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GI Exam 1 > Pathology of Esophagus > Flashcards

Pathology of Esophagus Flashcards

(52 cards)

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1
Q

dysphagia definition

A

difficulty swallowing due to mechanical and functional disorders

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2
Q

odynophasia definition

A

painful swallowing

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3
Q

heartburn definition

A

retrosternal burning pain , usually due to regurgitation of gastric contents into lower esophagus

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4
Q

hematemesis definition

A

vomiting of blood due to inflammation, or ulceration or rupture of blood vessels

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5
Q

Problem swallowing both solids and liquids then the issue is usually?

A

nerve related - peristalsis

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6
Q

Problem swallowing solids then the issue is usually?

A

an obstruction

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7
Q

Achalasia: symptoms:

A

progressive dysphagia, nocturnal regurgitation, young adults, functional obstruction

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8
Q

Achalasia - abnormalities:

A
  • aperistalsis
  • incomplete relaxation of LES (NO and VIP chemical issue)
  • increased resting tone of LES

–> lower esophagus is constricted and above LES is dilation due to crap getting stuck == muscle hypertrophy and thinned wall (distention)
birds beak appearance with CT contrast or MRI whatever

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9
Q

Achalasia - causes:

A

1) usually primary (idiopathic) uncertain etiology
2) Secondary causes:
- failure of distal inhibitory neurons containing NO and VIP
- degenerative changes in innervation
- decreased myenteric ganglia

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10
Q

Danger of achalasia?

Other complications?

A

-SCC*

  • candida esophagitis
  • diverticula
  • aspiration pneumonia
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11
Q

Secondary achalasia occurs with?

A

1) Chagas disease (Trypanosoma cruzi destroys ganglion cells)
* 2) Disorders of the vagal dorsal motor nuclei (polio surgical ablation)
* 3) Diabetic autonomic neuropathy
* 4) Infiltrative disorders (malignancy, amyloidosis, sarcoidosis)

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12
Q

Hiatal hernia - how does it happen? What 2 types?

A

1) cause unknown but there is a separation of diaphragmati crura with widening
2) types:
a) sliding hernia - MOST COMMON - proximal part of the stomach slides up through hole in diaphragm
b) paraesophageal - some portion of cardia goes through like a finger projection = possible acute strangulation!

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13
Q

True diverticula definition:

A

all of the layers of the whatever part of GI tract pouch out

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14
Q

false diverticula definition

A

only mucosa or submucosa pouch out

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15
Q

Zenker diverticula:
where is it?
what kind is it?

A

PROXIMAL

  • right above UES/cricopharyngeus muscle
  • FALSE DIVERTICULUM
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16
Q

Traction diverticula
where is it?
what kind is it?

A

midportion of esophagus

  • TRUE DIVERTICULUM
  • probably congenital or due to scarring from surgery or something
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17
Q

Epiphrenic diverticula
where is it?
what kind is it?

A
  • distal esophagus right above LES
  • TRUE DIVERTICULUM
  • probably due to peristaltic dyscoordination and LES relaxation
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18
Q

Patient presentation of diverticula?

A

usually bad breath

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19
Q

Mallory Weiss Tears

  • where do these happens?
  • who gets these often?
A
  • longitudinal lacerations/tears at GE junction
  • severe vomiting ex) ALCOHOLICS or pregnancy
  • hiatal hernia predisposes
  • people with Ulcers!
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20
Q

Mallory Weiss Tears

-what happens?

A

-Failure of reflex relaxation of LES

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21
Q

Mallory Weis Tears - patient symptoms:

Study These Flashcards
A
  • coughing up blood
  • if not coughing up look for blood stools - melena
  • usually no symptoms prior to massive rupture = fatal
22
Q

Main cause of Esophageal varices?

Study These Flashcards
A

Liver disease - alcohol cirrhosis!

2nd most common cause=schistosomiasis

23
Q

Esophageal varicies-

-what happens?

