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Body Systems' Pathology > Esophagus and stomach > Flashcards

Esophagus and stomach Flashcards

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1
Q

Characteristics of congenital anomalies

A
  1. most are discovered bc of regurgitation @feeding 🤱🏻
  2. most lesions are incompatible with life without prompt surgery
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2
Q

What is an atresia?

A

functional abnormality where a tubular organ in nature does not have a normal opening or cannot allow material to pass through it; @birth with reflux symptomatology

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3
Q

What is a fistula?

A

abnormal connection between two organs

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4
Q

What are an esophageal atresia and tracheoesophageal fistula ?

A

GI congenital defects where the esophagus + trachea don’t separate normally

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5
Q

👀 symptoms of esophageal atresia and tracheoesophageal fistula

A

Aspiration, suffocation, pneumonia, and severe fluid with electrolyte imbalances.

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6
Q

Types: Esophageal atresia and tracheoesophageal fistula

A
  1. The ends of the esophagus are not connected
  2. Upper end is connected to the trachea
  3. Esophagus is connected to the trachea → broncos speciation with bacteria (infection)
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7
Q

Treatment of esophageal atresia and tracheoesophageal fistula

A

surgery

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8
Q

Omphalocele

A

👀abdominal organs herniate into @umbilical cord

💡defect of the umbilical cord

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9
Q

Gastroschisis

A

🚩herniation of the abdominal organs (intestines) WITHOUT the visceral membrane

👀abdominal organs SLIPs out of the stomach cavity

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10
Q

What is a Meckel diverticulum?

A

outpouching of the ileal wall that communicates w/ lumen + three layers of the bowel wall
→ incomplete obliteration of the vitelline duct.

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11
Q

Meckel’s’ diverticulum rule of 2’s

A

✅2% of population
✅2 feet away from the ileocecal valve
✅ 2 inches long approx
✅ Symptomatic at 2 years old
✅ Twice as common in males
✅ 2 types of ectopic tissue

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12
Q

symptoms, epidemiology, and complications @Meckel diverticulum

A

👀asymptomatic NORMALLY | ♂ > ♀ (2:1)

  • painless lower GI bleeding in children < 2 years

Complications: diverticulitis (abdominal pain), bowel obstruction, and, rarely, peritonitis

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13
Q

Pathogenesis of Meckel diverticulum

A

🚩Incomplete obliteration of theomphalomesenteric duct→ Persistenceof the proximal (intestinal) segment of theduct →Meckel diverticulum

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14
Q

Mucosa in Meckel diverticulum

A

🚩ectopic gastric mucosa or pancreatic tissue → acid or enzyme secretion @diverticulum → ileal ulceration → bleeding
🌟two types of mucosa → native ileal mucosa + ectopic mucosa (em)

💡most common em: acid-producing gastric mucosa (∼ 60%); pancreatic, colonic, and duodenal mucosa

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15
Q

Symptoms of esophagitis

A

👀 dysphagia (difficulty swallowing) + odynophagia (pain while swallowing)

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16
Q

What is the gastroesophageal reflux disease?

A

A condition in which reflux causes troublesome symptoms (heartburn or regurgitation) and/or esophageal injury/complications

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17
Q

What is Barrett’s esophagus?

A

A result of chronic mucosal inflammation: abnormal healing process + change in the cellular structure of your esophagus lining

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18
Q

Reflux esophagitis GERD 🔥
What happens, why, and signs

A

stomach contents flow back into the esophagus
?¿ why ?¿ ← incompetent barriers @esophageal junctures
👀signs: heartburn, regurgitation with acid taste, chronic cough

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19
Q

pathogenesis of GERD

A

🚩chronic exposure to gastric juices → impares reparative capacity @esophageal mucosa → irritation of the mucosa

🌟irritation caused by gastroesophageal reflux → “schatzki rings” / red islands/ red erosions/ erosive patches

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20
Q

What do transient Lower Esophageal Sphincter Relaxations (TLESR) lead to?

A

GERD

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21
Q

What are the risk factors of GERD?

