Lec 2 Flashcards by Anna Cushing

What is the order of layers from in to out of esophagus?

mucosa
muscularis mucosa / submucosa
muscularis propria

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What structures are in esophagus submucosa?

veins, nerves [meissner’s plexus], salivary glands, elastic fibers

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What is the z line?

the line demarcating esophagus from stomach

esophagus = shinier, lighter color
stomach = not shiny, not squamous

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What is an especially dangerous cause of chemical esophagitis

alkalis = odorless and tasteless + rapid injury

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What is effect of akalis on esophagus short and long term?

immediately = necrosis, saponification, perforation

long term = chronic ulcer, stricture, squamous cell carcinoma

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How do pills cause esophagitis?

during sleep pill sandwiched in collapsed esophagus w/ no secretions

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What are “kissing ulcers” a sign of?

sign of esophagitis due to pill

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What are some chemical causes of esophagitis?

alkalis
pills taken at night
bisphosphonates

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What does candida esophagitis suggest?

early sign of immunocompromised states

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What do you see on endoscopy with candida esophagitis?

whitish plaques

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What does CMV esophagitis indicate?

immunocompromised state

- indicates viremia [esophagus not usually involved alone]

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What cells does CMV infect?

mesenchymal cells [endothelial, fibroblasts, myocytes]

NOT squamous cells

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What cells does herpes infect?

squamous cells

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What is the mucosal lining of the esophagus?

stratified squamous not normally keratinized

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Who gets esophageal varices?

patients with portal hypertension

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What is structure of muscularis propria?

2 muscle layers with myenteric nerve plexus sandwiched between

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Is esophagus smooth or skeletal?

upper 1/3 skeletal; bottom 2/3 smooth

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What 3 things do you see microscopically with HSV esophagitis?

cell cell detachment
multinucleation
ground glass nuclei

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What are symptoms of infectious esophagitis?

odynophagia = painful swallowing

Should you biopsy from ulcer or squamous epithelium to find CMV? What about herpes?

ulcer to find CMV

normal squamous epithelium to find herpes

What are risk factors for reflux esophagitis?

LES incompetence [due to hernia, drug, food, scleroderma]
high ab pressure [obesity, pregnancy]
reduced saliva [smoking]
bulimia

What substance cause injury to esophagus in reflux esophagitis?

gastric acid
pepsin
duodenal contents [trypsin, bile]

What do you see under microscope in reflux esophagitis?

dilated capillaries
edema
ballooning of squmaous cells
eosinophils, neutrophils
increased height of basal cell zone

What is eosinophilic esophagitis? treat?

infiltration of eosinophils in esophagus in person w/ allergy

treat by dietary restriction and steroids –> GERD therapies won’t work

What are symptoms of eosinophilic esophagitis?

dysphagia, food impaction

What is pathogenesis of eosinophilic esophagitis?

IgE and cell mediated injury

Where in esophagus can you get eosinophilic esophagitis? GERD?

EoE = pan esophageal GERD = distal esophagus usually

What age group gets EoE? GERD?

children and adults get EoE usually just adults get GERD

What stain can you use to pick up goblet cells?

alcian blue

How fast is progression of barrett's to cancer?

very slow progression takes many years

How do you diagnose barrett's esophagus?

do endoscopy + biopsy --> can't visualize dysplasia just by endoscopy need to do biopsy

What factors increase risk of barrett adenocarcinoma?

- duration of BE - length of Barrett segment - dysplasia - genetics

What is treatment of barretts esophagus?

surgical or by local ablation

Who usually gets barretts adenocarcinoma?

middle age white males

What are symptoms of barretts adenocarcinoma?

progressive dysphagia + weight loss

What is 5 year survival of barretts adenocarcinoma?

15-20%

Is squamous or adenocarcinoma of esophagus more common?

squamous is more common world wide | adenocarcinoma is more common in the US

Who is at risk for squamous cell carcinoma of esophagus?

in underdeveloped regions: dietary deficiencies, indoor coal burning industrialized: alcohol, smoking other: achalasia, lye stricture, celiac

Who gets squamous cell carcinoma?

``` males > females age > 50 smoking + alcohol urban environments more in african americans ```

What does squamous cell esophageal carcinoma look like grossly?

mid or distal esophagus invades surrounding organs and lymph nodes tumor tissue grey and cheesy due to keratin content

What are micro features of squamous cell esophageal carcinoma?

- vaguely resembles normal squamous epithelium - invasive pattern - polygonal cells arranged in sheets - lots of pink cytoplasm - if well differentiated have intercellular bridges and keratin pearls

Is sliding or rolling hiatal hernia more common?

sliding ?90%

What are esophageal webs and rings?

- fibromucosal membranes that project into lumen upper esophagus = web lower esophagus = ring

What is plummer-vinson syndrome?

triad of dysphagia [due to esophageal webs], iron deficiency anemia], and glossitis

What is mallory weis syndrome?

longitudinal tear across esophagogastric junction due to severe vomitting; leads to hematemesis usuually in bulemia and alcoholics