillaries and basal zone to entire squamous layer
  • normal: PE=50%, BZH=13%
  • abnormal: PE=84%, BZH=34%
31
Q

Pathogenesis of heartburn in GERD

A
  • erosive: mucosal breaks allow acid to get through

- non erosive: dilated intercellular spaces allow acid to get through

32
Q

Eosinophilic esophagitis: definition

A
  • clinicopathologic disorder
  • > 15 intraepithelial eosinophils per high power field
  • absence of pathologic GERD: normal pH, lack of response to high dose PPI medication
33
Q

Eosinophilic esophagitis: frequency, symptoms

A
  • frequency: increasingly recognized; 2-27/100,000 over 16 year period
  • symptoms include FOOD IMPACTION, dysphagia (adults), GERD, feeding intolerance (children)
34
Q

Eosinophilic esophagitis: diagnosis, treatment, complications

A
  • esophageal symptoms + mucosal biopsy + exclusion of GERD (lack of response to PPI or normal pH monitoring)
  • treatment: elimination and elemental diets, acid suppression, TOPICAL CORTICOSTEROIDS, dilatation of strictures
  • complications: stricture
35
Q

Endoscopy signs of eosinophilic esophagitis

A
  • trachealization, linear furrowing
36
Q

Histologic features of EoE

A
  • > 15 eos/HPF

- eosinophilic MICROABSCESSES, SUPERFICIAL LAYERING, BZH, DIS

37
Q

Barrett’s Esophagus: definition

A
  • endoscopically evident apparent columnar mucosa proximal to GEJ
  • biopsy demonstrating intestinal metaplasia (GOBLET CELLS)
38
Q

Barrett’s esophagus: prevalence, etiopathogenesis, symptoms

A
  • 10% of w/ symptomatic chronic GERD, many asymptomatic, 1.6% of general population
  • etiopathogenesis: reflux, inflammation, induction of CDX2, METAPLASIA
  • symptoms: GERD, asymptomatic, symptoms may improve in patients who develop BE
39
Q

Barrett’s Esophagus: diagnosis

A
  • 2 EGD’s with bx within 1 year (confirm dx; rule out PREVALEN DYSPLASIA)
40
Q

Barrett’s esophagus: treatment

A
  • PPI for GERD; ENDOSCOPIC ABLATIVE Tx or surgery for dysplasia/carcinoma
41
Q

Surveillance of Barrett’s esophagus

A
  • determined by absence or presence of dysplasia, grade of dysplasia
42
Q

Complications of Barrett’s esophagus

A
  • adenocarcinoma: 1/200 patients/year (.5%/year), RR=30-60
43
Q

Frequency of surveillance based on grade of dysplasia in BE

A
  • no dysplasia: q 3-5 years
  • indefinite for dysplasia: rebiopsy after tx underlying inflammation
  • low grade dysplasia: q 6-12 months
  • high grade dysplasia: q 3 months
44
Q

Intramucosal carcinoma

A
  • high grade dysplasia
  • managed w/ esophagectomy due to 40% “cancer” risk
  • 2/3 of these cancers are intramucosal, associated with
45
Q

Categories of esophageal diseases

A 
V: vascular
I: infectious/inflammatory
T: traumatic
A: anatomic
M: metabolic
I: idiopathic
N: neoplastic
46
Q

Presentation of adenocarcinoma

A
  • 95% present with advanced full blown adenocarcinoma rather than presenting and then progressing to it
47
Q

Treatment for adenocarcinoma

A
  • first do chemoradiation

- second do esophagectomy

48
Q

Incidence of esophageal cancer

A
  • increasing at an alarming rate

- due to obesity epidemic

49
Q

Squamous cell carcinoma: gross & histology

A
  • fungating, friable tumor mass

- keratin pearls on histology

50
Q

SCC vs. Adenocarcinoma

A
  • SCC: etiology-tobacco, alcohol, hot beverages; not a major disease in the west
  • adenocarcinoma: etiology-GERD, tobacco, obesity; much higher incidence

MODHIII - Unit 3 (20 decks)

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