Flashcards in GI: Esophagus Deck (57)
What is the breakdown of muscle distribution in the esophagus?
upper 1/3 = striated muscle
lower 2/3 = smooth muscle
related to partial of incomplete relaxation of the LES resulting in dilated esophagus and birds beak deformity on barium swallow
What autoimmune can lead to esophageal dysmotility?
What are the 2 most common types of malignancies associated with the esophagus and what are the risk factors for them?
1) squamous cell carcinoma (alcohol and tobacco)
2) adenocarcinoma (barrett's esophagus, tobacco, and obesity)
What is the medical emergency that is associated with massive hematemesis following retching and vomiting?
Esophageal varices are commonly associated with __________ and _____________
cirrhosis and portal hypertension
What is the one main histological criteria for Barrett's esophagus?
goblet cells (intestinal metaplasia)
What are the 2 viruses associated infectious esophagitis?
What fungus is associated with infectious esophagitis?
What is the epithelium subtype of the esophagus?
stratified non-keratinized squamous epithelium (barrier to blood absorbing things from food)
_______ has squamous epithelium while __________ has columnar epithelium
a thin cord-like non-canalized segment of esophagus associated with proximal blind pouch and lower pouch leading to the stomach
What is an esophageal fistula?
communication between trachea and esophagus
What does the most common TE fistula look like?
esophagus is connected to the end of the trachea
TE fistulas are commonly associated with _________
What is the prognosis for TE fistulas?
100% survival in the absence of other abnormalities (surgically repaired)
When does congenital pyloric stenosis present?
2-6 weeks old
What are the 3 identifying characteristics of achalasia?
2) relaxation of LES with swallowing
3) increased resting tone of LES
What is the cause of primary achalasia?
What are some secondary causes of achalasia?
bird's beak sign on barium swallow is associated with ____________
What are some of the complications of achalasia?
- 5% develop SCC
- aspiration pneumonia
histologically, ___________ ____ __________ _________ is associated with achalasia
inflammation of the myentereic plexus
(destroying the nerve cells causing problems with peristalsis)
Scleroderma leads to atrophy of what part of the esophagus?
smooth muscle in the lower 2/3 of the esophagus
(leading to dysphagia)
Define hiatal hernia
separation of diaphragmatic crura and widening of space between muscular crura and esophageal wall
What are the two types of hiatal hernias?
1) sliding (entire stomach pushes up - get reflux symptoms)
2) paraesophageal (rolling) LES still in place, no reflux symptoms)
______________ is a predisposing factor for mallory weiss tears
mallory weiss tears only affect which layers of the esophagus?
mucosa and submucosa
What are some complications of mallory weiss tears?
reflux, ulcerations, painful vomiting
Why do mallory weiss tears not require surgical repair?
because they only affect the mucosa and submucosa, not the muscular layer
What is the prognosis for esophageal varices once they rupture?
BAD 50% die from first bleed and 50% of survivors will bleed again within a year
What are the 2 medical emergencies associated with the esophagus?
1) esophageal varices
2) boerhaave syndrome
What is Boerhaave syndrome and why is it a medical emergency?
transmural rupture of esophagus (affects all layers and leads to severe vomiting and bleeding)
FATAL without surgical treatment
Boerhaave is associated with what kind of lung disease?
What are some causes of reflux esophagitis?
- decreased efficacy of LES
- sliding hiatal hernia
- slowed esophageal clearance of reflux material
- delayed gastric emptying and increased gastric volume
What does reflux esophagitis look like on scoping?
redness, mucosal breaks
What are the 3 causes of infectious esophagitis?
1) fungal (candida)
2) viral (CMV, HSV)
What are the layers of the esophagus?
outer muscular layers
What is the hallmark of candida infection of the esophagus?
What does herpes simplex virus infection look like in the esophagus?
punched out ulcers
molding of nuclei
multinucleation (more than 1 nuclei)
What is the hallmark of CMV infection?
owl eye inclusions
What is eosinophilic esophagitis
not sure? more commonly occurs in kids (GERD like symptoms)
see lots of eosinophils
What does chemical or pill induced esophagitis look like on endoscopy?
well defined border (very red) and see edema
List the histological clues associated with the various forms of esophagitis
infectious: pseudomembranes, cytopathic changes
reflux: inflammation and reactive changes
eosinophilic: lots of eosinophils
What is the single most important risk factor for adenocarcinoma?
Barrett's esophagus (30-40x rate)
what percentage of people with GERD develop barretts?
What does Barrett's look like on endoscopy?
salmon/red velvet colored mucosa (columnar epithelial lining)
long segment > 3cm
What is the histologic evidence of intestinal metaplasia?
Barrett's ---> low grade dysplasia ---> high grade --> __________
True or false: SCC is the most common cancer worldwide
What are some clinical symptoms of SCC?
change diet from solids to liquids
What things can cause SCC?
hot tea, alcohol, smoking, achalasia, webs, p53 mutations, etc
Where is SCC normally found in the esophagus?
middle > upper third
upper 1/3 --> cervical lymph nodes
middle 1/3 --> mediastinal/tracheobronchial nodes
lower 1/3 --> celiac and gastric nodes
What are the diagnostic histological features of SCC?
What are the early changes leading to adenocarcinoma?
allelic loss of cyclin
What are the later changes in adenocarcinoma?
amplification of c-ERB and cyclin