A

Obesity, tobacco and alcohol 🚬, pregnancy 🤰🏻, hiatal hernia, delayed gastric emptying, and increased age 🧓🏻

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22
Q

Causes of GERD

A
  1. Hiatal hernia: tone is not working ← deficiency in the hiatus → hernia (displacement where the stomach is in the thorax cavity)
    1. babies ~10% with Barret
    2. adults ~ 40-60 years old
    3. esophageal adenocarcinoma ← cancer precursor
  2. Secretion of gastric acids in the esophagus (adults)
  3. Secretion of biliary and duodenal @stomach due to the diet (adults)
  4. Infection !! (adults)
    1. pyrosis + dysphagia + regurgitation with an acid taste → → Barrett’s esophagus (no going back)
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23
Q

complications of GERD

A

Barrett’s Esophagus, ulceration @epithelium, hematemesis, melana (blood @feces), stenosis

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24
Q
A

Schatzi rings

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25
Macroscopic histology
Multiple hyperemic/red erosions within the squamous lined esophagus epithelium that overpasses the esophagogastric junction
26
Microscopic histology
- Vascular congestion, **++ eosinophils**, papillomatosis, *hyperplasia @basal layer* (20%), - Basal hyperplasia, papillary elongation, intercellular space dilation, intraepithelial ***eosinophils*** + ***neutrophils***
27
What can you see in this slide and pathology?
- intraepithelial eosinophils + neutrophils - GERD
28
Treatment of GERD
Proton pump inhibitors or histamine receptor antagonists
29
Morphology of GERD @robbins
30
What is Barrett's esophagus?
💡 *complication* of GERDs’ ~10% 💡 intestinal **metaplasia** @esophageal squamous mucosa + **⚠️ esophageal adenocarcinoma** 🌟 stratified squamous epithelium → simple columnar epithelium
31
Causes of Barrett's esophagus
🌟 **causes**→ alcohol, tabaco, obesity, pregnancy, **hernia hiatal**, ⬆️ gastric volume 🚩 gastroesophageal reflux esophagitis → inflammation → **Barrett's esophagus**
32
classification of Barrett's esophagus
1. Low grade dysplasia → ultra short segment z-line < 1 cm 2. Displasia de alto grado→ short segment z-line < 3 cm 3. **Adenocarcinoma** → p53 long segment z-line > 3 cm
33
Diagnosis of Barrett's esophagus
- endoscopy and histopathology - dx with goblet cell !! | alcine blue
34
Complications of Barrett's esophagus
ulcers + hematemesis + melena + asthma + aspiration pneumonia + laryngeal polyps/stenosis
35
physiopathology of Barrett's esophagus
🚩 ⬆️ gastroesophageal reflux + inflammation + RAS + hedgehog **→ →** 1. you don’t work —| 💤 **~~p63~~** ****“tu vas a ser una cel. plana estratificada”** 2. ahora serás → ⬆️ **SOX2** “**tu vas a ser una cel. cilíndrica**” 3. agregale moco para resistir → **CDX2 “ahora produce moco”** - 🔬 **moco neutro @**foveolas de un esófago normal← **tinción PAS** - 🔬 **moco *ácido* @**células caliciformes ← **azul alciano** → inflamación → **esofago de barret**
36
Microscopic histology
- Simple columnar epithelium: **tall/elongated cells** with **basally oriented nuclei**, - Goblet cells: **round with pale blue cytoplasm** (acid mucin) w/ nucleus @periphery of the cell 🌟 **Barret's Esophagus**
37
Macroscopic histology
Tongues or papillae and islands of red metaplastic mucosa above the GE junction (Lenguetas) 🌟 **Barret's Esophagus**
38
Dysplasia in Barret's esophagus
💡 Gland cells @Barrett's esophagus → ***abnormal over time*** 🌟 Dysplasia is a pre-cancer
39
Microscopic histology
- **Atypical mitosis** - **Nuclear hyperchromasia** - **Elongated nuclei** (chromatin irregularity) - **Nuclear stratification /crowding** - Irregular back-to-back glands with cellular crowding (adenocarcinoma) (**⬆️ nucleo-cytoplasmic ratio**) 🌟 Loss of goblet cells via altered gland architecture → *budding, irregular shapes, and cellular crowding* -Esophagus dysplasia
40
Classification of esophageal dysplasia
- Low grade: cytological atypia but little to no architectural atypia - High grade: ↑↑ cytologic atypia and architectural abnormalities—dysplastic epithelial cells limited @basement membrane
41
Follow-up of esophageal dysplasia
1. with no dysplasia: 1 year follow up → no dysplasia in 5 years we'll see 2. low grade: 1 year follow-up every year until the dysplasia leaves 3. high grade: surgical removal
42
Displasia @robbins
43
