Pathology- Esophagus Flashcards
(21 cards)
Achalasia
LES too tight
Failure of inhibitory neurons
Secondary form caused by Chaga’s disease- lesions of vagal motor nuclei
Dysphagia, Regurgitation
Increased risk of squamous cell carcinoma
Zenker’s Diverticulum
Located above UES
Outpouching of mucosa due to motility abnormalities- spasms
Traction Diverticulum
Mid esophagus
Associated with mediastinal adhesions or abnormal motility
Epiphrenic Diverticulum
Located above LES
Clinical Diverticulum
Mass formation
Regurgitation
Aspiration
Mallory-Weiss Syndrome
Longitudinal tears at gastroesophageal junction
Excessive vomiting
Alcoholics
Can penetrate stomach wall and cause mediastinitis
Mallory bodies
Esophageal Varices
Form at anastomoses between portal and caval systems
Causes: prolonged/severe portal hypertension, cirrhosis
Can rupture and cause serious hemorrhage
Hiatal Hernia
Upward protrusion of stomach through diaphragm
Congenital?
Increased age, obesity, smoking
Complications: reflux esophagitis, ulcerations, bleeding, perforations
GERD
Causes:
Hiatal Hernia, increased gastric volume, increased abdo pressure, decreased LES tone
Symptoms:
Heartburn, Regurg, Dysphagia, Hematemesis, Melena
Barrett’s Esophagus: metaplasia, Goblet cells, increased risk for adenocarcinoma
Esophagitis caused by Herpes simplex
Eosinophilic intranuclear inclusions
Multinucleate
Fine chromatin
Prominent nuclear membrane
Esophagitis caused by CMV
Affects fibroblasts and endothelial cells in lamina propria Very large cells OWLS EYE inclusions Large intranuclear inclusions Small cytoplasmic inclusions
Eosinophilic Esophagitis
Numerous eosinophils
Food allergies
Esophageal rings- contractions of muscularis propria from proteins released by eosinophils
Adenocarcinoma
40 year old white men
Risk increased by tobacco, obesity, radiation
Risk decreased by diet rich in fruits and veggies
Dysphagia, weight loss, hemorrhage, chest pain, vomiting
Advanced by the time symptoms appear
Squamous Cell Carcinoma
45 yo men from Iran, China, Brazil, South Africa
Etiology:
Alcohol, tobacco, loss of p53 and p16, nutritional deficiencies, nitrosamines, carcinogens in fungal contaminated food, esophageal injury/achalasia
Cytokeratin and intercellular bridges
Dysphagia, obstruction, cachexia, debilitation, hoarseness
Hemorrhage, sepsis, aspiration leading to chronic cough, metastasis to regional LNs
Pancreatic insufficiency
Malabsorption
Defective intraluminal digestion
Deficiency of pancreatic enzymes
Due to chronic pancreatitis or CF
Crohn’s disease
Malabsorption
Defective intraluminal digestion, terminal digestion at brush border, transepithelial transport
Celiac disease
Malabsorption Immune-mediated enteropathy HLA-DQ2, HLA-DQ8 Defective terminal digestion, transepithelial transport IgA antibodies against transglutaminase IgA/IgE antibodies against gliadin Anti-endomysial antibodies very specific to Celiac's Complications: Enteropathy-associated T-cell Lymphoma Small intestinal adenocarcinoma
Villous atrophy, Crypt hyperplasia
Tropical Sprue
Celiac-like malabsorption
Tropics, Caribbean
Follows acute diarrheal infection
More pronounced in distal small intestine
Rapidly responds to broad spectrum antibiotics
Whipple’s disease
Rare systemic disease- intestines, heart, joints, CNS
Gram (+) Tropheryma whippelii
Macrophages stuffed with organism and obstruct lymphatics
Malabsorptive diarrhea due to impaired lymphatic transport
Macrophages PAS+
Acid-fast stain will label mycobacteria but not Whipple
Fever, joint pain, lymphadenopathy, cardiac, neuro symptoms
Long course of broad spectrum antibiotics
Lactase deficiency
Congenital form: infants exposed to breastmilk
Acquired form: blacks, native americans, chinese
Abetalipoproteinemia
Spur cells- Acanthocytes
Inability to secrete triglyceride rich lipoproteins
Mutation of Microsomal Triglyceride Transfer Protein (MTP)
Intestinal cells unable to transport lipoproteins and free fatty acids- triglycerides accumulate
Deficiency of fat-soluble vitamins –> defective lipid membranes –> spur cells
