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imed3004 > Oesophageal pathology > Flashcards

Oesophageal pathology Flashcards

1
Q

Where does the oesophagus run?

A

It runs anteriorly to the aorta and posterior to the trachea.

Posterior to the aortic arch.

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2
Q

What mucosa lines the lumen of the epithelium?

A

Stratified squamous epithelium.

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3
Q

What are the layers of the oesophagus?

A

Mucosa:

Squamous epithelium

Basement membrane

Lamina propria

Muscularis mucosae

Submucosa: Loose connective tissue containing blood vessels, lymphatics, nerve fibers, and submucosal glands.

Muscularis propria:

Inner circular muscle coat

Auerbach nerve plexus

Outer longitudinal muscle coat

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4
Q

How does the epithelium of the oesophagus form?

A

Basal cell layer consists of newly formed cells which as it ages progressively goes towards the lumen and then is sloughed off into the lumen.

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5
Q

How does mucosa transition in oesophagus to the stomach?

A

Very abruptly from oesophageal squamous epithelium to gastric foveola epithelium with gastric glands.

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6
Q

What is a sliding hernia?

A

Most common type of oesophageal hernia.

Part of the stomach is pulled up above the diaphragm forming a bell shaped dilated segment.

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7
Q

What causes a sliding hernia?

A

Congenitally short oesophagus or due to secondary defect like scarring of oesophagus following chronic injury

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8
Q

What is a rolling hernia?

A

Also known as paraoesophageal hernia.

Portion of the cardiac end of the stomach pushes through the diaphragm rolling up alongside the oesophagus.

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9
Q

What causes GERD/GORD?

A

LES defects

Hiatus hernia

Increased volume

Inefficient gastroesophageal clearance

Lifestyle (Smoking, spicy food, etc)

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10
Q

What clinical issues arise from GERD/GORD?

A

Damage to mucosa

Secondary infections

Complications (Asthma, aspiration pneumonia, peptic stricture, polyps or steonsis of the larynx, barrett oesophagus, adenocarcinoma)

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11
Q

What can endoscope show in the oesophagus as a result of GERD?

A

Normal mucosa in 22% of cases

Erythema (32%)

Non-confluent erosions (30%)

Confluent erosions (12%)

Circumferential erosions (2%)

Ulcers and Barett’s strictures (2%)

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12
Q

What microscopic changes can be seen in GERD?

A

Hyperplasia of squamous epithelium: Thickening of the basal cell layer. Elongated subepithelial papillae.

Swollen cells / Spongiosis

Inflammatory cells: Neutrophils, lymphocytes, and eosinophils.

Erosions

Ulcerations.

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13
Q

What is eosinophilic oesophagitis?

A

Allergen mediated inflammation of the oesophagus.

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14
Q

When are people affected by eosinophilic oesophagitis?

A

There is seasonal variation of symptoms and most patients have a personal or family history of allergies

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15
Q

What are the clinical issues with eosinophilic oesophagitis?

A

Abdominal pains

Vomiting

Dysphagia / painful and difficul swallowing

Food bolus impaction

Reflux

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16
Q

What is seen on endoscopy of eosinophilic oesophagitis?

A

Characteristic rings

Stricture

Small calibre oesophagus

Furrows / lines

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17
Q

What are characteristic microscopic findings in people with eosinophilic oesophagitis?

A

Lots of eosinophils

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18
Q

How should the oesophagus biopsies be taken for eosinophilic oesophagitis?

A

Can be patchy so multiple biopsies are needed.

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19
Q

What must be seen on the microscopy of the oesophageal biopsies for a diagnosis?

A

15 to 20 eosinophils per HPF

Eosinophil microabscesses

Subepithelial fibrosis/scarring

Can overlap with reflux (Therefore need more than just GOJ biopsy - also need one from mid oesophagus)

20
Q

What organisms causes candida oesophagitis?

A

Candida albicans

Candida tropicalis

Candida krusei

Candida glabrata

Candida parasilosis

21
Q

What are the risk factors for candida oesophagitis?

A

Immunosuppression

Chemotherapy

Steroids

Major abdominal surgery

22
Q

What are the clinical features of candida oesophagitis?

