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GI Week 2 > Lecture 7: Esophagus and Stomach Histology > Flashcards

Lecture 7: Esophagus and Stomach Histology Flashcards

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1
Q

What is the first part of the GI tract according to Furth?

A

The brain

Thinking about the eating activates shit

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2
Q

What is the function of stomach and function?

A
  1. motility
  2. barrier
    Stomach = breakdown, hormone production and intrinsic factor
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3
Q

What is the epithelium of esophagus?

A

Stratified squamous

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4
Q

What type of epithelium lines the FETAL esophagus? Significance?

A

Ciliated COLUMNAR
Same epithelium as the trachea so it shows the common derivation of trachea and esophagus
Tracheo-esophageal fistulas then can occur

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5
Q

Where is the last place that you can find salivary glands?

A

Esophagus

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6
Q

What types of glands can be found in esophagus?

A

Salivary glands

Provides lubrication and enzymes like amylase

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7
Q

What are developmental abnormalities of esophagus?

A
  1. atresia
  2. fistula (tracheal-esophageal)
  3. Duplication cyst
  4. Inlet Patch
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8
Q

What is a duplicatioin cyst?

A

Rare congenital malformations of GI tract
Duplication of the segment to which it is adjacent
Can compress the airweay

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9
Q

What is an inlet patch?

A

A congenital anomaly when gastric mucosa is present at the end of what should be the esophagus
Can lead to esophagitis when acid is secreted by the gastric mucosa
Can actually be any type of mucosa
No biologic significance in patient

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10
Q

What is esophagitis?

A

Injury to the mucosal lining of the esophagus
Neutrophils and eosinophils are there
Lymphocytes are NORMAL

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11
Q

Why are there lymphocytes normally there in esophagus?

A

Because it is part of the mucosal associated lymphoid tissue (MALT)

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12
Q

What are the etiologies for esophagitis?

A 
Allergy
Pill
Crohns
Trauma
REFLUX
And a shitload more
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13
Q

What causes reflux esophagitis?

A

Failure of gastro-esophageal sphincter and gastric contents come up (bile and HCl)

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14
Q

Why does it matter as to the “type” or etiology of esophagitis a person may have?

A

Because it helps with treatment
Viral inclusions vs. neutrophils vs. fungus
Such as CMV

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15
Q

What are the histological/gross characteristics of eosinophillic esophagitis?

A 
Histology = eosinophils 
Gross = striped tiger like appearance
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16
Q

What are skin disorders that present as esophagitis?

A
  1. Pemphigus
  2. Pemphigoid
  3. Lichenoid reactions
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17
Q

Why does skin shit affect esophagus?

A

Because skin and esophagus have the same epithelium

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18
Q

What is pemphigus?

A

A skin disease in which watery blisters form on the skin

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19
Q

What is one of the most common causes of dysphagia?

A

A Schatzki Ring

Ingrowth of the squamous epithelium that blocks shit

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20
Q

What is achalasia?

A

HYPERmotility disorder
Lower esophageal sphincter is tight and won’t open or relax
Leads to squamous cell carcinoma progression
Esophagus will enlarge due to the blockage

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21
Q

What happens in connective tissue disorders like scleroderma?

A

Selective atrophy of inner circular muscle layer

Presents with Raynaud’s

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22
Q

What is a Mallory Weiss tear?

A

When you rip the distal esophagus causing massive bleeding

Happens after wrenching vomiting

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23
Q

How do you know if it is striated

vs. smooth muscle problem?

Study These Flashcards
A

If you have trouble swallowing it is striated

24
Q

What are the types of malignant tumors of the esophagus?

