Esophageal and Gastric Pathology Flashcards
(47 cards)
Describe the developmental process of the esophagus
Starts out as a single tube with trachea. Then laryngotracheal diverticulum forms…becomes epithelial ridges and eventually forms full trachea
How does epithelium change over course of fetal development?
From psedustratified columnar to columnar epithelium with mutinous secretion to non-keratinizing stratified squamous epithelium
Describe the embyronic development process of the stomach
Fusiform dilitation of the foregut and rotation
There is no epithelial changes
What is esophageal atresia?
Esophagus “not perforated”– basically the tube forms a dead end
Which is the most common developmental anomaly?
Esophageal atresia where esophagus not continuous and part that should be connected is continuous with stomach
What is a tracheoesophageal fistula?
Narrowing of tube with connection between esophagus and trachea
Esophogeal duplication: How does it present?
How is it treated?
It’s discovered after birth due to regurgitation during feeds. It requires prompt surgical repair because it is incompatible with life
Gastric Ectopia (inlet patch)
Presence of ectopic gastric mucosa in upper 1/3 of esophagus
Intantile hypertrophic pyloric stenosis: Epidemiology and presentation
More common in white males
Presents between 3rd/6th week of life with regurgitation, projectile vomiting
What are the types of obstruction? How do they present?
Webs– eccentric thin membranes often in proximal region
Ring: Diaphragm of tissue located in distal esophagus
Schatzki ring: both mucosa/submucosa
Often are asymptomatic
What is a pulsion diverticula?
Diverticulum due to increased intraluminal pressure. Located in proximal/distal esophagus
Secondary to motility disturbances such as achalasia
Describe a traction diverticula
Extrinsic inflammation retracts/pulls bowel outwards
Located in mid esophagus
Less common
Name some of the etiologies of esophagitis
Mechanical (achalasia), reflux, corrosive injuryies, pills/drugs, infections, allergies, radiation, GVHD, systemic disorders
What is mechanism of injury in achalasia?
Injury to myenteric plexus from toxins, trauma, viruses, bacteria, autoimmune
How does achalasia appear on barium swallow?
“Bird’s beak”– dilatation of esophagus with acute tapering at LES and narrowing of GEJ
What is boerhaave syndrome?
Rupture of the esophagus post vomiting due to sudden increase in intraluminal esophageal pressure
What are Mallory-Weirs tears?
Mucosal lacerations in distal esophagus and proximal stomach due to retching, vomiting, straining, coughing (often after heavy alc use)
How does viral esophagitis appear grossly?
On high magnification?
Gross: Shallow punched out ulcers
Histo: Herpes=Multinucleated squamous epithelial cells with intranuclear inclusions. CMV=big cells with nuclear/cytoplasmic inclusions
How does candida esophagitis appear? Both gross and high power.
Gross: Lots of white patches
Histology: pseudo hyphae and budding yeast
How does eosinophilic esophagitis appear on endoscopy?
“Trachealization”– ringed appearance with linear furrows
How does eosinophilic esophagitis present? Eli and symptoms
Epi: Children or adults, males, concurrent with other allergic conditions
Px: feeding difficulty, nausea, vomiting, dysphagia as a result of fibrosis of submucosa
How does scleroderma-caused esophageal sclerosis appear on high power?
Inner circular layer of smooth muscle is not well observed due to deposition of collagenous material– atrophy/fibrosis leads to LES defect, GERD, pulmonary infections
Which esophageal cancer is most common in the Western hemisphere? World wide?
Western hemisphere: adenocarcinoma
Worldwide: Squamous cell carcinoma
Esophageal carcinoma: Epidemiology
Associated with Barrett’s esophagus
RFs: males, age, longstanding reflux, obesity
