EXAM #1: PATHOLOGY OF THE ESOPHAGUS Flashcards Preview

Gastrointestinal System > EXAM #1: PATHOLOGY OF THE ESOPHAGUS > Flashcards

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

What form of esophageal cancer is associated with a "signet ring" appearance microscopically?

Poorly differentiated adenocarcinoma