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Gastrointestinal System > Pathology of Esophagus > Flashcards

Pathology of Esophagus Flashcards

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1
Q

What are the different types of oesophageal obstruction?

A

Mechanical and Functional

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2
Q

What are examples of mechanical obstruction?

A

Artesia
Fistula

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3
Q

What are examples of functional obstruction

A

Achalasia

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4
Q

What is the esophagus?

A

A muscular tube that extends from the pharynx to the stomach

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5
Q

What are the 4 layers of the esophagus?

A

Muscosa
Submucosa
Muscularis externa
Adventitia

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6
Q

What are the sublayers of the mucosa?

A

Epithelium
Lamina propria
Muscularis interna

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7
Q

What is the definition of mechanical obstruction?

A

Congenital group of disorders discovered shortly after birth due to regurgitation during feeding

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8
Q

How does Artesia occur?

A

From the failure of the primitive foregut to recanalize

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9
Q

Where does Artesia usually occur?

A

At or near the tracheal bifurcation and usually associated with the fistula connecting the lower and upper oesophageal pouches to bronchus or trachea

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10
Q

How does a fistula happen?

A

Results from incomplete separation of the primitive foregut into two completely separate tubes

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11
Q

What are the clinical features of oesophageal obstruction?

A

Vomiting
Aspiration
Suffocation
Pneumonia
Severe fluid and electrolyte imbalance

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12
Q

What is achalasia?

A

Failure pf the LES to relax with swallowing and poor peristalsis in the body of the esophagus

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13
Q

What are the two types of achalasia?

A

Primary and secondary

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14
Q

What is primary achalasia?

A

An inflammatory disease that cause loss of inhibitory neurons in the myenteric plexus

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15
Q

What does chronic inflammation of the myenteric plexus lead to?

A

Neuritis, ganglionitis and ganglion cell loss and fibrosis

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16
Q

What is secondary achalasia?

A

Trypanosoma cruzi infection causes destruction of myenteric plexus, failure of LES relaxation and dilation

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17
Q

What is secondary achalasia associated with?

A

Chagas disease

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18
Q

What are the clinical features of achalasia?

A

Dysphagia gor solids and liquids
Putrid breath
High LES pressure
Bird-beak sign on barium swallow
Increased risk of esophageal squamous cell carcinoma

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19
Q

What causes reflux esophagitis?

A

Regurgitation of gastric contents (GERD)

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20
Q

What is the most common cause of esophagitis

A

Reflux esophagitis

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21
Q

When is reflux esophagitis most common?

A

Individuals over 40

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22
Q

What is the associated clinical condition of reflux esophagitis called?

A

GERD

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23
Q

What are the agents that decrease the tone of the LES or increase abdominal pressure?

A

Alcohol, chocolate, fatty foods, cigarette smoking

Certain nervous system depressants

Pregnancy

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24
Q

What are the gross features of reflux esophagitis?

