GIT, Oral Cavity and Esophagus Path 1

Question 1

what is achalasia?

Answer 1

• absence of relaxation;

it is a FUNCTIONAL esophageal obstruction due to partial or incomplete relaxation of the LES (lower esophageal sphincter)

Question 2

what are some differences between oral leukoplakia and oral hairy leukoplakia

Answer 2

• dysplasia is seen in oral leukoplakia but NOT in oral hairy leukoplakia
• oral leukoplakia has malignant potential but oral hairy does not
• oral Leukoplakia is associated with HPV while oral hairy is HIV + EBV

Question 3

what infections are associated with Oral hairy Leukoplakia

Answer 3

• almost always seen only in patients with HIV who have a superimposed infection with EBV

Question 4

esophageal varices is the cause of death in 50% of patients with ______

Answer 4

advanced cirrhosis; esophageal varicies is associated with portal hypertension

Question 5

dilation above the LES is seen in ______

Answer 5

achalasia

Question 6

tracheal esophageal fistula is commonly associated with _____

Answer 6

esophageal atresia; the fistula occurs distal to the atresia

Question 7

what are 3 common biopsy findings in someone with reflux esophagitis that are due to reactive changes

Answer 7

• basal zone hyperplasia
• elongation of lamina propria papillae (due to the basal zone hyperplasia)
• hyperemia: dilated blood vessels in mucosa

Question 8

what is the triad of symptoms in Plummer Vinson Syndrome?

Answer 8

• esophageal webs
• glossitis
• iron deficiency anemia: koilonychia and splenomegaly

Question 9

achalasia is associated with increased risk for ______ carcinoma

Answer 9

squamous cell

Question 10

what are some secondary causes of achalasia (psudoachalasia)

Answer 10

• Chagas disease
• diabetic autonomic neuropathy
• malignancy, amyloidosis, sarcoidosis
• Down syndrome

Question 11

“serpingous salmon colored path” in the esophagus is used to describe ______

Answer 11

Barrett’s esophagus

Question 12

describe the epithelial cells in esophageal webs?

Answer 12

• upper: squamous mucosa with vascularized core

- only covered by mucosal epithelium

Question 13

_____ infection is associated with oral leukoplakia

Answer 13

HPV

Question 14

what are esophageal webs and rings?

Answer 14

protrusions of mucosa into the lumen

webs: upper
rings: lower

Question 15

what is the most common malignant neoplasm in the esophagus?

Answer 15

worldwide: squamous cell

US and Africa: adenocarcinoma

Question 16

what are the requirements for diagnosing someone with Barrett’s esophagus

Answer 16

• columnar mucosa AND goblet cells in histology (intestinal type of columnar epithelium)
• presence of dysplasia

Question 17

describe the epithelial cells in esophageal rings?

Answer 17

• Lower: undersurface have columnar epithelium and covered by mucosal AND submucosal epithelium

Question 18

in achalasia, the resting tone of the LES is ______

Answer 18

↑

Question 19

what are 3 growth patterns of squamous cell carcinoma of the esophagus?

Answer 19

• exophytic (narrows lumen)
• diffusely infiltrative
• ulcerated/excavated

Question 20

describe the metastasis of barrel’s esophagus

Answer 20

esophageal squamous mucosa → metaplastic columnar epithelium with goblet cells (like those in the intestine)

due to proliferation of stem cells for healing which then differentiate into columnar cells because they are resistant to peptic acid

Question 21

SCC of the esophagus can direct spread to: (2)

Answer 21

adjacent mediastinal structures:

• trachea
• heart

Question 22

what are some infectious causes for infectious esophagitis?

Answer 22

• fungal: candida

- viral: CMV and herpes (both are AIDS defining illnesses)

Question 23

what is a pathognomonic finding in biopsy for reflux esophagitis?

