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ACP GI and HBP system, Urogenital system > BAP35 - Esophageal pathology > Flashcards

BAP35 - Esophageal pathology Flashcards

1
Q

State the 4 histological layers in GI tract from the lumen to intraperitoneal organs.

A

Mucosa > Submucosa > Muscularis propria > Serosa

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2
Q

What is the difference between serosa and adventitia?

A

Serosa: intraperitoneal organs
Adventitia: extraperitoneal organs

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3
Q

Obstructive diseases can be categorized into mechanical and functional obstruction.
What are the 2 types of mechanical obstruction? Give examples

A
  1. Atresia
  2. Fistula
  3. Esophageal atresia: congenital absence of the lumen
  4. Tracheoesophageal fistula: abnormal connection
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4
Q

Which of the following about mechanical obstruction is incorrect?
A. In esophageal atresia, MC occurs near in the proximal 1/3 of the esophagus.
B. Patients may present with aspiration pneumonia
C. Patients may present with regurgitation
D. Patients will have severe fluid/electrolyte imbalance
E. Most common type of tracheoesophageal fistula involves connection to lower esophagus (type III)

A

A

  • MC of esophageal atresia happens near tracheal bifurcation
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5
Q

Atresia and Fistula are both due to _________________ in the 4th week of gestation.

A

Failure of foregut division

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6
Q

Functional obstruction of the esophagus = ?

A

Achalasia

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7
Q

Esophageal motor disorder is characterized by triads of?

A
  1. Aperistalsis
  2. Increased resting tone of LES (lower esophageal sphincter)
  3. Incomplete LES relaxation during swallowing
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8
Q

What are the etiologies of achalasia? (2)

A
  1. Primary: idiopathic (I don’t know but more professional) (degeneration of inhibitory neurons)
  2. Secondary: Chagas disease (destruction of myenteric plexus)
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9
Q

Which of the following about achalasia is correct?

A. Progressive dysphagia in 99% patients
B. Patients may present with nocturnal regurgitation
C. Complications include candida esophagitis
D. Aspirational pneumonia is a complication
E. Esophageal squamous cell carcinoma is an important complication.

A

All of the above

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10
Q

What are esophageal varices? Cause?

A

Dilated tortuous submucosal veins in lower esophagus due to portal hypertension

*40% mortality in 1st episode

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11
Q

State the pathogenesis of esophageal varices.

Portal hypertension&raquo_space;>?

A

Portal hypertension > Backflow of portal blood to portocaval system > Enlargement of submucosal venous plexus in distal esophagus > Massive hematemesis

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12
Q

Etiology: VITAMIN C&D?

A
  • Vascular
  • Inflammatory/ Infection
  • Traumatic/ toxin
  • Autoimmune
  • Metabolic
  • Iatrogenic/ Idiopathic
  • Neoplastic
  • Congenital
  • Degenerative
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13
Q

What are the 3 types of esophagitis?

A
  1. Mallory-Weiss syndrome
  2. Reflux esophagitis
  3. Barrett esophagus
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14
Q

In Mallory Weiss Syndrome, there are ____________________ tears of distal esophagus +/- proximal stomach.

A

Longitudinal mucosal (superficial)

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15
Q

Which of the following about Mallory Weiss syndrome is incorrect?

A. It is self limiting
B. It is associated with excessive alcohol intake
C. It is due to failed reflex relaxation of musculature in prolonged vomiting
D. Boerhaave syndrome is a severe form of MWS and is life-threatening
E. There is replacement of distal squamous epithelium with metaplastic columnar epithelium

A

E

Should be Barrett esophagus!

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16
Q

Pathogenesis of MWS:

Failed reflex relaxation of musculature in prolonged vomiting &raquo_space;>?

A

Increased intraluminal esophageal pressure > Laceration at or near gastroesophageal junction > Reflux of gastric content

17
Q

In Boerhaave syndrome (severe form of MWS), there is ___________esophageal tears, causing rupture of the ________ esophagus, spreading gastric content into ___________. This requires immediate surgical intervention as it is life-threatening.

A

Transmural;
distal;
mediastinum

18
Q

What is the most common type of esophagitis?

Definition of this type of esophagitis?

A

Reflux esophagitis - reflux of gastric content +/- duodenal bile into lower esophagus

19
Q

List 3 presentations of patients with reflux esophagitis.

A
  1. Heartburn (mimics angina)
  2. Dysphagia
  3. Regurgitation
20
Q

Which of the following about reflux esophagitis is correct?
A. It can cause stricture of the esophagus
B. It can progress to Barrett esophagus
C. Histology have no correlation with the symptoms of severity
D. In histology, there is basal zone hyperplasia
E. There is papillary elongation of the lamina propria
F. Leukocytic exocytosis can be observed (with neutrophil and eosinophil)

A

All of the above

C: correct, only for assessing Barrett esophagus

21
Q

Definition of Barrett esophagus.

A

Replacement of distal squamous epithelium with metaplastic columnar epithelium of the esophagus.

22
Q

What can be seen in endoscopic and histological examination in Barrett esophagus?

A

Endoscopic: Salmon-colored mucosa at 1cm about the OGJ.

Histological: Presence of goblet cells (intestinal metaplsia) + columnar cells

23
Q

Barrett esophagus is the major and only factor for esophageal ____________________ and ___________. But majority do not develop.

A 
Glandular dysplasia (pre-malignant lesion);
Adenocarcinoma
24
Q

Which of the following about esophageal carcinoma is incorrect?
A. It is male predominant
B. Common presenting age: 60-70 years old
C. 90% of CA esophagus is adenocarcinoma
D. Greatest risk factor for squamous cell carcinoma in esophagus is smoking, alcohol, hot drinks
E. They present with dysphagia, rapid weight loss and hemoptysis etc.

A

C

90% is SCC!

25
Q

Risk factor for Adenocarcinoma in the esophagus is Barrett esophagus.

List the risk factors for SCC in esophagus other that lifestyle factors. (2)

A
  1. Esophageal disease: achalasia, Plummer-Vinson syndrome (esophageal web, anemia, atrophic glossitis)
  2. Tylosis (hyperkeratosis of palms and soles; AD; RHBDF 2 mutation)
26
Q

Commonest site of SCC and Adenocarcinoma of the esophagus respectively?

A

SCC: Mid third
A: Distal third

27
Q

Explain the following presentations of esophageal carcinoma.

  1. Dry cough, hemoptysis
  2. Hoarseness of voice
  3. Hypercalcemia
A
  1. Tracheal invasion
  2. Invasion to the RLN
  3. PTHrP ~ lung SQCC/RCC
28
Q

Esophageal carcinoma is may be due to the overexpression of _________________, therefore, ___________ can be used as treatment.

A

HER2 oncoprotein;

Anti-HER2 monoclonal antibody (if tested HER2 +)

29
Q

Both squamous cell carcinoma and adenocarcinoma are _________ tumor.

A

Epithelial

ACP GI and HBP system, Urogenital system (10 decks)

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