Study These Flashcards
A
  1. adenocarcinoma
  2. squamous cell carcinoma
  3. sarcoma
  4. lymphoma
  5. melanoma
  6. metastatic
    Can also be benign
25
What is number 1 in cancer deaths among GI organs?
Colo-rectal | Colo-rectal is most common of GI
26
In esophagus, what is most common malignant tumors?
Carcinomas Squamous cell carcinoma is most common in world Adenocarcinoma is most common in western countries
27
What is the pathogenesis of adenocarcinoma?
Reflux of acid leads to metaplasia of the esophagus | Metaplasia then leads to formation of adenocarcinoma
28
What is Barrett esophagus?
Glandular metaplastic mucosa (goblet cells) INSTEAD OF squamous mucosa Patients with Barrett’s have an increased risk of progressing to esophageal adenocarcinoma Due to reflux 10% Over 50% of patients with barrett’s has no symptoms i. the length of intestinal metaplasia is determined at initiation of injury (doesn’t change) ii. short segments do not convert to long segments (so length of metaplasia is static) iii. the risk of cancer is greater in long segment than short segment
29
Where should you have goblet cells in GI?
Small intestine | So if you see that somewhere else, you are fucked
30
Does the esophagus have a serosa?
NO, it only has an adventitia
31
What are the etiologic factors for squamous cell carcinoma?
1. smoking 2. lye digestion 3. achalasia 4. diverticulum 5. not caused by HPV
32
What is the timeline of cancer diagnosis?
Squamous mucosa  intestinal metaplasia  Dysplasia  invasion = cancer Dysplasia only occurs in EPITHELIUM not in endothelium (so you don’t see that shit with HCC)
33
What is dysplasia?
Neoplastic epithelium that remains confined within basement membrane of epithelial surface Nuclei = large, hyperchromatic, irregular contours)
34
What are the three glandular regions of stomach and what are their functions?
1. cardia -are of reactive changes 2. Corpus -oxyntic mucosa (acid producing) 3. Antrum -mucous glands predominate NO OXYNTIC glands Gastrin producing endocrine cells
35
What are the normal architecture of normal antrum?
DEVOID of MALT (because acid is all you neeed) Flat Makes gastrin Motility function
36
What is acute gastritis?
Acute inflammation and/or erosion of gastric mucosa Breakdown of mucosal barrier can allow luminal contents (HCL) to diffuse to lamina propia Done by NSAIDs, EtOH, pills
37
What is chronic gastritis?
Chronic inflammation (lymphocytes and plasma cells) in gastric mucosa
38
What are the two causes of chronic gastritis?
1. H. pylori | 2. autoimmune gastritis
39
What pills can cause gastritis?
Iron pill
40
What does it mean to have “activity” with acute gastritis? Significance?
Activity = presence of neutrophils | Gastritis with activity suggests presence of H. pylori or bacteria
41
What does ATROPHIC chronic gastritis?
Loss of parietal and chief cells | How you lose them is not necessary for label
42
What is the significance of atrophic chronic gastritis?
1. carcinoma/lymphoma evolution | 2. AUTOIMMUNE etiology
43
What does it mean for something to be antralized?
It means your parietal and chief cells of your OXYNTIC (corpus) mucosa is killed so the histology slide looks more like the antrum than the corpus
44
What are antibodies attacking in autoimmune gastritis?
They attack H+ pump
45
What happens when you have autoimmune gastritis?
``` No parietal cells Hypergastrin secretion Proliferation of ECL cells “carcinoid tumors” Benign and wont kill your shit ```
46
What is the difference between H pylori and autoimmune gastritis?
H pylori starts in the antrum and moves up to corpus | Autoimmune gastritis starts from corpus (because it is where the chief cells) and moves down to antrum
47
What is the significance of fundic gland polyp?
It is benign with no clinical consequences Dilatation of oxyntic and chief cells Bigger oxyntic and chief cells
48
What are the key characteristics of hyperplastic gastric polyp?
Benign Located in the antrum Arise on some form of underlying gastritis
49
How can you have enlarged gastric folds?
1. lymphoma 2. gastric cancer 3. metastatic breast lobular carcinoma 4. diffuse gastritis 5. true increase in gastric epithelium (hypertrophic gastrophies)
50
What is Menetriers Disease?
Error in TGF alpha signaling Induces epithelial (foveolar) cell proliferation Inhibits parietal cell acid secretion Increases mucin production Too much mucin = less protein available which will lead to lower serum albumin Lower serum albumin = diarrhea
51
What are the two types of gastric cancer?
1. Intestinal | 2. Signet Ring
52
What are the key characteristics of intestinal type gastric cancer?
Gland formation | Repeated injury/chronic gastritis
53
What are the key characteristics of signet ring type?
E-cadherin No injury/gastritis Sporadic, so no geographic variation
54
What does gastric signet ring carcinoma present as?
Linitus plastic (leather bottle stomach)
55
What happens when you lose E-cadherin?
Loss of cell to cell adhesion | Makes cell bunch up into signet ring type shape

GI Week 2 (15 decks)

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