A

Severe cases have hyperaemic mucosa with focal haemorrhage

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25
What is the morphological features of reflux esophagitis, in mild cases?
Often unremarkable
26
What is the morphological features of reflux esophagitis, in severe cases?
Recruitment of eosinophils into squamous mucosa, followed by neutrophils Increase lymphocyte Basal zone hyperplasia Elongation of lamina propria ito upper third of esophagus
27
What are the clinical features of reflux esophagitis?
Heartburn and dysphagia Noticeable regurgitation of sour-tasting gastric contents Attacks of severe chest pain (Chronic GERD)
28
What are the complications of reflux esophagitis?
Esophageal ulceration Hematemesis Melena Stricture development Barrett esophagus
29
What is the treatment of reflux esophagitis?
Proton pump inhibitors
30
Why are PPI's the treatment for reflux oesophagitis?
Reduce gastric acidity and provide symptomatic relief
31
What is the ethology of Eosinophilic Esophagitis?
Allergic, majority are atopic
32
What are the symptoms of Eosinophilic Esophagitis in adults?
Food impaction and dysphagia
33
What are the symptoms of Eosinophilic Esophagitis in children?
Feeding intolerance or GERD like symptoms
34
What is a differential characteristic of Eosinophilic Esophagitis?
Failure of high dose PPI treatment and the absence of acid reflux
35
What are the microscopic features of eosinophilic esophagitis?
Epithelial infiltration by eosinophils
36
What is the treatment of eosinophilic esophagitis?
Dietary restrictions Topical or systemic corticosteroids
37
What is Barrett's Esophagus?
Result of chronic GERD Characterised by intestinal metaplasia within the lower oesophageal squamous mucosa
38
What is the epidemiology of Barrett's Esophagus?
10% of people with symptomatic GERD More common in white males Present between 40 and 60 Increased risk of oesophageal adenocarcinoma Smokers have greater chance
39
What are the gross features of Barrett's Esophagus?
Tongues or patches of red, velvety mucosa extending upwards from gastroesophageal junction
40
What are the microscopic features of Barrett's Esophagus?
Gastric or intestinal metaplasia Well-formed goblet cells interspersed with gastric foveolar cells Dysplasia Intermucosal carcinoma
41
What are the clinical features of Barrett's Esophagus?
Diagnosis is established by endoscopy with biopsy Patients followed up closely to diagnose any complication
42
What happens to low grade dysplasia after giving Barrett's Esophagus treatment?
Regression
43
What are chemical and infectious esophagitis?
Damage to stratified squamous mucosa of the esophagus by a variety of irritants
44
What are the irritants that cause chemical and infectious esophagitis?
Alcohol Corrosive acids or bases Excessively hot fluids Heavy smoking Pill-induced esophagitis
45
What are the clinical features of chemical and infectious esophagitis?
Pain, odynophagia (pain when swallowing) Hemorrhage (severe cases) Stricture (severe cases) Perforation (severe cases)
46
Which kind of patients is infectious esophagitis associated with?
Immunocompromised patients
47
What are the most common organisms causing infectious esohpgaitis?
Fungal organisms: Candida Herpes Simplex Virus Cytomegalovirus (CMV)
48
What will be seen in the endoscopy of infectious esophagitis caused by candida?
Adherent, grey-white pseudomembranes
49
What will be seen in the endoscopy of infectious esophagitis caused by HSV?
Endoscopy: punched-out ulcers
50
What will be seen histologically of infectious esophagitis caused by HSV?
Multicluated viral inclusion within rim of degenerated epithelial and Cowdry A inclusion of virus
51
What will be seen in the endoscopy of infectious esophagitis caused by CMV?
Shallower ulcerations
52
What will be seen histologically of infectious esophagitis caused by CMV?
Nuclear and cytoplasmic inclusions within capillary endothelium and stromal cells
53
What is the most common laceration of the esophagus?
Mallory-Weiss Tears
54
What are Mallory-Weiss Tears associated with?
Severe retching or vomiting May occur with acute alcohol intoxication
55
What is the pathogenesis of the Mallory-Weiss Tears?
Reflex relaxation of the gastroesophageal musculature precedes the anti peristaltic contractile wave associated with vomiting This relaxation is taught to fail during prolonged vomiting --> refluxing gastric contents --> cause the oesophageal wall to stretch and tear
56
What are the clinical features of the Mallory-Weiss Tears?
Hematemesis ABdominal pain
57
What is the prognosis of Mallory-Weiss Tears?
Risk of Boerhaave syndrome: rupture of esophagus leading to air in the mediastinum and subcutaneous emphysema
58
What are oesophageal varices?
Dilated submucosal veins in the lower esophagus
59
How does oesophageal varice arise?
Secondary to portal hypertension or cirrhosis
60
What is the morphology of oesophageal varices through angiography?
Tortuous dilated veins lying primarily within the submucosa of distal oesophagus and proximal stomach
61
What are the histologic features of oesophageal varices?
Overlying mucosa can be intact but is ulcerated and necrotic if rupture has occurred
62
What are the gross features of oesophageal varices?
May not be obvious, collapse in the absence of blood flow
63
What are the clinical features of esophageal varices?
Asymptomatic but risk of rupture exists: a. Presents with painless hematemesis b. Most common cause of death in cirrhosis
64
What is the effect of inflammation on the mucosa?
Can destroy the mucosa/submucosa, wearing the tissue and leading to rupture with haemorrhage
65
What are the types of oesophageal tumors?
Adenocarcinoma and Squamous Cell Carcinoma
66
What is adenocarcinoma?
Typically arises in a background of Barrett esophagus and long standing GERD
67
Which part of the esophagus does adenocarcinoma affect?
Lower one third
68
What are the risk factors for adenocarcinoma?
Patients with documented dysplasia Tobacco use, obesity, previous radiation therapy
69
What is the epidemiology of adenocarcinoma?
Occurs mainly in whites 7x more common in men than women
70
What is the pathogenesis of adenocarcinoma?
1. Inactivation of the INK4A/CDKN tumor suppressor gene p16 2. p53 loss and inactivation of RB 3. Mutations are often present in early stages of oesophageal adenocarcinoma
71
What is the location of adenocarcinoma?
Occurs usually in the distal one third of esophagus, may invade gastric cardia
72
What are the gross features of adenocarcinoma?
Large exophytic mass Infiltrate diffusely, ulcerate and invade deeply
73
What are the microscopic features of adenocarcinoma?
Barret's esophagus usually present adjacent to tumor Tumor produces mucins and forms glands
74
What are the clinical features of adenocarcinoma?
Progressive dysphagia Weight loss Pain Hematemesis
75
What are the clinical features of squamous cell carcinoma?
Hoarse voice Cough
76
What causes squamous cell carcinoma?
Malignant proliferation of squamous cells
77
Where does squamous cell carcinoma usually present?
In the upper or middle third of esophagus
78
What is the epidemiology of squamous cell carcinoma?
Occurs in adults > 45 4x more communion males than females
79
What are the risk factors of squamous cell carcinoma?
Alcohol and tobacco use Poverty Caustic esophageal injury Achalasia Plummer-Vinson syndrome Consumption of very to beverages Previous radiation therapy
80
What is the pathogenesis of squamous cell carcinoma?
Incompletely defined
81
What are the gross features of squamous cell carcinoma?
Three types of tumors: a. Ulcerating b. Polypoid, projects into lumen c. Infiltrating, principal plane of growth is in the wall
82
What does the infiltrating squamous cell carcinoma invade?
Respiratory tree --> pneumonia Aorta --> catastrophic exsanguination Mediastinum and pericardium
83
What are the microscopic features of the squamous cell carcinoma?
Neoplastic squamous cells range from well defined with epithelial pearls to poorly differentiated
84

Gastrointestinal System (29 decks)

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