🌟 Malignant tumors of the esophagus
✅ asymptomatic on early staged 🏥 Evidence with metastasis
44
They are the two most common esophageal malignant tumors
squamous carcinoma 🥇 & adenocarcinoma 🥈
45
Risk factor of esophageal malignant tumors
smoking 🚬 , years >60 old 👴🏻, and achalasia (defective smooth muscles of the lower splinter)
46
General life expectancy and treatment squamous of carcinoma 🥇 & adenocarcinoma 🥈
💡 life expectancy of 5 years: <10% 💡treatment: surgery w/or quimio-radiotherapy
47
Benign tumors of the esophagus
Mesenchymal & arise within the esophageal wall; leiomyomas 🥇
48
Adenocarcinoma 🥈
🥈 second most common 🌟 ***neoplastic progression of Barrett's esophagus and long standing GERD***
49
Physiopathology of an adenocarcinoma
📍lower ⅓ of the esophagus + esophagogastric junction 🚩 longggg progression of Barrett's esophagus ← acquisition of **genetic** + **epigenetic** changes → **↑↑** p53, amplification 💪🏻 of c-ERB-B2, Cyclin 1, Cyclin E + *silencing* of *~~p16~~* 🧬 early stages:  ***TP53*** and ***CDKN2A*** (suppression genes) → **CDKN2A**: p16 + p19-ARF (tumor suppressor proteins) 🧬 high grade dysplasia + adenocarcinoma: ***TP53*** and ***SMAD4*** 🧬 later on: *EGFR, ERBB2, MET, cyclin D1,* and *cyclin E* genes
50
Etiology and progression of an adenocarcinoma
***etiology***: columnar glandular epithelium GERD → barrett's esophagus→ dysplasia → adenocarcinoma
51
Risk factors and protectors of an adenocarcinoma
52
Symptoms of an adenocarcinoma
👀 pain or difficulty swallowing 💥, progressive weight loss 🧍🏻, hematemesis 🩸🤮, chest pain 💢 , or vomiting 🤮
53
Macroscopic histology
🌟 adenocarcinoma 🌟 - **Last third of the esophagus** ~ *may invade gastric cardias* - **Dark mass** surrounded by Barrets obscure mucosa
54
Microscopic histology
🌟 adenocarcinoma 🌟 - **Big intestinal GLANDS** w/ mucin production - well-or-moderately differentiated - well-formed tubular or papillary structures - **Back to back irregular glands with dysplasia** - Signet-ring cells (not common; poor diagnosis)
55
Signet-ring cells
56
🌟 adenocarcinoma 🌟
57
Squamous carcinoma 🥇
🥇 most common 🌟 classical squamous carcinoma @middle third 🌟 *malignant epithelial tumor w/ squamous cell differentiation ← keratinocyte type cells @intercellular bridges or keratinization*
58
Squamous carcinoma general info
🌟 years > 50 old🧍🏻‍♂️; **♂️** 4:1 ♀️; ↑ afro-americans 🌎 survival rate of 9% 💡superficial affectation: ~75% 5 years survival rate
59
Physiopathology @squamous carcinoma
🚩  risks factors exposure (e.g. tobacco, alcohol) → esophageal epithelium → restorative measures (e.g. ↑↑ cell proliferation) 🔃 repetitive exposure → ↑↑ genetic abnormalities → **carcinoma** 🧬 Amplification 💪🏻 of transcription factor gene **SOX2** **(stem cell self-renewal; “**tu vas a ser una cel. cilíndrica**”) 🧬 **↑↑** cell cycle regulator cyclin **D1**, **↓↓** loss-of-function mutations @~~TP53~~, ~~CDH1~~ (E-cadherin), and ~~NOTCH1~~
60
Risk factors @squamous carcinoma
Dietary deficiency in fruits or vegetables, alcoholism 🍺 (⬆️ permeability @GI tract), tobacco 🚬, drinking hot beverages ☕🌡️, vitamin deficit, genetic cancer, radiation, HPV, poverty, achalasia, Plummer-Vinson syndrome, polycyclic hydrocarbons, and nitrosamines
61
Etiology @squamous carcinoma
***etiology***: squamous epithelium normal squamous mucosa **→** low grade intraepithelial neoplasia (squamous dysplasia) **→** high grade intraepithelial neoplasia **→** **invasive squamous cell carcinoma** 😈
62
classification @squamous carcinoma
📝 Grading → degree of cytological atypia, mitotic activity and presence of keratinization 🌟 Grade 1 (well differentiated): - Contains enlarged cells with abundant eosinophilic cytoplasm and keratinization - Cytological atypia is minimal and the mitotic rate is low - Invasive margin is pushing and the cells remain well ordered 🌟 Grade 2 (moderately differentiated): - Has evident cytological atypia and the cells are less ordered - Mitotic figures are easily identified 🌟 Grade 3 (poorly differentiated): - Consists predominantly of basal-like cells forming nests with or without central necrosis
63
Symptoms @squamous carcinoma
👀 dysphagia (difficulty swallowing) 😓, odynophagia (pain on swallowing) 💥, or gradual obstruction 🪨, weight loss 🧍🏻, and debilitation

Body Systems' Pathology (1 decks)

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