Flashcards in Pathology of the esophagus Deck (65):
What is dysphagia?
DIfficulty swallowing due to mechanical and functional disorders
What is odynophagia?
Problems swallowing solids and liquids problems are suggestive or what type of etiology, as opposed to solids alone?
Solids alone is more likely obstructional
What are the ssx of achlasia?
Progressive dysphagia, nocturnal regurgitation, or functional obstruction
What are the three abnormalities associated with achalasia?
Incomplete relaxation of LES
Increased resting tone of LES
What are the causes of achalasia?
primary = unknown
Secondary = changes in innervation (NO VIP release)
What is the morphology of achalasia?
Dilated lower esophagus
What is the danger associated with achalasia?
Damage to what nerve plexus can lead to achalasia?
What are the pathological changes above the esophagus in achalasia? (3)
Diminished myenteric ganglia
What is the infectious organism that can lead to secondary achalasia?
Chagas disease (trypanosoma cruzi destroys ganglion cells)
Disorder of what motor nuclei can lead to achalasia?
Vagal dorsal motor nuclei
How can DM cause achalasia?
What are the infiltrative disorders that can cause secondary achalasia?
What are the two different hiatal hernias?
Sliding (whole cardiac portion)
Paraesophageal (just a finger projection)
What is the complication that can occur with a paraesophageal hiatal hernia?
Strangulation of the esophagus
What is a true diverticulum?
Has all four components of the GI tract wall outpouched
What is a false diverticulum?
Just mucosa and submucosa are outpouched
What is a Zenker diverticulum? Is this true or false?
Immediately above the UES
What is a traction diverticulum? Is this true or false?
Midportion of the esophagus
What is an epiphrenic diverticula? Is this true or false?
Immediately above the LES
What is the cause of Traction diverticula?
Congenital or scarring
What is the cause of epiphrenic diverticula?
What are Mallory-Weiss tears?
Longitudinal tears at GE junction, caused by failure of the relaxation of the LES and peptic ulcers
What is the complication with esophageal varices?
Can rupture and bleed--very hard to stop
What is the infectious agent that can lead to cirrhosis of the liver, and esophageal varices?
What are the symptoms of esophagitis?
What is the cause of esophagitis?
Reflux esophagitis (GERD)
Infections and chemical causes
What is the cause of reflux esophagitis?
Decreased efficacy of antireflux mechanisms (CNS depressants, prego, irritants), leading to increased acid in the esophagus
What are the substances that may cause reflux esophagitis?
What are the gross characteristics of reflux esophagitis?
Reddening and streaking of the esophagus
What WBCs increase in esophagitis?
Eosinophils and, later, neutrophils
What happens histologically with reflux esophagitis?
Basal zone hyperplasia, and elongation of the lamina propria papillae
Where does Barrett's esophagus occur?
above the LES
What percent of esophagitis pts will develop barrett's esophagus?
What is the risk of Barrett's esophagus?
What are the gross characteristics of Barrett's esophagus?
Salmon colored esophagus
What is the adenomatous change in Barrett's' esophagus?
Dysplasia in the glands of the esophagus (piling up of gland cells)
What are the signs of high grade dysplasia in esophagitis?
When does dysplasia become cancer?
When the dysplasia reaches below the basement membrane
What are the causes of Barrett's esophagus?
Irritants (EtOH, very hot fluids, dry swallow of pills)
What are the histological findings of radiation esophagitis?
Fibrosing of the mucosa
What is a common-ish complication of radiation esophagitis?
Fibrosis and sticking to other nearby structures
Whitish plaques on the epithelium of the esophagus = ?
What are the histological characteristics of candida?
Non-hyphae branching at 45 degrees
What is the viral cause of esophagitis in AIDS or immunocompromised pts? (hint: it's not HIV)
What is the cause of strictures of the esophagus?
Fibrosis that occurs with frequent exposure to stuff
What is scleroderma?
Autoimmune disease causing sclerosing of the skin and CT
What are the tests for scleroderma?
What is the cause of stenosis by scleroderma?
Fibrosis in smooth muscles (weaken muscles)
Where do benign tumors arise from in the esophagus?
What is the most common benign tumor of the esophagus?
What are the two malignant tumors of the esophagus?
What is the origin of scc and adenocarcinoma of the esophagus?
Who usually gets SC of the esophagus?
Black males who are overweight
What are the malignant HPV viruses? What are the proteins that these affect?
16 18 31 33 35
What is the viral cause of esophagitis?
How can diet cause esophageal CA?
act as promoters, potentiations
How does nitrosamines from cigarette smoke lead to CA?
What are the three types of SCC in the esophagus?
Where in the esophagus dose adenocarcinoma usually occur?
Who usually gets adenocarcinoma of the esophagus?
What are the histological findings of very aggressive adenocarcinoma?
What layer of the GI tract houses the lymphatics?