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PATHOLOGYY2S2 > upper GIT > Flashcards

upper GIT Flashcards

1
Q

describe the esophagus?

A

hollow muscular tube

Extends from the epiglottis to the gastroesophageal junction

25 cm

has 2 physiological sphincters ( UES , LES )

mucosa/ submucosa / muscularis/ adventitia

non-keratinized stratified squamous epithelium

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2
Q

what is a heartburn?

A

burning pain in the chest

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3
Q

what is dysphagia?

A

difficulty swallowing

non specific word ( Could be due to any reason ) , very generic term

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4
Q

what is hematemesis ?

A

vomiting of blood

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5
Q

what are the two types of obstruction?

A

mechanical —> congenital anomaly for example

functional —> problem in contraction

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6
Q

what are examples of mechanical obstruction?

A

ectopic tissue ( abnormal tissue ) –> gastric tissue , sebaceous , pancreatic

atresia / fistula / stenosis / webs

Schiatzki ring –> lower esophagus ( leads to narrowing )

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7
Q

what is atresia?

A

failure of canalization –> the tube stops before reaching the place it is supposed to be at

it is a congenital anomaly

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8
Q

what is a fistula?

A

abnormal connection —> tube connects somewhere abnormal

also congenital anomaly

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9
Q

what is the most common place for atresia/fistula of esophagus?

A

most commonly near tracheal bifurcation and usually it is associated with a fistula connecting upper or or lower esophageal pouches to a bronchus or trachea

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10
Q

what is the result of atreisa/fistula?

A

aspiration

suffocation

pneumonia ( food goes to lung )

severe fluid and electrolyte imbalances

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11
Q

what is stenosis ?

A

narrowing of the esophagus due to inflammation and scarring

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12
Q

what are the causes of stenosis ?

A

chronic gastroesophageal reflux

irradiation

caustic injury

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13
Q

what is esophageal ring / web?

A

folds that block your esophagus either partially or completely

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14
Q

describe the rings?

A

bands of normal esophageal tissue that form constrictions AROUND the inside of esophagus ( surround the whole lumen )

different types depending on the location

Esophagus ring —> type A ring ( muscular )

lower esophageal sphincter ring –> Type B ring ( schatzki ring )

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15
Q

what is the commonest location for rings?

A

distal esophagus ( lower ? )

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16
Q

describe webs?

A

thin layers of cells that grow across the inside of esophagus

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17
Q

what is the commonest location for webs?

A

upper esophagus

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18
Q

what are the causes for webs/rings?

A

iron deficiency anemia

plummer vinson syndrome

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19
Q

what are the triads of plummer vinson syndrome ?

A

upper esophageal web

dysphagia

iron deficiency anemia ( carcinoma of oropharynx and upper esophagus )

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20
Q

what is functional obstruction ?

A

esophageal dysmotiltiy that interferes with the coordinated waves of peristaltic contractions responsible for delivering food and fluid to stomach

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21
Q

what are examples of functional obstruction?

A

Achalasia

hiatal hernia

zenker diverticulum

esophagophrenic diverticulum

mallory weiss tear

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22
Q

what is achalasia?

A

esophagospasm –> motiltiy disorder involving smooth muscle layer of esophagus in the absence of other explanations like cancer or fibrosis

( SO MOTILITY DISORDER WITHOUT AN EXPLANAING CAUSE )

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23
Q

what are the characteristics of achalasia?

A

difficulty swallowing

Regurgitation

chest pain

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24
Q

what are 3 triads of of achalasia ( failure to relax )

A

esophageal aperistalsis –>
inability of smooth muscles to move food down the esophagus

