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