Flashcards in EXAM #1: PATHOLOGY OF THE ESOPHAGUS Deck (55)
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1
Q
What is the definition of odnophasia?
A
Painful swallowing
2
Q
What should you think when a patient complains of odnophasia?
A
Infectious cause
3
Q
What is the pathologic feature of Achalasia?
A
Failure of relaxation of the LES
4
Q
What are the symptoms of Achalasia?
A
Progressive dysphagia
5
Q
What causes Achalasia?
A
1) Idiopathic
2) Degenerative changes leading to decreased myenteric ganglia
3) Secondary causes
2) Degenerative changes leading to decreased myenteric ganglia
3) Secondary causes
6
Q
What morphology is seen in Achalasia?
A
Dilated esophagus proximal to the LES
7
Q
What are patients with Achalasia at risk for?
A
1) SCC
2) Aspiration
3) Esophagitis
4) Diverticula formation
5) Obstruction
2) Aspiration
3) Esophagitis
4) Diverticula formation
5) Obstruction
8
Q
What disease can cause Secondary Achalasia?
A
Chagas Disease
(Trypanosoma cruzi --parasite-- that destroys ganglion cells)
(Trypanosoma cruzi --parasite-- that destroys ganglion cells)
9
Q
List the secondary causes of Achalasia.
A
1) Chagas Disease
2) Disorders of the vagal dorsal motor nuclei
3) Diabetic neuropathy
4) Infiltration disorders
2) Disorders of the vagal dorsal motor nuclei
3) Diabetic neuropathy
4) Infiltration disorders
10
Q
What are the two types of Hiatal Hernias?
A
1) Sliding*
2) Paraesophageal
*Most common
2) Paraesophageal
*Most common
11
Q
Which of the hiatal hernias is more dangerous?
A
Paraesophageal--risk of strangulation
12
Q
What are the symptoms of a hiatal hernia?
A
GERD
13
Q
What is the definition of a diverticula?
A
Outpouching of the GI tract
14
Q
What are the three different types of diverticula seen in the esophagus? Which are false and which are true?
A
1) Zenker- False
2) Traction- True
3) Epiphernic- True
2) Traction- True
3) Epiphernic- True
15
Q
Where is a Zenker diverticula?
A
Proximal--immediately above the UES
16
Q
Where are Traction diverticula?
A
Midportion of the esophagus
17
Q
Where are Epiphrenic diverticula?
A
Distal--just above the LES
18
Q
What is the primary presenting symptom of an esophageal diverticula?
A
Halatosis
19
Q
What can cause a Traction Diverticula?
A
Mediastinal lymph nodes in TB "pulling" the esophagus out
20
Q
What is a Mallory-Weiss tear?
A
Longitudinal tear at the gastroesophageal junction
21
Q
What are the common causes of Mallory-Weiss tears?
A
1) Alcoholics
2) Bulemia nervosa
3) Hyperemesis gravidarum
2) Bulemia nervosa
3) Hyperemesis gravidarum
22
Q
What happens when there is rupture of a Mallory-Weiss tear?
A
Booerhave Syndrome
23
Q
What is the primary symptom of Mallory Weiss tear?
A
Hematemesis
24
Q
Outline the anatomy of an esophageal varice.
A
N/A
25
Q
What are the most common causes of esophageal varices?
A
1) Alcoholism
2) Schistosmiasis
2) Schistosmiasis
26
Q
What are the symptoms of an esophageal varice?
A
Non prior to rupture, then rapidly fatal with SEVERE hematemesis
27
Q
What is esophagitis?
A
Inflammation of the esophagus
28
Q
What are the symptoms of esophagitis?
A
Dysphagia
GERD
Hematemesis
Melena
GERD
Hematemesis
Melena
29
Q
List the specific causes of Esophagitis.
