Esophagus Path Flashcards Preview

Block 7 - GI > Esophagus Path > Flashcards

Flashcards in Esophagus Path Deck (30):
1

What is different about the esophagus than the rest of the gut?

no serosa to help limit spread of tears/rips and cancer

2

What kinds of muscle is the esophagus made of?

upper - mostly skeletal
middle - skeletal and smooth
distal - mostly smooth

3

What are the four layers of the wall of the esophagus?

mucosa - squamous epithelial lining and lamina propria, bordered by muscularis mucosa
submucosa - glands
muscularis propria
adventitia

4

What changes at the gastro-esophageal junction and how is it seen grossly?

squamous lining of esophagus meets glandular of stomach
white/pale tan changes to pink

5

What are the symptoms of esophageal varices?

none unless they bleed - then light headedness, pale, hematemesis, black tarry stools

6

Other than esophageal varices, what are other causes of upper GI bleeding?

gastric and duodenal ulcers
Mallory-Weiss tears
less common - gastric tumors, severe GERD, vascular ectasias

7

What can cause esophagitis?

infections (CMV, Candida)
irritant or corrosive substances
prolonged gastric intubation
XRT or chemo
GERD - most common
allergy (eosinophilic)

8

What are the symptoms of eosinophilic esophagitis?

dysphagia - most common
recurrent food impactions
heartburn
maybe hx of atopy

9

What is the mechanism of eosinophilic esophagitis proposed to be?

corrugated esophagus with concentric mucosal rings found
histamine release from sensitized mast cells - Ach release and contraction of muscularis mucosa

10

What is seen on endoscopic exam of eosinophilic esophagitis?

narrow lumen
circular ridges and longitudinal furrows
dilation of strictures --> tears in mucosa

11

What are the microscopic features of eosinophilic esophagitis?

top heavy distribution of eosinophils

12

What are possible symptoms of reflux esophagitis?

odynophagia and dysphagia
chest pain
erosions and ulcerations of squamous mucosa --> metaplasia = Barrett
nausea after eating
stomach fullness or bloating

13

What causes GERD?

mechanical problems with LES
excess acid/pepsin/bile
slowed gastric clearance
ingestion of irritating substances (smoke, meds)
decreased efficacy of anti-reflux mechanism
ineffective peristalsis

14

What is medical therapy for reflux esophagitis?

PPIs
surgery to tighten LES

15

What is the criteria for a pathologist to diagnose reflux esophagitis?

eosinophils, possible neutrophils, in epithelium (not top heavy distribution like EE)
basal zone hyperplasia (>20% of wall)
papillae elongation (more than 2/3 way up epithelium)

16

What are the potential consequences of severe reflux esophagitis?

fibrosis of esophagus
dysphagia, odynophagia, heartburn and/or slow GI bleeding leading to iron def
barrett

17

What is Barrett esophagus?

replacement of squamous epithelium of distal esophagus with intestinal columnar epithelium, presence of any goblet cells

18

What does Barrett esophagus put you at risk for?

esophageal adenocarcinoma - esp among men with long term reflux who smoke and drink

19

What are the two types of esophageal cancer and where in the esophagus do they occur?

squamous cell - upper 2/3
adenocarcinoma - lower 1/3

20

Which esophageal cancers are increasing and decreasing in prevalence?

SCC decreasing (smoking and alcohol decreasing) - black males
adenocarcinoma increasing (reflux) - white males >50!

21

What are symptoms of esophageal cancer?

dysphagia, odynophagia, weight loss, chest pain radiating to back, hoarseness, coughing, hematemesis, increased risk of aspiration pneumonia

22

Why is esophageal cancer often not diagnosed until late stage?

no symptoms til half of lumen is obstructed - already big tumor

23

What is the microscopic appearance of adenocarcinomas?

arise in glandular epithelium - lumens, cribiforming, papillary growth, mucin production, cohesive cell nests/balls, signet ring forms

24

Where do SCCs arise?

arise in squamous epithelium - native (skin, esophagus, mouth) or metaplastic (endocervix, bronchi)

25

What are the microscopic features of SCC?

disordered cell arrangement, hyperchromasia, high N:C ratio, apoptotic figures, keratin, keratin pearls, desmosomes

26

What is the most important prognostic indicator in esophageal cancer?

STAGE

27

What is the basic survival rate for esophageal cancer?

15%
most pts die w/i 1 yr of diagnosis

28

What are curative treatments for esophageal cancer?

if EARLY - endoscopic mucosal resection, surgical resection, radiation with chemo

29

What are palliative treatments for esophageal cancer??

stent to keep lumen open, feeding gastrostomy, tumor ablation, radiotherapy

30

What are the T designations for esophageal cancer?

T1 - tumor no deeper than submucosa (not seen)
T2 - tumor invades into muscularis propria
T3 - tumor invades adventitia
T4 - tumor invades adjacent structures/organs