EXAM #1: PATHOLOGY OF THE ESOPHAGUS

Question 1

What is the definition of odnophasia?

Answer 1

Painful swallowing

Question 2

What should you think when a patient complains of odnophasia?

Answer 2

Infectious cause

Question 3

What is the pathologic feature of Achalasia?

Answer 3

Failure of relaxation of the LES

Question 4

What are the symptoms of Achalasia?

Answer 4

Progressive dysphagia

Question 5

What causes Achalasia?

Answer 5

1) Idiopathic
2) Degenerative changes leading to decreased myenteric ganglia
3) Secondary causes

Question 6

What morphology is seen in Achalasia?

Answer 6

Dilated esophagus proximal to the LES

Question 7

What are patients with Achalasia at risk for?

Answer 7

1) SCC
2) Aspiration
3) Esophagitis
4) Diverticula formation
5) Obstruction

Question 8

What disease can cause Secondary Achalasia?

Answer 8

Chagas Disease

Trypanosoma cruzi –parasite– that destroys ganglion cells

Question 9

List the secondary causes of Achalasia.

Answer 9

1) Chagas Disease
2) Disorders of the vagal dorsal motor nuclei
3) Diabetic neuropathy
4) Infiltration disorders

Question 10

What are the two types of Hiatal Hernias?

Answer 10

1) Sliding*
2) Paraesophageal

*Most common

Question 11

Which of the hiatal hernias is more dangerous?

Answer 11

Paraesophageal–risk of strangulation

Question 12

What are the symptoms of a hiatal hernia?

Answer 12

GERD

Question 13

What is the definition of a diverticula?

Answer 13

Outpouching of the GI tract

Question 14

What are the three different types of diverticula seen in the esophagus? Which are false and which are true?

Answer 14

1) Zenker- False
2) Traction- True
3) Epiphernic- True

Question 15

Where is a Zenker diverticula?

Answer 15

Proximal–immediately above the UES

Question 16

Where are Traction diverticula?

Answer 16

Midportion of the esophagus

Question 17

Where are Epiphrenic diverticula?

Answer 17

Distal–just above the LES

Question 18

What is the primary presenting symptom of an esophageal diverticula?

Answer 18

Halatosis

Question 19

What can cause a Traction Diverticula?

Answer 19

Mediastinal lymph nodes in TB “pulling” the esophagus out

Question 20

What is a Mallory-Weiss tear?

Answer 20

Longitudinal tear at the gastroesophageal junction

Question 21

What are the common causes of Mallory-Weiss tears?

Answer 21

1) Alcoholics
2) Bulemia nervosa
3) Hyperemesis gravidarum

Question 22

What happens when there is rupture of a Mallory-Weiss tear?

Answer 22

Booerhave Syndrome

Question 23

What is the primary symptom of Mallory Weiss tear?

Answer 23

Hematemesis

Question 24

Outline the anatomy of an esophageal varice.

Answer 24

N/A

Question 25

What are the most common causes of esophageal varices?

Answer 25

1) Alcoholism | 2) Schistosmiasis

Question 26

What are the symptoms of an esophageal varice?

Answer 26

Non prior to rupture, then rapidly fatal with SEVERE hematemesis

Question 27

What is esophagitis?

Answer 27

Inflammation of the esophagus

Question 28

What are the symptoms of esophagitis?

Answer 28

Dysphagia GERD Hematemesis Melena

Question 29

List the specific causes of Esophagitis.

Answer 29

1) Reflux esopagitis 2) Barrett's Esophagus 3) Infections/ chemical causes 4) Eosinophilic esophagitis

Question 30

What causes reflux esophagitis?

Answer 30

Decreased efficacy of antireflux mechanisms i.e. LES tone

Question 31

What are the risk factors for GERD?

Answer 31

``` Alcohol Tobacco Obesity Fat-rich diet Caffeine Hiatal hernia ```

Question 32

What is the normal epithelium of the esophagus?

Answer 32

Nonkeratinized stratified squamous epithelium

Question 33

What is the normal epithelium of the stomach?

Answer 33

Non-ciliated simple columnar epithelium with goblet cells

Question 34

Describe the progression of the histologic morphology in GERD.

Answer 34

1) Eosinophilia 2) Basal zone hyperplasia 3) Elongation of lamina propria papillae 4) Superficial necrosis/ ulceration

Question 35

What is Barrett's Esophagus?

Answer 35

Replacement of normal distal squamous mucosa with metaplastic columnar epithelium

Question 36

How much does Barrett's Esophagus increase the risk for carcinoma?

Answer 36

30-40x

Question 37

How does Barrett's Esophagus appear grossly?

Answer 37

Velvety salmon spotting above the GE junction

Question 38

Histologically what is the hallmark of low grade dysplasia in Barett's Esophagus?

Answer 38

"Picket Fence Nuclei"

Question 39

What marks the progression from dysplasia to carcinoma in Barett's Esophagus?

Answer 39

Invasion of the basement membrane

Question 40

What does radiation of the esophagus lead to?

Answer 40

Fibrosis (healing) of the esophagus, which can cause dysphagia and impaired peristalsis

Question 41

In HIV patients, what virus can lead to very painful swallowing?

Answer 41

HSV-1 associated esophageal ulcers

Question 42

What is the most common cause of esophageal strictures?

Answer 42

Irritation/ trauma and subsequent healing

Question 43

What foods will patients with esophageal strictures have difficulty with?

Answer 43

Solids

Question 44

What is Scleroderma?

Answer 44

- Autoimmune disease leading to vascular obliteration and fibrosis of smooth muscle - Major cause of stricture/ dysphagia

Question 45

What is the most common benign tumor of the esophagus?

Answer 45

Leiomyoma--a tumor of smooth muscle

Question 46

What are the two most common malignant tumors of the esophagus?

Answer 46

1) Adenocarcinoma | 2) Squamous Cell Carcinoma

Question 47

What is an Adenocarcinoma?

Answer 47

Neoplastic proliferation of glands

Question 48

What is a Squamous Cell Carcinoma?

Answer 48

Neoplastic proliferation of epithelium

Question 49

What is the most common cause of cancer in the esophagus worldwide? What about in the US?

Answer 49

``` Worldwide= SCC US= Adenocarcinoma ```

Question 50

What are the risk factors for SCC?

Answer 50

1) Chronic esophagitis 2) Alcohol 3) Smoking 4) Achalasia 5) Carcinogens in food 6) HPV

Question 51

What are the clinical features of SCC?

Answer 51

- Late diagnosis - Progressive dysphagia - Extreme weight loss

Question 52

What are the three types of SCC of the esophagus?

Answer 52

1) Protruding 2) Flat 3) Evacuated (ulcers)

Question 53

Where do adenocarcinomas typically arise?

Answer 53

Distal 1/3 of the esophagus

Question 54

Where do SCCs typically arise?

Answer 54

Middle 1/3 of the esophagus

Question 55

What form of esophageal cancer is associated with a "signet ring" appearance microscopically?

Answer 55

Poorly differentiated adenocarcinoma