EXAM #1: PATHOLOGY OF THE ESOPHAGUS Flashcards Preview

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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
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
8
Q
What disease can cause Secondary Achalasia?
A
Chagas Disease

(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
10
Q
What are the two types of Hiatal Hernias?
A
1) Sliding*
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
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
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
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
29
Q
List the specific causes of Esophagitis.
A
1) Reflux esopagitis
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
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
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
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
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
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
51
Q
What are the clinical features of SCC?
A
- Late diagnosis
- 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)
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