Disease of esophagus Flashcards
What is Achalasia cardia and what are its key features?
Achalasia cardia is characterized by the failure of the lower esophageal sphincter (LES) to relax properly, leading to functional abnormalities. Key features include:
Absence of peristalsis
Partial relaxation of the LES during swallowing
Increased resting tone of the LES
What are the age range and etiology of Achalasia cardia?
Achalasia cardia typically affects individuals aged 20-40 years. Its etiology includes primary causes with unknown origins and secondary causes such as Chagas disease, polio, diabetic neuropathy, malignancy, amyloidosis, and immune-mediated factors.
Describe the macroscopic and microscopic findings in Achalasia cardia.
In primary achalasia, the number of ganglion cells in the Auerbach’s plexus is reduced.
The distal esophagus exhibits muscular wall thickening.
The proximal esophagus shows dilation and thinning of the esophageal wall.
What is Mallory Weiss syndrome and how does it occur?
Mallory Weiss syndrome refers to lacerations in the esophagus, typically caused by severe retching or vomiting, which leads to failure of reflex relaxation of the gastrointestinal tract, resulting in massive dilation of the esophageal wall and mucosal ulceration.
Explain the pathogenesis, cause, and treatment of Esophageal varices.
Pathogenesis: Esophageal varices occur due to congestion and dilation of the collateral bypass vascular channels in the lower esophagus, where the portal and systemic systems communicate.
Cause: Portal hypertension, often resulting from liver cirrhosis or hepatic schistosomiasis.
Treatment: Sclerotherapy and balloon tamponade are common interventions.
What is Gastroesophageal Reflux Disease (GERD), and what are its pathogenesis and risk factors?
: GERD is a chronic condition characterized by diffuse erosive/ulcerative esophagitis. Its pathogenesis involves decreased lower esophageal sphincter tone, loss of secondary peristalsis following transient LES relaxation, increased acidity, increased intra-abdominal pressure, and delayed gastric emptying. Risk factors include pregnancy, ascites, obesity, delayed gastric emptying, peristaltic disorders, and scleroderma.
What are the clinical features and complications of GERD?
Clinical features of GERD include heartburn, regurgitation, dysphagia, and intermittent chest pain. Complications may include ulceration, hematemesis, esophageal stricture, and Barrett’s esophagitis.
Describe Barrett’s Esophagus including its pathogenesis, age distribution, and complications.
Barrett’s Esophagus is a complication of long-standing GERD characterized by columnar epithelial metaplasia of the esophageal stratified squamous epithelium. It typically affects individuals aged 40 to 60 years, with a higher prevalence in males. Complications may include adenocarcinoma of the esophagus.
What are the causes of infectious and non-infectious esophagitis? Mention some specific features and risk factors.
Causes: Chemical factors (alcohol, acids, alkalis, heavy smoking, cytotoxic anticancer agents), infections (bacteria, viruses such as HSV and CMV, fungi such as candidiasis), radiation, graft versus host disease, Crohn’s disease, and severe skin diseases.
Specific features: Microscopic findings may include acute inflammation, superficial necrosis, and ulceration, with specific features such as fungal hyphae in candidiasis and nuclear inclusions in HSV and CMV infections.
Risk factors: Immunodeficient individuals are particularly susceptible.
What are the epidemiology, risk factors, and clinical features of carcinoma of the esophagus?
Epidemiology: Carcinoma of the esophagus is more common in individuals over 50 years old, with a higher incidence in males.
Risk factors: For squamous cell carcinoma, risk factors include conditions like Achalasia cardia, Plummer-vinson syndrome, stricture, diverticula, esophageal web, as well as lifestyle factors like alcohol consumption, betel chewing, smoking, and dietary factors. Adenocarcinoma is associated with GERD.
Clinical features: Dysphagia, weight loss, hemorrhage, sepsis, iron deficiency anemia, and chest pain are common clinical manifestations.
Describe the macroscopic and microscopic types of esophageal carcinoma.
Macroscopic features may include a cauliflower appearance, ulceration, and diffuse infiltrative patterns.
Microscopic types include squamous cell carcinoma and adenocarcinoma, each with specific genetic mutations such as p53, p16INK4, cyclinD1 amplification, C-Myc, and EGFR for squamous cell carcinoma, and p53 and c-ERB-B2 for adenocarcinoma.
