Pathology of the esophagus Flashcards Preview

Gastrointestinal > Pathology of the esophagus > Flashcards

Flashcards in Pathology of the esophagus Deck (65):
1

What is dysphagia?

DIfficulty swallowing due to mechanical and functional disorders

2

What is odynophagia?

Painful swallowing

3

Problems swallowing solids and liquids problems are suggestive or what type of etiology, as opposed to solids alone?

Nerve problems

Solids alone is more likely obstructional

4

What are the ssx of achlasia?

Progressive dysphagia, nocturnal regurgitation, or functional obstruction

5

What are the three abnormalities associated with achalasia?

Aperistalsis
Incomplete relaxation of LES

Increased resting tone of LES

6

What are the causes of achalasia?

primary = unknown

Secondary = changes in innervation (NO VIP release)

7

What is the morphology of achalasia?

Dilated lower esophagus

8

What is the danger associated with achalasia?

SCC
ASpiration
Obstruction

9

Damage to what nerve plexus can lead to achalasia?

Myenteric

10

What are the pathological changes above the esophagus in achalasia? (3)

Muscular hypertrophy/thinning

Diminished myenteric ganglia

Mucosal damage

11

What is the infectious organism that can lead to secondary achalasia?

Chagas disease (trypanosoma cruzi destroys ganglion cells)

12

Disorder of what motor nuclei can lead to achalasia?

Vagal dorsal motor nuclei

13

How can DM cause achalasia?

Neuropathy

14

What are the infiltrative disorders that can cause secondary achalasia?

Malignancy
Amyloidosis
Sarcoidosis

15

What are the two different hiatal hernias?

Sliding (whole cardiac portion)
Paraesophageal (just a finger projection)

16

What is the complication that can occur with a paraesophageal hiatal hernia?

Strangulation of the esophagus

17

What is a true diverticulum?

Has all four components of the GI tract wall outpouched

18

What is a false diverticulum?

Just mucosa and submucosa are outpouched

19

What is a Zenker diverticulum? Is this true or false?

Immediately above the UES
False

20

What is a traction diverticulum? Is this true or false?

Midportion of the esophagus
True

21

What is an epiphrenic diverticula? Is this true or false?

Immediately above the LES
True

22

What is the cause of Traction diverticula?

Congenital or scarring

23

What is the cause of epiphrenic diverticula?

Peristaltic discoordination

24

What are Mallory-Weiss tears?

Longitudinal tears at GE junction, caused by failure of the relaxation of the LES and peptic ulcers

25

What is the complication with esophageal varices?

Can rupture and bleed--very hard to stop

26

What is the infectious agent that can lead to cirrhosis of the liver, and esophageal varices?

Schistosomiasis

27

What are the symptoms of esophagitis?

Dysphagia
Dyspepsia
Regurgitation
Hematemesis
Melena

28

What is the cause of esophagitis?

Reflux esophagitis (GERD)
Infections and chemical causes

29

What is the cause of reflux esophagitis?

Decreased efficacy of antireflux mechanisms (CNS depressants, prego, irritants), leading to increased acid in the esophagus

30

What are the substances that may cause reflux esophagitis?

EtOH
Caffeine
Smoking
Chocolate/fired foods

31

What are the gross characteristics of reflux esophagitis?

Reddening and streaking of the esophagus

32

What WBCs increase in esophagitis?

Eosinophils and, later, neutrophils

33

What happens histologically with reflux esophagitis?

Basal zone hyperplasia, and elongation of the lamina propria papillae

34

Where does Barrett's esophagus occur?

above the LES

35

What percent of esophagitis pts will develop barrett's esophagus?

10%

36

What is the risk of Barrett's esophagus?

adenocarcinoma (30-40x)

37

What are the gross characteristics of Barrett's esophagus?

Salmon colored esophagus

38

What is the adenomatous change in Barrett's' esophagus?

Dysplasia in the glands of the esophagus (piling up of gland cells)

39

What are the signs of high grade dysplasia in esophagitis?

Prominent nucleoli

40

When does dysplasia become cancer?

When the dysplasia reaches below the basement membrane

41

What are the causes of Barrett's esophagus?

Irritants (EtOH, very hot fluids, dry swallow of pills)

42

What are the histological findings of radiation esophagitis?

Fibrosing of the mucosa

43

What is a common-ish complication of radiation esophagitis?

Fibrosis and sticking to other nearby structures

44

Whitish plaques on the epithelium of the esophagus = ?

Candida

45

What are the histological characteristics of candida?

Non-hyphae branching at 45 degrees

46

What is the viral cause of esophagitis in AIDS or immunocompromised pts? (hint: it's not HIV)

Herpes

47

What is the cause of strictures of the esophagus?

Fibrosis that occurs with frequent exposure to stuff

48

What is scleroderma?

Autoimmune disease causing sclerosing of the skin and CT

49

What are the tests for scleroderma?

Antinuclear antibodies
Scler-70
Anti topoisomerase

50

What is the cause of stenosis by scleroderma?

Vascular obliteration
Fibrosis in smooth muscles (weaken muscles)

51

Where do benign tumors arise from in the esophagus?

mesenchymal tissue

52

What is the most common benign tumor of the esophagus?

Leiomyomas

53

What are the two malignant tumors of the esophagus?

SCC
Adenocarcinoma

54

What is the origin of scc and adenocarcinoma of the esophagus?

Epithelial origin

55

Who usually gets SC of the esophagus?

Black males who are overweight

56

What are the malignant HPV viruses? What are the proteins that these affect?

16 18 31 33 35

E6 E7

57

What is the viral cause of esophagitis?

HPV

58

How can diet cause esophageal CA?

act as promoters, potentiations

59

How does nitrosamines from cigarette smoke lead to CA?

p53 mutations

60

What are the three types of SCC in the esophagus?

Protruded
Flat
Excavated

61

Where in the esophagus dose adenocarcinoma usually occur?

Distal 1/3

62

Who usually gets adenocarcinoma of the esophagus?

White males

63

What are the histological findings of very aggressive adenocarcinoma?

Signet ring

64

What layer of the GI tract houses the lymphatics?

Submucosa

65

What are the Keratin pearls?

histological characteristics of SCC