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Flashcards in GI: Esophagus Deck (57)
1

What is the breakdown of muscle distribution in the esophagus?

upper 1/3 = striated muscle
lower 2/3 = smooth muscle

2

Define achalasia

related to partial of incomplete relaxation of the LES resulting in dilated esophagus and birds beak deformity on barium swallow

3

What autoimmune can lead to esophageal dysmotility?

scleroderma

4

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)

5

What is the medical emergency that is associated with massive hematemesis following retching and vomiting?

Boerhaave Syndrome

6

Esophageal varices are commonly associated with __________ and _____________

cirrhosis and portal hypertension

7

What is the one main histological criteria for Barrett's esophagus?

goblet cells (intestinal metaplasia)

8

What are the 2 viruses associated infectious esophagitis?

CMV
HSV

9

What fungus is associated with infectious esophagitis?

candida

10

What is the epithelium subtype of the esophagus?

stratified non-keratinized squamous epithelium (barrier to blood absorbing things from food)

11

_______ has squamous epithelium while __________ has columnar epithelium

esophagus, gastrum

12

Define atresia

a thin cord-like non-canalized segment of esophagus associated with proximal blind pouch and lower pouch leading to the stomach

13

What is an esophageal fistula?

communication between trachea and esophagus

14

What does the most common TE fistula look like?

esophagus is connected to the end of the trachea

15

TE fistulas are commonly associated with _________

cardiac abnormalities

16

What is the prognosis for TE fistulas?

100% survival in the absence of other abnormalities (surgically repaired)

17

When does congenital pyloric stenosis present?

2-6 weeks old

18

What are the 3 identifying characteristics of achalasia?

1) anti-peristalsis
2) relaxation of LES with swallowing
3) increased resting tone of LES

19

What is the cause of primary achalasia?

UNKNOWN, idiopathic

20

What are some secondary causes of achalasia?

chagas
polio
surgical ablation
diabetes
sarcoid
malignancy
amyloid

21

bird's beak sign on barium swallow is associated with ____________

achalasia

22

What are some of the complications of achalasia?

- 5% develop SCC
- candida
- diverticula
- aspiration pneumonia

23

histologically, ___________ ____ __________ _________ is associated with achalasia

inflammation of the myentereic plexus

(destroying the nerve cells causing problems with peristalsis)

24

Scleroderma leads to atrophy of what part of the esophagus?

smooth muscle in the lower 2/3 of the esophagus

(leading to dysphagia)

25

Define hiatal hernia

separation of diaphragmatic crura and widening of space between muscular crura and esophageal wall

26

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)

27

______________ is a predisposing factor for mallory weiss tears

hiatal hernias

28

mallory weiss tears only affect which layers of the esophagus?

mucosa and submucosa

29

What are some complications of mallory weiss tears?

reflux, ulcerations, painful vomiting

30

Why do mallory weiss tears not require surgical repair?

because they only affect the mucosa and submucosa, not the muscular layer

31

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

32

What are the 2 medical emergencies associated with the esophagus?

1) esophageal varices
2) boerhaave syndrome

33

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

34

Boerhaave is associated with what kind of lung disease?

subcutaneous emphysema
pneumomediastinum

35

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

36

What does reflux esophagitis look like on scoping?

redness, mucosal breaks

37

What are the 3 causes of infectious esophagitis?

1) fungal (candida)
2) viral (CMV, HSV)

38

What are the layers of the esophagus?

squamous epithelium
lamina propria
muscularis
submucosa
outer muscular layers

39

What is the hallmark of candida infection of the esophagus?

pseudomembrane formation

40

What does herpes simplex virus infection look like in the esophagus?

punched out ulcers

molding of nuclei
multinucleation (more than 1 nuclei)
marginization

41

What is the hallmark of CMV infection?

owl eye inclusions

42

What is eosinophilic esophagitis

not sure? more commonly occurs in kids (GERD like symptoms)

see lots of eosinophils

43

What does chemical or pill induced esophagitis look like on endoscopy?

well defined border (very red) and see edema

44

List the histological clues associated with the various forms of esophagitis

infectious: pseudomembranes, cytopathic changes
chemical/pill: edema
reflux: inflammation and reactive changes
eosinophilic: lots of eosinophils

45

What is the single most important risk factor for adenocarcinoma?

Barrett's esophagus (30-40x rate)

46

what percentage of people with GERD develop barretts?

10%

47

What does Barrett's look like on endoscopy?

salmon/red velvet colored mucosa (columnar epithelial lining)

long segment > 3cm
short segment

48

What is the histologic evidence of intestinal metaplasia?

goblet cells

49

Barrett's ---> low grade dysplasia ---> high grade --> __________

adenocarcinoma

50

True or false: SCC is the most common cancer worldwide

TRUE

51

What are some clinical symptoms of SCC?

change diet from solids to liquids

52

What things can cause SCC?

hot tea, alcohol, smoking, achalasia, webs, p53 mutations, etc

53

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

54

What are the diagnostic histological features of SCC?

keratin pearls

55

What are the early changes leading to adenocarcinoma?

p53 mutation
allelic loss of cyclin

56

What are the later changes in adenocarcinoma?

amplification of c-ERB and cyclin

57

Adenocarcinoma is associated with ____________ and _________ while SCC is associated with ____________ and __________.

obesity and Barrett's

smoking and heavy alcohol use