Esophagus Pathology Flashcards Preview

MODHIII - Unit 3 > Esophagus Pathology > Flashcards

Flashcards in Esophagus Pathology Deck (50)
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1

Vascular diseases

- esophageal varices

2

Infectious/inflammatory diseases

- achalasia, chemical esophagitis, infectious esophagitis, reflux esophagitis

3

Traumatic diseases

- mallory-weiss syndrome

4

Anatomic diseases (congenital/acquired)

C: atresia, diverticula, fistula, hiatal hernia, rings, stenosis, webs
A: diverticula, fistula, hiatal hernia, rings, stenosis, webs

5

Idiopathic diseases

- achalasia

6

Neoplastic diseases

- adenocarcinoma, barrett's esophagus, benign tumors, squamous cell carcinoma

7

Squamocoloumnar junction (SCJ)

Z line

8

Anatomic gastroesophageal juction (GEJ)

defined as takeoff of gastric fold

9

Relation of SCJ to GEJ

- normally SCJ approximates GEJ

10

Anatomic disease: atresia & fistula

- congenital
- choking, coughing, cyanosis w/ feeding
- amenable to surgical correction

11

Anatomic disease: achalasia

- failure of LES to relax: narrow distal segment, dilated proximal segment
- progressive destruction of myenteric plexus
- dysphagia
- increased risk of carcinoma

12

Achalasia: primary vs. secondary

- primary: idiopathic
- secondary: Chagas disease, scleroderma

13

Anatomic disease: hiatal hernia

- protrusion of stomach above diaphragm
- idiopathic and asymptomatic
- two types: sliding (95%), paraesophageal (rolling-5%)
**PE hernia patients at risk for strangulation (infarction of incarcerated hernia)**

14

Anatomic diseases: diverticula-types

- congenital vs. ACQUIRED
- true (contain all gut layers) vs. FALSE
- PULSION (peristalsis against a closed sphincter) vs. traction (extrinsic pull, secondary to inflammation)

15

Zenker diverticula

- pulsion, from above UES

16

Mid esophageal diverticula

traction

17

Epiphrenic diverticula

- pulsion, from above LES

18

Mallory-Weiss syndrome

- hematemesis from lacerations of GEJ mucosa/submucosa
- caused by forceful retching/coughing/vomiting
- alcoholics, persons with eating disorders

19

Esophageal varices causes

- consequence of portal hypertension

20

Stenosis, Webs, Rings

Web: shelf of tissue, congenital, post inflammation
Ring: circumfrential, example-Schatzki @ SCJ

21

Chemical and pill esophagitis cause

- topical injury due to ingestion of alcohol, corrosive substances (acid,lye), hot liquids
- cytotoxic chemotherapy (radiation, GVHD)
- "stuck" pills: doxycycline (acne), aspirin, iron, alendronate

22

Kissing ulcers

- ulcers facing each other
- seen with doxycycline

23

Infectious esophagitis: who gets it, presentation

- seen in immunocompromised
- ODYNOPHAGIA

24

Infectious esophagitis: causes & presentation

- candida: white plaques
- herpes: numerous punched out ulcers (3 Ms: multinucleation, margination, molding)
- cytomegalovirus: single deep ulcer, "owl's eye"

25

GERD vs. reflux esophagitis (RE)

- GERD: condition that develops when reflux of stomach contents causes troublesome symptoms and or complications
- RE: endoscopic or histologic evidence of reflux associated injury

26

GERD: prevalence, pathophysiology, symptoms

- 10-20% in West,

27

GERD: diagnosis, treatment, complications

- diagnosis: clinical, further testing if not responding to treatment
- treatment: antacids, anti secretory (PPIs), surgical (nissen fundoplication)
- complications: stricture, barrett's esophagus, adenocarcinoma

28

Types of GERD

- erosive: mucosal break (40%)
- non erosive (60%)

29

Histologic features of reflux

- epithelial hyperplasia: basal zone hyperplasia, papillary elongation
- dilated intercellular spaces
- intraepithelial eosinophils

30

Epithelial hyperplasia

- compare height of papillaries and basal zone to entire squamous layer
- normal: PE=50%, BZH=13%
- abnormal: PE=84%, BZH=34%

31

Pathogenesis of heartburn in GERD

- erosive: mucosal breaks allow acid to get through
- non erosive: dilated intercellular spaces allow acid to get through

32

Eosinophilic esophagitis: definition

- clinicopathologic disorder
- >15 intraepithelial eosinophils per high power field
- absence of pathologic GERD: normal pH, lack of response to high dose PPI medication

33

Eosinophilic esophagitis: frequency, symptoms

- frequency: increasingly recognized; 2-27/100,000 over 16 year period
- symptoms include FOOD IMPACTION, dysphagia (adults), GERD, feeding intolerance (children)

34

Eosinophilic esophagitis: diagnosis, treatment, complications

- esophageal symptoms + mucosal biopsy + exclusion of GERD (lack of response to PPI or normal pH monitoring)
- treatment: elimination and elemental diets, acid suppression, TOPICAL CORTICOSTEROIDS, dilatation of strictures
- complications: stricture

35

Endoscopy signs of eosinophilic esophagitis

- trachealization, linear furrowing

36

Histologic features of EoE

- >15 eos/HPF
- eosinophilic MICROABSCESSES, SUPERFICIAL LAYERING, BZH, DIS

37

Barrett's Esophagus: definition

- endoscopically evident apparent columnar mucosa proximal to GEJ
- biopsy demonstrating intestinal metaplasia (GOBLET CELLS)

38

Barrett's esophagus: prevalence, etiopathogenesis, symptoms

- 10% of w/ symptomatic chronic GERD, many asymptomatic, 1.6% of general population
- etiopathogenesis: reflux, inflammation, induction of CDX2, METAPLASIA
- symptoms: GERD, asymptomatic, symptoms may improve in patients who develop BE

39

Barrett's Esophagus: diagnosis

- 2 EGD's with bx within 1 year (confirm dx; rule out PREVALEN DYSPLASIA)

40

Barrett's esophagus: treatment

- PPI for GERD; ENDOSCOPIC ABLATIVE Tx or surgery for dysplasia/carcinoma

41

Surveillance of Barrett's esophagus

- determined by absence or presence of dysplasia, grade of dysplasia

42

Complications of Barrett's esophagus

- adenocarcinoma: 1/200 patients/year (.5%/year), RR=30-60

43

Frequency of surveillance based on grade of dysplasia in BE

- no dysplasia: q 3-5 years
- indefinite for dysplasia: rebiopsy after tx underlying inflammation
- low grade dysplasia: q 6-12 months
- high grade dysplasia: q 3 months

44

Intramucosal carcinoma

- high grade dysplasia
- managed w/ esophagectomy due to 40% "cancer" risk
- 2/3 of these cancers are intramucosal, associated with

45

Categories of esophageal diseases

V: vascular
I: infectious/inflammatory
T: traumatic
A: anatomic
M: metabolic
I: idiopathic
N: neoplastic

46

Presentation of adenocarcinoma

- 95% present with advanced full blown adenocarcinoma rather than presenting and then progressing to it

47

Treatment for adenocarcinoma

- first do chemoradiation
- second do esophagectomy

48

Incidence of esophageal cancer

- increasing at an alarming rate
- due to obesity epidemic

49

Squamous cell carcinoma: gross & histology

- fungating, friable tumor mass
- keratin pearls on histology

50

SCC vs. Adenocarcinoma

- SCC: etiology-tobacco, alcohol, hot beverages; not a major disease in the west
- adenocarcinoma: etiology-GERD, tobacco, obesity; much higher incidence