Flashcards in EXAM #1: PATHOLOGY OF THE ESOPHAGUS Deck (55):
What is the definition of odnophasia?
What should you think when a patient complains of odnophasia?
What is the pathologic feature of Achalasia?
Failure of relaxation of the LES
What are the symptoms of Achalasia?
What causes Achalasia?
2) Degenerative changes leading to decreased myenteric ganglia
3) Secondary causes
What morphology is seen in Achalasia?
Dilated esophagus proximal to the LES
What are patients with Achalasia at risk for?
4) Diverticula formation
What disease can cause Secondary Achalasia?
(Trypanosoma cruzi --parasite-- that destroys ganglion cells)
List the secondary causes of Achalasia.
1) Chagas Disease
2) Disorders of the vagal dorsal motor nuclei
3) Diabetic neuropathy
4) Infiltration disorders
What are the two types of Hiatal Hernias?
Which of the hiatal hernias is more dangerous?
Paraesophageal--risk of strangulation
What are the symptoms of a hiatal hernia?
What is the definition of a diverticula?
Outpouching of the GI tract
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
Where is a Zenker diverticula?
Proximal--immediately above the UES
Where are Traction diverticula?
Midportion of the esophagus
Where are Epiphrenic diverticula?
Distal--just above the LES
What is the primary presenting symptom of an esophageal diverticula?
What can cause a Traction Diverticula?
Mediastinal lymph nodes in TB "pulling" the esophagus out
What is a Mallory-Weiss tear?
Longitudinal tear at the gastroesophageal junction
What are the common causes of Mallory-Weiss tears?
2) Bulemia nervosa
3) Hyperemesis gravidarum
What happens when there is rupture of a Mallory-Weiss tear?
What is the primary symptom of Mallory Weiss tear?
Outline the anatomy of an esophageal varice.
What are the most common causes of esophageal varices?
What are the symptoms of an esophageal varice?
Non prior to rupture, then rapidly fatal with SEVERE hematemesis
What is esophagitis?
Inflammation of the esophagus
What are the symptoms of esophagitis?
List the specific causes of Esophagitis.
1) Reflux esopagitis
2) Barrett's Esophagus
3) Infections/ chemical causes
4) Eosinophilic esophagitis
What causes reflux esophagitis?
Decreased efficacy of antireflux mechanisms i.e. LES tone
What are the risk factors for GERD?
What is the normal epithelium of the esophagus?
Nonkeratinized stratified squamous epithelium
What is the normal epithelium of the stomach?
Non-ciliated simple columnar epithelium with goblet cells
Describe the progression of the histologic morphology in GERD.
2) Basal zone hyperplasia
3) Elongation of lamina propria papillae
4) Superficial necrosis/ ulceration
What is Barrett's Esophagus?
Replacement of normal distal squamous mucosa with metaplastic columnar epithelium
How much does Barrett's Esophagus increase the risk for carcinoma?
How does Barrett's Esophagus appear grossly?
Velvety salmon spotting above the GE junction
Histologically what is the hallmark of low grade dysplasia in Barett's Esophagus?
"Picket Fence Nuclei"
What marks the progression from dysplasia to carcinoma in Barett's Esophagus?
Invasion of the basement membrane
What does radiation of the esophagus lead to?
Fibrosis (healing) of the esophagus, which can cause dysphagia and impaired peristalsis
In HIV patients, what virus can lead to very painful swallowing?
HSV-1 associated esophageal ulcers
What is the most common cause of esophageal strictures?
Irritation/ trauma and subsequent healing
What foods will patients with esophageal strictures have difficulty with?
What is Scleroderma?
- Autoimmune disease leading to vascular obliteration and fibrosis of smooth muscle
- Major cause of stricture/ dysphagia
What is the most common benign tumor of the esophagus?
Leiomyoma--a tumor of smooth muscle
What are the two most common malignant tumors of the esophagus?
2) Squamous Cell Carcinoma
What is an Adenocarcinoma?
Neoplastic proliferation of glands
What is a Squamous Cell Carcinoma?
Neoplastic proliferation of epithelium
What is the most common cause of cancer in the esophagus worldwide? What about in the US?
What are the risk factors for SCC?
1) Chronic esophagitis
5) Carcinogens in food
What are the clinical features of SCC?
- Late diagnosis
- Progressive dysphagia
- Extreme weight loss
What are the three types of SCC of the esophagus?
3) Evacuated (ulcers)
Where do adenocarcinomas typically arise?
Distal 1/3 of the esophagus
Where do SCCs typically arise?
Middle 1/3 of the esophagus