Pathology Of Upper GI Tract Flashcards
(39 cards)
Epithelial of Esopahgus vs. Stomach
Esophagus - stratified squamous non-keratinized epithelia
Stomach - columnar mucosa
What is a hernia?
An abnormal protrusion of tissue/organ through the wall of the cavity in which it resides
Hiatal Hernia
Abnormal protrusion of a segment of the stomach above the diaphragm (hiatus is the opening of the diaphragm through which the esophagus passes)
What are the two types of Hiatal Hernias?
% of each and description
Sliding Hiatal hernia
- 95% of hiatal hernias, has a bell shaped dilation
Nonaxial (paraesophageal) Hiatal hernia
5% of Hiatal Hernias, usually along the greater curvature
What is the significance of Hiatal Hernias?
- commonality
- symptoms
- complications
Common - 1-20% of adults have them (children as well)
Usually asymptomatic - only 9% with sliding hernias have heartburn or regurgitation of gastric juice into mouth
Complications
- ulceration
- bleeding
- perforation
- strangulation of paraesophageal hernias
Achalasia of the Esophagus
Description
Causes
Function disorder of the esophagus characterized by increased resting tone and incomplete relaxation of the lower esophageal sphincter preventing food from entering the stomach
Primary (unknown cause)
Secondary
- Chana’s disease (trypanosoma Cruzi)
- malignancy
- sarcoidosis
Radiologically - bird beak design
Esophagitis
Definition
Causes
Inflammation and epithelial damage of the esophagus
Inflammation can be caused by:
- infection, irritant or autoimmune
Causes of esophagitis:
- gastroesophageal reflux
- infection (uncommon unless immunocompromised)
- eosinophilic esophagitis (males 20-40)
- other
Eosinophilic Esophagitis
Definition
How does it present?
- type of esophagitis characterized by numerous eosinophils within the squamous mucosa associated with dysphagia
- presents as:
1) dysphagia (difficulty swallowing, food impact ion, heartburn)
2) more common in males; affects both children and adults
3) endoscopy: ring appearance (like trachea)
4) Biopsy required to confirm presence of eosinophils
5) Need to exclude GERD
GERD
Definition
Symptoms
Gastric contents leak backwards into esophagus causing irritation/inflammation of esophagus
Symptoms
- variable heartburn
- water brash
- frequent belching
Factors contributing to GERD
- low resting tone in LES
- delayed esophageal clearance
- delayed gastric emptying
- increased abdominal pressure
- increased acid production
How is GERD Diagnosed?
Clinical - history and relief with medication (PPI)
Endoscopy if:
- heartburn with alarm features (bleeding, weight loss)
- persistent reflux or previous severe erosive esophagitis
- Hx of esophageal stricture with persistent dysphagia
Complications associated with GERD
Stricture (scarring)
Ulceration
Bleeding
Barrett Esophagus
Adenocarcinoma
What does a biopsy of GERD show?
1) increasing inflammatory cells in epithelial layer (eosinophils, neutrophils, excess T cells)
2) basal cell hyperplasia exceeding 15-20% of epithelial thickness
3) elongation of lamina propria papillae extending into upper 1/3 of epithelium
How is GERD treated?
PPI
Antacids
Diet modification
Weight loss
Barrett Esophagus
Definition
Significance
How is it diagnosed?
Distal squamous mucosa of esophagus replaced by meta plastic columnar epithelium in response to prolonged injury (columnar epithelium may be more resistant to acid)
- risk for dysplasia and subsequent esophageal adenocarcinoma
- diagnosed via endoscopic and histologic features (biopsy)
Endoscopic features of BE
Red velvety GI type mucosa b/w pale squamous mucosa
- tongues extending up from GEJ or broad band displacing the GE junction proximally
Histologic features of BE
- squamous epithelium replaced by columnar epithelium of intestinal type (small bowel or colon)
- other types of glandular epithelium
- cardiac type epithelium with mucosal distortion, glandular atrophy, mild inflammation
Assessment of BE
-two segment types of BE
Long-segment - Barrett mucosa extending 3cm or more from GE jxn
Short-segment - Barrett mucosa extends <3cm from GE jxn
How is BE treated?
Anti-reflux therapy
Endoscopy every 1-2 years to detect dysplasia, carcinoma (4 quadrant biopsies at intervals of 2cm or less throughout the length of the Barrett’s segment plus any suspicious lesions
Postulated pathway of Dysplasia from BE
Esophagitis —> BE without dysplasia —> low grade dysplasia —> high grade dysplasia —> invasive adenocarcinoma
What is dysplasia arising in BE?
Dysplasia epithelium that does not invade lamina propria (premalignant)
Usually patchy or irregular and may appear endoscopically as thickened, or a polyploid mass
Dysplasia is assessed as low or high grade based on histologic assessment of biopsies
Esophageal carcinoma
A malignant neoplasm of the esophagus
Two types:
1) squamous cell carcinoma (upper 2/3 of esophagus)
2) adenocarcinoma (distal 1/3 of esophagus)
Squamous cell carcinoma
In upper 2/3 of esophagus
Most common world wide
Risk factors are tobacco and alcohol
Adenocarcinoma of esophagus
Distal 1/3 of esophagus
Common in western countries
Risk factor - Barrett esophagus
