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06. Gastrointestinal Pathology > 3. Esophagus > Flashcards

3. Esophagus Flashcards

1
Q

Disorders in the Esophagus

A
  1. Congenital anomalies
    - Esophageal agenesis
    - Esophageal atresia
  2. Esophagitis
    - Laceration & Ruptures
    - Chemical & Infectious esophagitis
    - Reflux esophagitis (GERD)
  3. Barrett Esophagus
  4. Esophageal obstruction
    - Diffuse esophageal spasm
    - Esophageal stenosis
    - Esophageal mucosal webs
    - Esophageal rings (Schatzki Rings)
    - Achalasia
  5. Neoplasm
    - Squamous cell carcinoma
    - Adenocarcinoma
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2
Q

Esophageal agenesis

A

Complete absence of the esophagus

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3
Q

Esophageal atresia

A
  1. Thin non-canalized cord replaces a segment of the
    esophagus, causing esophageal obstruction
  2. Occurs most commonly at or near to the bifurcation of the trachea
  3. Usually associated with a tracheoesophageal fistula
    connecting the upper esophageal pouch to the trachea or the lower esophageal pouch to a bronchus
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4
Q

Definition of esophagitis

A

Inflammation of the esophageal mucosa

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5
Q

Laceration and ruptures leading to esophagitis

A
  1. Mallory-Weiss Tears
    - Longitudinal tears in the esophagus near the gastroesophageal junction
    - Often associated with severe retching or vomiting secondary to acute alcohol intoxication
    - Postulated to be due to failure of normal reflex relaxation of the gastroesophageal musculature preceding antiperistaltic contractile waves in prolonged vomiting, resulting in stretching & tearing of the esophageal wall
    - Presents with upper GI bleeding (hematemesis)
  2. Boerhaave Syndrome
    - Distal esophageal rupture due to vomiting
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6
Q

Chemical esophagitis

A

Esophageal mucosal damage by chemical irritants:

  • Alcohol, corrosive acids/alkalis, excessively hot liquids, heavy smoking
  • Chemotherapy & radiation
  • Uremia
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7
Q

Infectious esophagitis

A

Esophageal mucosal damage by infectious agents:

  1. HSV, CMV, Candida
  2. Typically occurs in immunocompromised patients
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8
Q

Pathological effects & complications of Chemical & Infectious Esophagitis

A
  1. Dysphagia
  2. Hemorrhage
  3. Stricture
  4. Perforation
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9
Q

Definition of reflux esophagitis (Gastroesophageal Reflux Disease)

A

Reflux of acidic gastric contents into the lower esophagus resulting in acid-induced mucosal damage
- Due to decreased lower esophageal sphincter (LES) tone &/or increased abdominal pressure

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10
Q

Causes of reflux esophagitis

A
  1. Hiatal hernia (functional decrease in LES tone)
  2. Alcohol & tobacco use, pregnancy, antidepressants,
    obesity (decrease LES tone)
  3. Delayed gastric emptying (increases abdominal
    pressure)
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11
Q

Pathological effects & complications of reflux esophagitis (GERD)

A
  1. Retrosternal pain (heartburn)
  2. Dysphagia (sclerosis & stricture)
  3. Peptic ulceration of esophageal mucosa with resultant hematemesis
  4. Intestinal metaplasia leading to Barrett esophagus with increased risk of adenocarcinoma
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12
Q

Definition of Barrett Esophagus

A

Complication of chronic GERD (10%), characterized by intestinal metaplasia within the esophageal squamous mucosa

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13
Q

Causes of Barrett esophagus

A

Chronic gastroesophageal reflux disease (i.e. anything

that causes prolonged reflux esophagitis)

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14
Q

Criteria for the diagnosis of Barrett esophagus

A
  1. Endoscopic evidence of columnar epithelium above
    gastroesophageal junction
  2. Histologic evidence of intestinal metaplasia (presence of goblet cells)
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15
Q

Morphology of Barrett esophagus

A
  1. [Grossly]
    - Occurs in distal esophagus
    - Red velvety mucosa amidst pearly grey- white appearance of normal squamous epithelium
  2. [Histologically]
    - Squamous epithelium replaced by metaplastic intestinal epithelium
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16
Q

Pathological Effects & Complications of Barrett esophagus

A
  1. Ulceration of esophageal mucosa & resultant bleeding
  2. Scarring & strictures
  3. Dysplasia
  4. Esophageal adenocarcinoma (40x risk)
17
Q

Diffuse esophageal spasm

A

Causes increase in esophageal wall stress, resulting in the formation of small diverticulae (pseudodiverticulae as they lack a true muscularis)

  • Zenker diverticulum (immediately above UES)
  • Traction diverticulum (midpoint of esophagus)
  • Epiphrenic diverticulum (immediately above LES)
18
Q

Esophageal stenosis

A
  1. Due to fibrous thickening of the submucosa
  2. Causes:
    - Congenital
    - Acquired: chronic GERD, chemical and radiation-induced esophagitis
19
Q

Esophageal mucosal webs

A
  1. Ledge-like, semicircumferential protrusions of mucosa most commonly found in the upper esophagus
  2. Unknown cause, but associated with GERD & chronic graft-versus-host disease
20
Q

Esophageal rings (Schatzki rings)

A

Similar to esophageal mucosal webs but are circumferential & thicker, including submucosa &, in some cases, hypertrophic muscularis propria

21
Q

Achalasia

A

Characterised by the triad of:

  1. Incomplete LES relaxation
  2. Increased LES tone
  3. Aperistalsis of the esophagus
22
Q

Causes of achalasia

A
  1. Primary achalasia: idiopathic (failure of distal esophageal inhibitory neurons)
  2. Secondary achalasia: Chagas disease, diabetic
    autonomic neuropathy, lesions of dorsal motor nuclei (due to polio or surgical ablation)
23
Q

Epidemiology and associations of squamous cell carcinoma

A
  1. Older age group
  2. Males > females
  3. China, africa
  4. Dietary & environmental factors: alcohol, tobacco, nitrites, nitrosamines
24
Q

Squamous cell carcinoma is typically found in

A

Middle portion of the esophagus

25
Q

Pathogenesis of squamous cell carcinoma

A
  1. Carcinoma-in-situ to invasive squamous cell carcinoma progression
  2. Plentiful submucosal lymphatics present in esophageal wall, which permits tumour cell infiltration above & below level of apparent tumour (hence surgical resection of tumour may not clear all tumour cells)
  3. Local extension into mediastinum (direct invasion)
  4. Lymph node metastases: upper 1/3 (to cervical nodes), middle 1/3 (to mediastinal nodes), lower 1/3
    (to gastric & celiac nodes)
26
Q

Complications and pathological effects of squamous cell carcinoma

A
  1. Dysphagia, odynophagia
  2. Invasion of surrounding structures (pericardium, respiratory tree)
  3. Potentially forms tracheoesophageal fistula with subsequent aspiration
27
Q

Epidemiology and associations of adenocarcinoma

A
  1. Males > Females
  2. Associated with Barrett esophagus (40x risk)
  3. Dietary & environmental factors: tobacco, obesity, prior radiation therapy
28
Q

Adenocarcinoma is typically found in the

A

Distal esophagus (lower 1/3 of the esophagus)

29
Q

Pathogenesis of adenocarcinoma

A
  1. Typically arises in a background of Barrett esophagus & chronic GERD
  2. Intestinal metaplasia → dysplasia → invasive adenocarcinoma progression

06. Gastrointestinal Pathology (5 decks)

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