A

Difficulty swallowing / Painful swallowing

23
Q

how is candida oesophagitis treated?

A

Antifungal

24
Q

How is candida oesophagitis diagnosed?

A

White patches and plaques on endoscopy

Pseudohyphae seen in PASD or GMS stain slides

25
Q

What causes viral oesophagitis?

A

Herpes virus

26
Q

What are the risk factors for viral oesophagitis?

A

Immunosuppression (may occur in otherwise healthy individuals)

27
Q

What are the clinical features of viral oesophagitis?

A

Chest pain

Odynophagia

Dysphagia

Upper GI bleeding

28
Q

How can viral oesophagitis be diagnosed?

A

Viral ulcerations that can be bleeding

Viral inclusions (multinucleated viruses indicate herpes virus and owl’s eye inclusions indicate CMV)

29
Q

What viruses can cause viral oesophagitis?

A

Herpes virus

Cytomegaly virus (characteristically affects immunocomprimised patients)

30
Q

What do ulcers caused by CMV look like?

A

Large confluent ulcers that don’t look bloody or haemorrhagic.

Microscopy shows large inclusions (owl’s eye inclusions)

31
Q

What is barrett’s oesophagus?

A

Metaplasia from specialised squamous epithelium of the tubular oesophagus to specialised intestinal type glandular mucosa with mucin secreting goblet cells (columnar eptihelium)

32
Q

What causes Barrett’s oesophagus?

A

GERD (including that caused by hiatus hernia)

Obesity

Smoking

Alcohol use

More common in white race and males.

33
Q

What are the clinical features of barrett’s oesophagus?

A

Some are asymptomatic

Heartburn

Cough

Reflux symptoms.

34
Q

What is used to facilitate diagnosis of barrett’s oesophagus endoscopically?

A

Methylene blue

35
Q

What can be seen in diagnosis of barrett’s oesophagus microscopically?

A

Goblet cells on PASD stain (same stain used for candida)

36
Q

Why should Barrett’s oesophagus be treated?

A

It is a fertile ground for cancers.

37
Q

What primary cancers are most commonly seen in the oesophagus?

A

Adenocarcinoma

Squamous cell carcinoma

38
Q

What are the risk factors for adenocarcinoma in the oesophagus?

A

Male gender (80% of people with oesophageal adenocarcinomas are male)

GORD

Obesity

Smoking

Alcohol

39
Q

What age is adenocarcinoma of the oesophagus most commonly seen?

A

Average age at presentation is 65 years and 80% in males.

40
Q

How does adenocarcinoma present?

A

Dysphagia

Retrosternal pain

Epigastric pain

41
Q

How is adenocarcinoma treated?

A

Endoscopic treatment for early lesions (Laser, photodynamic, and mucosal resection)

Chemoradial and surgery for high stage tumours.

42
Q

What does microscopy of adenocarcinoma affected oesophagus show?

A

Complex and irregular glands

Invading tumour into stroma

Marked cellular and nuclear atypia

43
Q

What are the risk factors for squamous cell carcinoma?

A

Tobacco

Alcohol

Nutrition - nitrosamines in pickled/moldy foods

Vitamin deficiencies

Thermal injury

HPV

Plummer-Vinson syndrome (ring/web and iron deficiency anaemia)

Achalasia (failure of smooth muscle to relax / motility disorder)

Tylosis (thickened skin on palms and soles/skin disorder.

Coeliac disease: Due to iron deficiency anaemia

PHx of corrosive ingestion

44
Q

How does SCC of the oesophagus present clinically?

A

Difficulty swallowing

45
Q

How is SCC of the oesophagus treated?

A

Combination Radiotherapy, chemotherapy, and surgery

46
Q

Other conditions that can appear in the oesophagus:

A

Oesophageal varices (Associated with portal hypertension)

Oesophageal atresia and fistulas

Oesophageal diverticula

Achalasia

Other tumours benign and malignant (papilloma, leiomyoma, lipoma, granular cell tumour, GIST, melanoma, carcinoid, sarcoma, and metastasis

imed3004 (50 decks)

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