Path-Esophagitis

Question 1

what are the histology layers of the digestive tract?

Answer 1

epithelium, lamina propria, muscularis mucosa, submucosa, muscularis propria (with auerbach’s plexus), serosa/adventitia

Question 2

what components of the digestive tract epithelium are stratified squamous?

Answer 2

esophagus, anus

Question 3

which components of the digestive tract are connective tissue?

Answer 3

lamina propria, mubmucosa, serosa/adventitia

Question 4

describe the muscle layers inside the digestive tract

Answer 4

two layers of muscularis propria are perpendicular to one another; skeletal muscle in top of esophagus and anus, smooth mm in between

Question 5

auerbach’s plexus is made up of _____ ganglia

Answer 5

parasympathetic

Question 6

where are blood vessels found within the wall of the GI tract?

Answer 6

inside the connective tissue always (lamina propria, submucosa)

Question 7

where are immune cells found within the GI tract?

Answer 7

scattered immune cells within the mucosa (epithelium+lamina propria) (GALT) where they can respond to antigen in the lumen

Question 8

neoplastic disorders of the gut usually affect this layer of the GI tract

Answer 8

epithelium

Question 9

infectious and inflammatory conditions of the gut start in what later of the GI tract

Answer 9

mucosa (epithelium + lamina propria + muscularis mucosa) because this is where inflammatory cells are

Question 10

most bleeding comes from the ____ layer of the GI tract

Answer 10

submucosa

Question 11

motility disorders are pathologic processes of the ____ layer

Answer 11

muscularis propria

Question 12

pathogenesis of GI erosion

Answer 12

surperficial necrosis involving mucosa only; heals by regeneration without fibrosis or scar

Question 13

pathogenesis of GI ulcer

Answer 13

deeper necrosis involving mucosa + deeper layers; heals with granulation tissue leading to fibrosis and scar formation

Question 14

causes of GI stenosis

Answer 14

congenital, stricture (necrosis = circumferential fibrosis/scar which contracts), neoplasms

Question 15

presentation with GI stenosis

Answer 15

causes obstruction of movement of lumen contents; dysphagia if esophagus

Question 16

what nerves surround the esophagus?

Answer 16

vagus and recurrent laryngeal nerves

Question 17

___ are found within the mucosa of the esophagus

Answer 17

mucous glands

Question 18

the vast majority of hiatal hernias are (sliding/paraesophageal)

Answer 18

sliding (95%)

Question 19

hiatal hernias are usually (congenital/acquired)

Answer 19

acquired

Question 20

hiatal hernias increase likelihood of GERD due to?

Answer 20

development of an incompetent lower esophageal sphincter

Question 21

name 5 categories of etiology for esophagitis

Answer 21

1. infectious, 2. drug/pill, 3. corrosive/chemical, 4. eosinophilic, 5. GERD

Question 22

what is the pathogenesis of esophagitis?

Answer 22

etiology -> mucosal necrosis -> erosion or ulceration (+/- stricture)

Question 23

three common sources of infectious esophagitis; who is at risk for it?

Answer 23

candida, CMV, herpes; immunocompromised, DM, EtOH, increased age, systemic ABX

Question 24

esophageal candidiasis is an overgrwoth of (normal/abnormal) GI flora, which looks like?

Answer 24

normal; superficial white plaques “pseudomembranes” on roof of mouth and esophagus

Question 25

esophageal candidiasis can be seen histologically with a ____ stain and looks like?

Answer 25

PAS stain; "spaghetti with meatballs" -- spaghetti is pseudohyphae and meatballs are budding yeast (?PMNs)

Question 26

what is seen on gross pathology of HSV I (herpetic esophagitis)?

Answer 26

superficial vesicles, erosions/ulcers, plaques

Question 27

what type of cell does HSV infect?

Answer 27

keratinocytes in the epithelium

Question 28

describe the histopath of HSV

Answer 28

ground glass (viral material), chromatin margination, multinucleation with nuclear molding

Question 29

gross pathology of CMV esophagitis

Answer 29

erosions/ulcers only

Question 30

what cell types are infected by CMV?

Answer 30

lamina propria (endothelial + fibroblasts)

Question 31

histopath of CMV

Answer 31

nuclear- and cyto-megaly; nuclear inclusions (classic owl eye effect)

Question 32

histopath of pill esophagitis

Answer 32

localized inflammation +/- erosion/ulceration

Question 33

chemical esophagitis is usually due to ____ in adults, and ____ in children

Answer 33

suicide; accidental ingestion

Question 34

what agents can cause chemical/corrosive esophagitis?

Answer 34

strong alkaline agents or strong acids (cleaning products) -- lye, sulfuric acid or HCl

Question 35

what chemical agent causes the worst chemical esophagitis?

Answer 35

alkaline solutions (liquid)

Question 36

alkali cause ____ necrosis, and acids cause _____ necrosis

Answer 36

liquefactive; coagulative (protective eschar)

Question 37

chemical esophagitis can be 1st, 2nd, or 3rd degree -- how deep and what are the consequences of 2nd degree?

Answer 37

injury to submucosa/muscularis propria leading to ulceration, granulation tissue, and fibrosis (can cause stricture)

Question 38

what is the pathogenesis of eosinophilic esophagitis?

Answer 38

chronic allergic rxn -> infiltration of eosinophils in epithelium (can see on histo)

Question 39

the gross pathology of eosinophilic esophagitis?

Answer 39

varies (normal, microabscesses, strictures)

Question 40

pathogenesis of GERD

Answer 40

reflux of gastric contents (acid, pepsin, +/- bile) into esophagus -> chemical injury to mucosa

Question 41

gross pathology of GERD

Answer 41

distal esophagus shows erythema +/- erosions/ulcers; ulcers can cause strictures

Question 42

histopath of GERD

Answer 42

intraepithelial inflammation with neutrophils and eosinophils

Question 43

long-term acid exposure from GERD causes the normal _____ epithelium of the esophagus to turn into _____ epithelium like that seen in the _____

Answer 43

stratified squamous; simple columnar epithelium with crypts and villi; stomach/intestine

Question 44

eventually, Barrett's esophagus could cause?

Answer 44

adenocarcinoma of the esophagus