Study These Flashcards
A
  • collateral bypass channels bc of portal hypertension (liver damage - blood cant get through liver so finds another way back to heart)
  • dilated submucosal and subepithelial veins
  • rupture == massive bleed, frequently fatal
24
Q

Esophagitis - definition:

Study These Flashcards
A

inflammation of esophageal mucosa

25
esophagitis - prevelance:
northern iran and some of china - might be diet related
26
esophagitis - symptoms
``` dysphagia, heartburn, regurgitation, hematemiesis, melena ```
27
esophagitis - etiology: | -most common cause?
- can be physical, chemical, or biologic - USUALLY A COMBO OF THINGS - decreased efficacy of antireflux mechanisms (LES tone) - *REFLUX ESOPHAGITIS* MOST COMMON! - barretts - infectious & chemical - eosinopilic
28
Some causes of esophagitis:
- sliding hiatal hernia - slow clearance of refluxed material & acid exposure - inflammation - delayed gastric emptying = inc gastric volume
29
What causes the damage in reflux esophagitis?
acid peptic juices!
30
Early marker of reflux esophagitis?
**Eosinophils!**
31
Tissue changes of reflux esophagitis:
- eosinophils, lymphocytes, and PMNs - basal zone hyperplasia 9-thickens! - elongation of lamina propria papillae - superficial necrosis - ulceration
32
Prolonged Reflux esophagitis = tendency to develop:
Barrett esophagus = metaplasia = risk for esopageal carcinoma!!
33
Key feature to see for Barrett esophagus?
-metaplasia from squamous to columnar WITH GOBLET CELLS!*
34
Salmon red epithelium in esophagus think:
Barrett esophagus - metaplasia has happened!
35
Radiation esophagitis usually heals how and which layer?
Severe fibrosis of submucosa
36
Major cause of esophagus strictures?
inflammation* - peptic - caustic - ischemic - post op - radiation - congenital - infectious - trauma - scleroderma*
37
Scleroderma predisposes/causes what issue? How? What issues do these patients have?
- esophageal stricture - vascular obliteration and fibrosis in smooth muscle = weak LES, poor esophageal contraction, delayed gastric emptying - swallowing liquids and solids in addition to a whole bunch of other stuff
38
Prevalence of benign esophageal tumors? Which is most common
- RARE - most common is leiomyoma - usually mesenchmal within wall of esophagus
39
Malignant tumors of esophagus: - discovery? - origin of tumor? - most common?
- discovered LATE - epithelial origin - **Squamous cell carcinoma** and **adenocarcinomas **
40
most common cancer of esophagitis worldwide??
SCC
41
most common regions for SCC/esophagitis?
Highest in Iran N China S Africa S Brazil
42
Population stats regarding SCC/esophagitis?
M to F varies but blacks more likely than whites
43
Causes of SCC/esphagitis:
- dietary enivornmental factors a promoters/potentiators of carcinogens - nitroso compounds knock out p53 via mutations - stepwise accumulation - Chronic esophagitis and associated chronic inflammation = dysplasia
44
First place esophageal SCC metastasizes?
LN! then they like the liver and lungs
45
Patient presentation of esophageal SCC?
- **Extreme weight loss** - progressive gradual dysphagia - not noticed until lumen 30-50% blocked (low survival) - substernal or back pain - hoarseness and cough
46
3 types of esophageal SCC? | Which is most common
- ***protruded***- polypoid, fungating - flat - diffuse, infiltrative - excavated - necrotic, ulcerates deeply
47
Adenocarcioma of esophagus: - think what tissue type affected? - most common area to get? - associated with what disease? - some risk factors?
- think GLANDS - distal 1/3 - most from Barrett - tobacco , obesity, H pylori? ETOH
48
Cause of adenocarcina? | population stats?
- cause = mutlistep process - overexpression of p53 WHITE MORE COMMON THAN BLACK MORE MALES
49
Which esophageal is more common in whites and which in blacks?
-- Whites = adenocarcinoma --Blacks = SCC
50
Adenocarcinoma micro - what is associated with more aggressive cancer?
lots of mucin-producing cells | **-signet ring**
51
prognosis for SCC and adenocarcinoma?
both really poor if superficial adenocarcinoma 5yr is 80%
52
Lymphatics and esophagus
Lymphatics all over the place and run from top to bottom = easy spread for the tumor if it wants to metastasize

GI Exam 1 (11 decks)

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