Flashcards in CH10 - Gastrointestinal Pathology Deck (345)
What is Boerhaave syndrome?
rupture of esophagus leading to air in the mediastinum and subcutaneous emphysema
What is esophageal varices?
Dilated submucosal veins in the lower esophagus
What does esophageal varices arise with?
It arises secondary to portal hypertension
What does the distal esophageal vein normally drain into?
the portal vein via the left gastric vein
What is seen in portal hypertension?
the left gastric vein backs up into the esophageal vein, resulting in dilation (varices)
What are the symptoms for esophageal varices?
Asymptomatic, but risk of rupture exists
What does esophageal varices present with?
What is the most common cause of death in cirrhosis?
What is achalasia?
Disordered esophageal motility with inability to relax the lower esophageal sphincter (LES)
What is achalasia due to?
damaged ganglion cells in the myenteric plexus
Where are the ganglion cells of the myenteric plexus located?
between the inner circular and outer longitudinal layers of the muscularis propria
What are the ganglion cells of the myenteric plexus important for?
regulating bowel motility and relaxing the LES.
What causes damage to ganglion cells [of the myenteric plexus]?
can be idiopathic or secondary to a known insult (e.g., Trypanosoma cruzi infection in Chagas disease)
What are the clinical features for achalasia?
1. Dysphagia for solids and liquids 2. Putrid breath 3. High LES pressure on esophageal manometry 4. Bird-beak sign on barium swallow study 5. Increased risk for esophageal squamous cell carcinoma
What is there an increased risk for with achalsia?
Esophageal squamous cell carcinoma
What is GERD?
Gastroesophageal reflux disease - Reflux of acid from the stomach due to reduced LES tone
What are the risk factors for GERD?
include alcohol, tobacco, obesity, fat-rich diet, caffeine, and hiatal hernia.
What are the clinical features for GERD?
1. Heartburn (mimics cardiac chest pain) 2. Asthma (adult-onset) and cough 3. Damage to enamel of teeth 4. Ulceration with stricture and Barrett esophagus are late complications.
What is barrett esophagus?
Metaplasia of the lower esophageal mucosa from stratified squamous epithelium to nonciliated columnar epithelium with goblet cells seen in
What % of patients with GERD present with Barrett Esophagus?
Barrett Esophagus is a response of what to what stimuli?
Response of lower esophageal stem cells to acidic stress
What might Barrett Esophagus progress to?
May progress to dysplasia and adenocarcinoma
What is esophageal carcinoma?
Subclassified as adenocarcinoma or squamous cell carcinoma
What is adenocarcinoma?
a malignant proliferation of glands;
What is the most common type of esophageal carcinoma in the West?
From what does adenocarcinoma arise?
from preexisting Barrett esophagus; usually involves the lower one-third of the esophagus
What is squamous cell carcinoma?
it is a malignant proliferation of squamous cells
What is the most common esophageal cancer worldwide?
Squamous cell carcinoma
Where does squamous cell carcinoma usually arise?
in upper or middle third of the esophagus;