Pathology of Esophagus and Stomach Flashcards Preview

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Flashcards in Pathology of Esophagus and Stomach Deck (38):
1

What is the triad associated with Plummer-Vinson Syndrome?

Iron deficiency anemia
Atrophic glossitis
Esophageal webs

*Postmenopausal women, increased risk of esophageal squamous cell carcinoma.

2

What is a Schatski ring?

Similar to a web but thicker and circumferential

A ring is above the GE junction
B ring is at the GE junction

3

What causes esophageal stenosis?

Inflammation and scarring from things like chronic GERD, irradiation, scleroderma or caustic injury

4

What are the three characteristics of achalasia?

1. Incomplete LES relaxation
2. Increased LES tone
3. Aperistalsis of esophagus

5

What are some complications associated with Achalasia?

1. Squamous cell carcinoma
2. Candida esophagitis
3. Diverticula
4. Aspiration pneumonia

6

What are some causes of pseudoachalasia?

Nerve damage from:
1. Tyrpanosoma cruzi
2. Metastatic tumor
3. Amyloidosis
4. Sarcoidosis

7

What are some possible complications of a hiatal hernia?

Ulceration
Bleeding
Perforation
Strangulation (paraesophagus)

8

What is a Zenker diverticulum?

Outputting just above the UES
Can be caused by motor dysfunction, increased stress on wall or GERD
Some symptoms include dysphagia, regurgitation, mass in neck or aspiration of contents

9

Where does a traction diverticula occur?

Near the midpoint of the esophagus
From scarring of mediastinal lymphadenitis or same as Zenkers
Generally asymptomatic

10

Where does a Epiphrenic diverticulum occur?

Just above the LES
Caused by dyscoordination of peristalsis or LES relaxation
Symptoms include massive nocturnal regurgitation

11

What causes esophageal varies?

Secondary to portal hypertension -- can lead to massive hemorrhage
Mortality 40-50%

12

What are some histological features of reflux esophagitis?

1. Elongation of the lamina propria papillae
2. Reactive epithelial changes
3. Acute and chronic inflammatory cells
4. Basal and supra-basal cell hyperplasia

13

What are some general consequences of reflux?

Bleeding
Ulceration
Stricture development
Barrett's esophagus

14

What are some features of eosinophilic esophagitis?

1. GERD symptoms
2. No response to GERD therapy
3. Characteristic endoscopic appearance (rings)
4. Allergic etiology?

15

What does the histology look like for eosinophilic esophagitis?

Basal cell hyperplasia
>20 eosinophils per high power field

16

What type of cells are prominent in Barrett's Esophagus?

Goblet cells in the intestinal metaplasia

17

Where do most esophageal adenocarcinomas arise?

Near the GE junction in Barrett's esophagus
Occurs after age 40, mean age of 60

18

What are some common presentations of squamous cell carcinoma of the esophagus?

Occurs after age 50
Male predominance

19

What are some factors associated with development of squamous cell cancer?

Dietary
Lifestyle
Predisposing esophageal disorder
Genetics

20

Regurgitation and projectile vomiting
Palpable mass, visible peristalsis
No bile in vomit
2-4 weeks of age

Hypertrophic pyloric stenosis

21

What does acute gastritis pathology look like?

Punctate erosions with dark adherent blood

22

What is chronic gastritis?

Chronic mucosal inflammatory changes leading to atrophy and metaplasia
Set-up for dysplasia and neoplasia

23

What are some causes of chronic gastritis?

Chronic infection (H. pylori) - type B
Immunologic (in association with pernicious anemia) - type A
Toxic
Post surgery

24

How does the morphology of chronic gastritis appear?

Lymphocytic mucosal infiltrate -- neutrophils in epithelium and gastric pits
Regenerative change
Metaplasia
Atrophy
Dysplasia

25

In autoimmune gastritis, what are the antibodies against?

Parietal cells and intrinsic factor --> achlorhydia, hypergastrinemia, and pernicious anemia

26

Name some diseases associated with H. pylori.

Chronic gastritis
Peptic Ulcer Disease
Gastric carcinoma
Gastric MALToma

27

What layer does PUD penetrate?

The muscularis mucosa

28

Where is the most common location for PUD?

Duodenum, first part
Stomach, antrum
Within Barrett mucosa

29

What is the most frequent complication of PUD?

Bleeding -- may be life threatening

30

Curling ulcers and Cushing ulcers are types of what?

Acute Gastric Ulceration

31

What causes curling ulcers?

Proximal duodenum associated with severe burns or trauma

32

What causes Cushing ulcers?

Associated with intracranial injury, operations or tumors; high incidence of perforation

33

What are some types of hypertrophic gastropathy?

Menetrier disease -- massive hyperplasia of surface mucous cells
Hypertrophic-hypersecretory gastropathy -- hyperplasia of parietal and chief cells
Gastric gland hyperplasia due to excessive gastrin secretion -- setting of gastrinoma: ZE syndrome

34

Are polyps common in the stomach?

No -- majority are associated with chronic gastritis and are non-neoplastic but must remove when seen because they can bleed and transform

35

What is a Virchow node?

involvement of the left supraclavicular node from metastasis from the stomach

36

What is Sister Mary Joseph nodule?

Local spread of gastric carcinoma to periumbilical region

37

What is Krukenberg tumor?

bilateral metastases to the ovaries, abundant mucus, signet ring cells

38

What is Linitis plastica?

When the stomach wall is grossly thickened and leathery -- due to diffuse type gastric carcinoma