Path basis of esophageal disease [3] Flashcards Preview

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Flashcards in Path basis of esophageal disease [3] Deck (14):
1

Features of esophagitis
- how common is it?

inflammatory cells (eosinophils or neutrophils) + thickening of basal layer (reactive epithelial changes) →
Basal cell hyperplasia

Grossly: reddening/inflammation/hyperemia (still have vascularization, but white mucosa is gone)

Very common: 5% of US adult

2

Causes of Esophagitis

1. Chemical injury
2. Infxn
3. Immune related
4. Radiation
5. Trauma

3

How can chemical injury → esophagitis?

reflux of gastric contents into LE
Acids, alkalis, alcohol, tobacco
Medications

4

What types of infxn can lead to esophagitis?

Fungal (candida): white plaques
Viral (HSV): Punched out ulcer

5

How can immune related diseases → esophagitis?

EoE
Dermatologic diseases (lichen planus)

6

Describe the features of the prevalent form of esophagitis, reflux esophagitis
if left untreated, what complications can develop?

injury/inflammation from gastric contents into esophagus (GERD)

Typical presentation: Heartburn + regurgitation

Severe ulcerations
Strictures
Barretts esophagus (salmon color)
Adenocarcinoma

7

Clinical features of EoE

Vomiting
Pain
dyspepsia (indigestion) → odynophagia (painful swallowing)
stenosis

*recall: caused by allergic/immunologic factors

8

GERD-Barrett esophagus-dysplasia-esophageal adenocarcinoma sequence.

GERD → metaplasia → low grade dysplasia → high grade dysplasia → adenocarcinoma

If high grade dysplasia gets necrosis and get complexity of glands, rounded nuclei → can progress

(7M:1F for adeno - glandular epi malignancy)

9

Zenkers diverticulum
- where
- sx
- associated with?

Uppermost portion of Eso
Regurg, halitosis, aspiration
Assoc w/ reduced UES compliance

10

Esophageal webs and rings
- sx?
- population?
- associated with?

Mostly asymptomatic
Dysphagia + choking sensation
dysphagia → odynphagia
assoc. with Plummer-Vinson syndrome

(gross: mucosal folds or indentations, dx by post inflammatory stenosis)

11

Boerhaave syndrome

exacerbation of esophageal laceration (mallory weiss tears) → rupture

- can see air in mediastinum
associated with alcohol intox, but not as life threatening as varices

12

Esophageal varices
why is it a medical emergency?

Cirrhosis of liver → portal HTN →
Blood back up into L gastric and up the Esophageal vasculature →
distention of esophageal vasculature →
Outpouches/varices in eso

Trauma can tear + Cirrhosis pts have ↓ clot factors → excessive bleeding → medical emergency

13

Most common type of esophageal atresia + tracheoesophageal fistula

Esophageal atresia with distal TEF
- drooling

14

How does the H shape tracheoesophageal (TE) fistula usually present?

in older children with repeated bouts of pneumonia
- no drooling