2 - Esophageal Path Flashcards
why do invasive esophageal lesions spread through the mediastinum so quickly?
no serosa
path of achalasia
marked reduction or absence of myenteric ganglion cells**
may also see diffuse squamous hyperplasia, florid lymphocytic esophagitis, submucosal gland atrophy
Boerhaave’s syndrome
full thickness esophageal perforation
Mallory-Weiss
partial thickness esophageal tears
MCC fungal esophagitis
candida
important criteria for diagnosis of candida esophagitis
pseudohyphae must infiltrate the tissue
commonly implicated drugs for pill esophagitis
abx (esp doxycycline), emepronium bromide, KCl, ferrous sulfate, quinidine, alendronate
corrosive/caustic esophagitis - what is it
usually due to alkaline or acid ingestion
coughing, crying, vomiting after ingestion
path of corrosive esophagitis
nonspecific necrosis and inflammation
acid - tends to be coag necrosis w/ eschar formation limiting depth of injury
alkaline - liquefactive necrosis, no eschar so tend to be deeper
3 tiered esophageal defense system
antireflux barriers (LES) luminal clearance mech (gravity, peristalsis, salivary bicarb) tissue resistance (cell membrane, jxns)
predisposing factors to esophageal reflux
dec LES tone (tobacco, alcohol)
anything that inc abdominal pressure
reflux esophagitis path
if severe, intraepithelial eos and lymphs
basal zone hyperplasia
congestion of small vessels w/ microhemorrhage
only shows hyperemia by endoscopy
Barrett esophagus
conversion of normal squamous epithelium to metaplastic columnar epithelium due to chronic GERD
predisposed to develop adenoCA
MC type of esophageal CA in US
adeno (squamous is worldwide though)
tx/prognosis for esophageal CA
esophagectomy - not common anymore
photodynamic therapy
prognosis is bad