Answer 23

presence of intraepithelial (squamous epithelium) inflammatory cells: eosinophils, neutrophils and lymphocytes

usually wont see the in the epithelial layer

Question 24

“layers of keratitis squares over underlying mucosal acanthosis (hyperkartotic)”

Answer 24

• oral hairy leukoplakia which is hyperkeratotic thickenings
• all layers of the squamous epithielium is undergoing hyperplasia

Question 25

the loss of ________ innervation of the _____ is a common cause of primary achalasia

Answer 25

loss of inhibitory innervation of the LES

Question 26

longitudinal _______ tears at the ________ is seen in Mallory Weiss Syndrome

Answer 26

longitudinal mucosal tears in the esophagogastric junction most often limited to the mucosa and heal by themselves

Question 27

squamous cell carcinoma of the esophagus most commonly occurs in ________

Answer 27

middle 1/3

Question 28

describe the white patches seen on oral leukoplakia

Answer 28

well defined what patch or plaque that cannot be removed by scarping and is found on the buccal mucosa, tongue or floor of the mouth

Question 29

↓ in LES tone is seen in _____

Answer 29

GERD (reflux esophagitis) ↑ tone is seen in achalasia

Question 30

what are some complications of reflux esophagitis

Answer 30

- bleeding - strictures (due to fibrosis from inflammation) - aspiration pneumonitis: reflux contents during sleep can go up tot he esophageal trachea junction and go into lungs - Barrett's esophagus and adenocarcinoma

Question 31

dysphagia to mainly liquids and/or both solids and liquids is seen with ______

Answer 31

achalasia

Question 32

dysphagia to solids → liquids is seen with which upper GI condition

Answer 32

adenocarcinoma

Question 33

arrange the following in order of least to most malignant potential: - oral leukoplakia, oral hairy leukoplakia, erythroplakia

Answer 33

oral hairy > oral > erythroplakia

Question 34

white patches in the mouth that are easily scraped out is most likely ______

Answer 34

candidiasis

Question 35

_______ has white patch or plaques that CANNOT be removed by scraping

Answer 35

Oral Leukoplakia

Question 36

Barrett's esophagus is a precursor lesion for ______

Answer 36

adenocarcinoma

Question 37

what are some associations with oral leukoplakia

Answer 37

- tobacco use - chronic friction such as from ill fitting dentures - HPV infection

Question 38

adenocarcinoma occurs in the ______ part of the esophagus

Answer 38

lower 1/3 | - most common in white men

Question 39

histologic hallmark of eosinophilic esophagitis is abundant eosinophils in squamous layer due to ______

Answer 39

allergies (moves distal → proximal)

Question 40

what are some primary causes of achalasia?

Answer 40

- loss in intrinsic INHIBITORY innervation of the LES → absence of relaxation - loss or absence of ganglion cells in the myenteric plexus

Question 41

esophageal atresia is commonly associated with what other abnormality?

Answer 41

tracheo-esophageal fistula

Question 42

Plummer Vinson syndrome has a high risk for _________ carcinoma of the esophagus

Answer 42

squamous cell carcinoma of the upper esophagus and lower pharynx

Question 43

______ is a premalignant lesion to _______ that can be caused by reflux esophagitis

Answer 43

Barret's esophagus → adenocarcinoma

Question 44

discuss the malignant potential of oral leukoplakia and oral hairy leukoplakia

Answer 44

- oral hairy leukoplakia DOES NOT have malignant potential | - oral leukoplakia has small malignant potential

Question 45

hematemesis due to _________ is usually painless

Answer 45

esophageal varices

Question 46

what are some infections that are commonly seen in esophagitis

Answer 46

- HSV, CMV and candidiasis

Question 47

what inflammatory molecules can you find in the biopsy of someone with reflux esophagitis?

Answer 47

- eosinophils - neutrophils - lymphocytes

Question 48

what would you seen on a H&E slide of a biopsy of a white plaque seen with oral leukoplakia

Answer 48

- dysplasia (can progress to squamous cell)