incomplete relaxation of the LES

Increased LES tone

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25
what is primary achalasia?
idopathic unknown
26
what is secondary achalasia?
arise due to diseases : chagas disease ( typanosoma cruzi infection ) Achalasia like disease : diabetic autonomic neuropathy infiltrative disorder such as malignancy , amyloidosis , sarcoidosis
27
describe hiatal hernia?
protrusion of the stomach into the thorax due to diaphragmatic crura defects ( diaphragmatic muscular defect ) widening of space which of the lower esophagus passes through
28
what are the 2 types of hiatal hernia?
sliding 95% of cases paraesophageal 5% of cases in all cases the stomach is above the diaphragm
29
describe sliding hiatus hernia?
both cardia and fundus of the stomach will be above
30
describe the paraesophageal hiatus hernia?
only the fundus will go above the diaphragm not the cardia junction
31
what is hiatal hernia usually associated with ?
associated with reflux Very common and increase with age
32
what are the complications of hiatal hernia?
ulceration bleeding perforation Strangulation
33
when does congenital hernia appear?
infants and children who has congenital hiatal hernias only appear later in life
34
what is esophageal diverticulum?
outpouching of mucosa through the muscular layer of esophagus
35
what are the classifications of epsophageal diverticulum?
true diverticulum ---> outpouching through all 4 layers false diverticulum ----> only through mucosa and submucosa layers
36
where is zenker esophageal diverticulum located?
high
37
describe zenker diverticulum?
posterior outpouching of mucosa and submucosa ( psuedo diverticulum ) through cricopharyngeal muscle it is pseudo /false diverticulum
38
what are the causes of zenker diverticulum?
incoordination between pharyngeal propulsion and cricopharyngeal relaxation and tightness of cricopharyngeus muscle
39
what are the characteristics of esophageal diverticulum?
bad breath ( severe halitosis ) regurgitation of food zenker smells bad
40
what is traction diverticulum?
traction from mediastinal inflammatory lesions
41
what is the location of traction?
Mid
42
whats assoicated with epiphrenic diverticulum?
motor dysfunction like achalasia/diffuse esophageal spasm
43
what is the location of epiphrenic diverticulum?
low
44
what is laceration?
longitudinal tears of the lower esophagus
45
what is the most common esophageal laceration?
mallory weiss tears?
46
what is the most common cause of mallort weiss tears?
alcoholics
47
laceration are usually secondary to what?
severe vomiting
48
what are the general characteristics of lacerations?
usually in alcoholics usually in mucosal tears
49
describe the process of laceration?
normally a reflex relaxation of the gastroesophageal musculature follows the contractile waves associated with the vomiting this relaxation reflex fails during prolonged vomiting , with the result that reflux gastric contents ---> cause esophageal wall to stretch and tear and the patient will present with hematemesis
50
what are the 3 common areas of portal /caval anastomoses ?
esophageal umbilical Hemorrhoidal
51
describe varices ?
100% related to portal hypertension Found in 90% of cirrhotic -- alcoholic liver disease hepatic schistomomiasis
52
what is the most feared complication of varices?
massive sudden fatal hemorrhage
53
how can varices be detected?
angiography and appear as tortuous dilated veins lying primarily within the submucosa of the distal esophagus and proximal stomach
54
what are the chemicals that could damage the stratified squamous mucosa of the esophagus?
LYE --> suicide attempts with strictures alcohol Extremely HOT drinks Chemo (harmful to all high turnover mucosas) all lead to esophagitis
55
what are infections that could to esophagitis ?
HSV CMV fungus --> especially candida ( usually in HIV )
56
what are other causes of esophagitis ?
GERD /reflux barretts esophagus
57
what are the risk factors for esophagitis?
decreased LES tone increased abdominal pressure obesity hiatal hernia slowed reflux clearing Delayed gastric emptying alcohol , tobacco
58
in which population is GERD more common in?
adults older than 40 years infants and children ( less likely )
59
what is the typical clinical presentation of GERD?
heartburn dysphagia regurgitation chest pain excessive salivation Gas Bloating Trouble sleeping sensitivity to some foods and liquids
60
what are the atypical presentation of GERD?
persistent cough chronic sore throat frequent and or difficulty swallowing Asthma hoarseness excessive throat cleaning bad breath dental erosions gum disease Ear and nose discomfort
61
what are the histological changes in Mild GERD?
mild gerd --> unremarkable
62
what are the histological changes in significant GERD?
hyperemia inflammatory cells in the squamous mucosa : eosinophils neutrophils lymphocytes basal zone hyperplasia lamina propria papillae elongated and congested due to regeneration
63
what is barretts esophagus?
complication of chronic GERD that is characterized by intestinal metaplasia within the esophageal squamous mucosa 10% of gerd patients get it white males 40-60 years of age
64
what is the diagnostic criteria for barrets esophagus?
Goblet cells present in esophageal mucosa
65
what is significance of barretts esophagus ?
single most common risk factor for esophageal adenocarcinoma any part of mucosa that becomes barretts is at risk search for dysplasia when you see barrets ( periodic endoscopy with biopsy )
66
what happens to G-E junction in barretts?
breached G-E junction
67
how is barretts esophagus recognized?
endoscopically as patches of red , velvety mucosa extending upward from the gastroesophageal junction alternates with residual smooth pale squamous mucosa and proximally interferes with light brown columnar gastric mucosa distally Diagnosis requires endoscopy and biopsy
68
what are the benign tumors of esophagus?
leiomyomas fibrovascular polyps condylomas HPV lipomas
69
what are the malignant tumors of esophagus ?
squamous cell carcinoma adenocarcinoma
70
what are the risk factors of squamous carcinoma?
tobacco ---> most imp Alcohol --> most imp polycyclic hydrocarbons nitrites / nitrosamines fungi in food ( nitrosamines ) esophagitis HPV infection
71
what is the most location for squamous carcinoma ?
50% of cases are in middle third of esophagus
72
what is the location of adenocarcinomas?
distal third esophagus
73
describe the process of developing squamous carcinoma?
dysplasia ----> in-situ ----> infiltration adenocarcinoma no in situ form
74
what are the risk factors of adenocarcinoma?
Barret esophagus, long standing GERD Tobacco obesity previous radiation therapy heterotopic gastric or submucosal glands whites 7 times more in men than women
75
describe the process of developing adenocarcinoma?
squamous epithelium ---> esophagitis ----> barret esophagus ---> dysplasia ----> carcinoma
76
what are the features of adenocarcinoma?
invade adjacent gastric cardia barret esophagus adjacent to the tumor tumor produce mucin and form glands

PATHOLOGYY2S2 (12 decks)

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