Esoph and Gastric Pathophys

Question 1

Esophageal Atresia

Answer 1

Esophagus closes before reachign stomach

Question 2

Treacheal-esophageal fistula

Answer 2

Hole between the two structures

Question 3

Duplication cyst

Answer 3

Embryologic abnormality where you have a pouch that is a duplication of the esophagus where food can get stuck, give bad breath, regurgitation

Question 4

Duplication cyst increases your risk for…?

Answer 4

Increased risk for squamous cell carcinoma of the esoph due to stasis of food

Question 5

Inlet patch

Answer 5

Patches of ciliated or gastric type epithelium in the esophagus of embryologic origin (since fetal esophagus is initially ciliated since its is derived from same embryonic origin as trachea)

-no consequences for pt

Question 6

Esophagitis

Answer 6

Inflammatory injury to mucosal lining of the esophagus causing inflammation–neutrophils and eosinophils are never normal while lymphocytes are sometimes normal

Question 7

Reflux esophagitis

Answer 7

Failure of LES causing gastric contents to come into the esophageal lumen. Often causes linear ulcerations

Question 8

Herpes esophagitis

Answer 8

Ulcers caused by herpetic infection, generally only in immunocompromised people

Question 9

Candida esophagitis

Answer 9

fungal infection that often causes white, cheesy plaques

Question 10

Eosinophilic esophagitis

Answer 10

Allergic reaction that can be caused by food or seasonal allergies causing infiltration or eosinophils that can lead to rings and fibrosis of esophagus

Question 11

Schatzki ring

Answer 11

• Muscular ring covered by squamous epithelium

- One of the most common causes of dysphagia

Question 12

Achalasia

Answer 12

• Initially a hypermotility disorder where LES does not relax thereby impeding on the progression of food bolus into stomach.
• Over time, esophagus dilates to accommodate inc pressure and food
• This leads to food stasis, increasing risk of squamous dysplasia and squamous cell carcinoma progression

Question 13

Scleroderma

Answer 13

Causes selective atrophy of inner circular muscle layer of muscularis propria (smooth muscle so it is just the distal part)

Question 14

Mallory Weiss Tear

Answer 14

A rip in distal esophagus causing massive bleeding due to repeated wrenching vomiting

Question 15

List the benign tumors

Answer 15

• Papilloma
• Granular cell
• Mixed
• Lieyomyoma

Question 16

List the malignant tumors

Answer 16

• Squamous and adenomcarcinoma
• Malignant nerve sheath
• ADenoid cystic
• Lieyomyo-sarcoma

Question 17

Most common tumor worldwide vs US?

Answer 17

World: squamous cell carcinoma
USA: adenocarcinoma

Question 18

Risk factors for adenocarcinoma?

Answer 18

• *obesity
• reflux
• diet
• male
• microbiome

Question 19

Precursor lesion for adenocarcinoma?

Answer 19

Barrett’s esophagus (intestinal metaplasia in esophagus)

Question 20

Long vs short segment of intestinal metaplasia

Answer 20

• Short segments do not convert to long segments (ie length of metaplasia is static)
• Risk of cancer is greater in long segment than in short segment Barett

Question 21

Risk factors for squamous cell carcinoma

Answer 21

Drinking, smoking, moldy foods, geography, achalasia, lye ingestion, NOT HPV

Question 22

Gastritis

Answer 22

• Inflammatory disorder of stomach that can be acute (iron pills, NSAIDs etc) or chronic (h pylori, autoimmune)
• Ulcers can bleed or completely perforate the stomach
• With or without “Activity” means with or without neutrophils.

Question 23

What does atrophic gastritis mean?

Answer 23

Atrophic means loss of parietal and chief cells in the oxyntic mucosa.

Can lead to carcinoma/lymphoma

Most commonly caused by autoimmune disease

Question 24

Acute gastritis leads to…

Answer 24

Barrier/epithelial breakdown/bleeding and inflammation allowing HCL to back diffuse into the lamina propria

Question 25

Where does h pylori preferentially infect?

Answer 25

Antrum - binds to surface cells by receptors so need biopsy to see organism - with prolonged infection and injury, epithelium may undergo intestinal metaplasia and h pylori will migrate up - some inject toxic Cag A, which injures the cell

Question 26

Describe long term injury associated with atrophic gastritis

Answer 26

- pH increases due so G cells produce more gastrin - Gastrin levels get too high trying to stimulate parietal cells, but there are none to stimulate - ECLs are still stimulated, so histamine is released and ECL cells proliferate causing carcinoid tumors - Also have decreased intrinsic factor (as well as acid) which leads to bacterial overgrowth and vitamin B12 deficiency, cancer and pernicious anemia

Question 27

Fundic gland polyps

Answer 27

Benign protrusions, no proliferation involved

Question 28

Hyperplastic gastric polyp

Answer 28

- Benign, must define the underlying gastric pathology - Can be a source of bleeding, arise in gastritis setting - USually in antrum, but can be anywhere - Little neoplastic risk - Composed of inflamed and proliferating mucosa

Question 29

Why may gastric folds become enlarged?

Answer 29

1. Lymphoma 2. Gastric cancer 3. MEtastatic breast lobular carcinoma 4. Diffuse gastritis 5. hypertrophic gastrophathies (true increase in gastric epith)

Question 30

Zollinger Ellison Syndrome

Answer 30

- Gastrin secreting tumor causes expansion of parietal cell compartment and hypertrophy or folds - Increased acid production leads to gastric ulcers (not stomach ulcers since there is no perforation of epithelium) - Low pH inactivated pancreatic enzymes

Question 31

Extra nodal marginal zone b cell lymphoma

Answer 31

- Most common lymphoma in the stomach | - H pylori causes lymphocytic response and these can transform

Question 32

Two types of gastric cancer

Answer 32

1. Intestinal (Gland formation) | 2. Signet rings (single cells)

Question 33

Pathogenesis of intestinal gastric cancer

Answer 33

- Repeated injury/chronic gastritis (can be due to h py) leads to intestinal metaplasia, dysplasia, adenocarcinoma - Vit C protective as is vegetable consumption - No inc risk with alcohol use - Inc risk with processed meat due to N-nitroso compounds - Can present as a non-healing ulcer

Question 34

PAthogenesis of signet ring intestinal gastric cancer

Answer 34

- No injury/gastritis, need two hit E cadherin mutation. - Associated with lobular breast cancer - Presents as giant folds or leather bottle stomach