A
1) Reflux esopagitis
2) Barrett's Esophagus
3) Infections/ chemical causes
4) Eosinophilic esophagitis
2) Barrett's Esophagus
3) Infections/ chemical causes
4) Eosinophilic esophagitis
30
Q
What causes reflux esophagitis?
A
Decreased efficacy of antireflux mechanisms i.e. LES tone
31
Q
What are the risk factors for GERD?
A
Alcohol
Tobacco
Obesity
Fat-rich diet
Caffeine
Hiatal hernia
Tobacco
Obesity
Fat-rich diet
Caffeine
Hiatal hernia
32
Q
What is the normal epithelium of the esophagus?
A
Nonkeratinized stratified squamous epithelium
33
Q
What is the normal epithelium of the stomach?
A
Non-ciliated simple columnar epithelium with goblet cells
34
Q
Describe the progression of the histologic morphology in GERD.
A
1) Eosinophilia
2) Basal zone hyperplasia
3) Elongation of lamina propria papillae
4) Superficial necrosis/ ulceration
2) Basal zone hyperplasia
3) Elongation of lamina propria papillae
4) Superficial necrosis/ ulceration
35
Q
What is Barrett's Esophagus?
A
Replacement of normal distal squamous mucosa with metaplastic columnar epithelium
36
Q
How much does Barrett's Esophagus increase the risk for carcinoma?
A
30-40x
37
Q
How does Barrett's Esophagus appear grossly?
A
Velvety salmon spotting above the GE junction
38
Q
Histologically what is the hallmark of low grade dysplasia in Barett's Esophagus?
A
"Picket Fence Nuclei"
39
Q
What marks the progression from dysplasia to carcinoma in Barett's Esophagus?
A
Invasion of the basement membrane
40
Q
What does radiation of the esophagus lead to?
A
Fibrosis (healing) of the esophagus, which can cause dysphagia and impaired peristalsis
41
Q
In HIV patients, what virus can lead to very painful swallowing?
A
HSV-1 associated esophageal ulcers
42
Q
What is the most common cause of esophageal strictures?
A
Irritation/ trauma and subsequent healing
43
Q
What foods will patients with esophageal strictures have difficulty with?
A
Solids
44
Q
What is Scleroderma?
A
- Autoimmune disease leading to vascular obliteration and fibrosis of smooth muscle
- Major cause of stricture/ dysphagia
- Major cause of stricture/ dysphagia
45
Q
What is the most common benign tumor of the esophagus?
A
Leiomyoma--a tumor of smooth muscle
46
Q
What are the two most common malignant tumors of the esophagus?
A
1) Adenocarcinoma
2) Squamous Cell Carcinoma
2) Squamous Cell Carcinoma
47
Q
What is an Adenocarcinoma?
A
Neoplastic proliferation of glands
48
Q
What is a Squamous Cell Carcinoma?
A
Neoplastic proliferation of epithelium
49
Q
What is the most common cause of cancer in the esophagus worldwide? What about in the US?
A
Worldwide= SCC
US= Adenocarcinoma
US= Adenocarcinoma
50
Q
What are the risk factors for SCC?
A
1) Chronic esophagitis
2) Alcohol
3) Smoking
4) Achalasia
5) Carcinogens in food
6) HPV
2) Alcohol
3) Smoking
4) Achalasia
5) Carcinogens in food
6) HPV
51
Q
What are the clinical features of SCC?
A
- Late diagnosis
- Progressive dysphagia
- Extreme weight loss
- Progressive dysphagia
- Extreme weight loss
52
Q
What are the three types of SCC of the esophagus?
A
1) Protruding
2) Flat
3) Evacuated (ulcers)
2) Flat
3) Evacuated (ulcers)
53
Q
Where do adenocarcinomas typically arise?
A
Distal 1/3 of the esophagus
54
Q
Where do SCCs typically arise?
A
Middle 1/3 of the esophagus
55
Q
What form of esophageal cancer is associated with a "signet ring" appearance microscopically?
A
Poorly differentiated adenocarcinoma
