Chapter 13: GI Congenital and Esophagus Flashcards
Where do the upper, middle, and lower esophageal lymph nodes drain?
How about the upper, middle, and lower esophageal veins?
Upper - Cervical lymph nodes, superior vena cava
Middle - Mediastinal nodes, Azygous system
Lower - Celiac and gastric nodes, portal vein
A baby develops aspiration after birth. What is the likely diagnosis?
Tracheoesophagela fistula. Generally combined with some esophageal atresia (esophageal stenosis can occur in separate settings)
Usually upper end of esophagus ends in a blind pouch, lower end communicates with the trachea. Pouch fills with mucus.
What is VATER syndrome?
Associated with atresia of the proximal esophagus.
Vertebral defects
Anal atresia
Tracheoesophageal fistula
Renal dysplasia
Esophageal atresia and fistula are associated with what other congenital condition?
Congenital heart disease
Some tubular remnants are found that replicate the normal anatomy of the affected bowel.
Duplication cysts.
Most ommon in the small bowel. Usually continuous with segment of bowel from which arise. May form expanding intramural masses, can obstruc bowel.
A middle-aged woman presents with difficulty swallowing. Endoscopy shows a thin mucosal membrane projecting into the esophageal lumen.
Esophageal webs.
Core of fibrovascular tissue lined by normal esophageal epithelium.
Treat with dilation with large rubber bougies. Excise with biopsy forceps.
A patient presents with esophageal webs, mucosal lesions of the mouth and pharynx, and iron deficiency anemia.
Plummer-Vision (Paterson-Kelly) syndrome.
Nearly all women.
Carcinoma of the oropharynx and upper esophagus is a complication.
A patient presents with intermittant dysphagia. Imaging reveals a lower esophageal narrowing.
Schatzki Ring. Usually at gastroesophageal junction.
Upper surface is stratified squamous epithelium, the lower columnar epithelium.
An outpouching of the esophageal wall that contains all layers of the esophagus.
An outpouching of the esophageal wall that contains all layers of the esophagus except the muscular layer.
True and false esophageal diverticulum, respectively.
An elderly man presents complaining of regurgitating food he ate several days ago. On examinaiton, there is an outpouching of the esophagus filled with food.
Zenker diverticulum - a false diverticulum. Appears high in the esophagus.
Aspiration pneumonia may occur.
A patient presents with an asymptomatic diverticulum in the middle of th eesophagus.
Traction diverticula.
Used to attach to adjacent mediastinal lymph nodes, associated with tuberculous lymphadenitis.
Reflects a disturbance in the motor function of the esophagus.
A young patient presents with nocturnal regurgitation of fluid. Examination reveals an enlargement of the esophagus immediately above the diaphragm.
Epiphrenic diverticula. A true diverticulum.
Motor disturbances of the esophagus (achalasia, diffuse esophageal spasm) in 2/3rds of patients.
A patient presents with food retention in the esophagus. It is found that the lower esophageal sphincter fails to relax with swallowing, and there is an abscence of peristalsis in the body of the esophagus.
Achalasia - associated with loss of myenteric ganglion cells. Chronic inflammation around myenteric nerves and residual ganglion cells.
Genetic, viral, and autoimmune factors suggested.
Complication of Chagas disease - Trypanosoma cruzi destroys ganglion cells.
Symptoms of achalasia may occur in amyloidosis, sarcoidosis, malignancies.
A patient presents with GERD. Exam reveals abnormally reduced esophageal motility and peristalsis. Examination reveals impairment of the lower esophageal sphincter, such that it is no longer distinct from the upper stomach.
Microscopic examination shows fibrosis of esophageal smooth muscle with nonspecific inflammatory changes.
Scleroderma.
A cap of gastric mucosa moves upward above the diaphragm following enlargement of the diaphragmatic hiatus.
Sliding hernia, asymptomatic.
A patient presents with long-standing heartburn. Biopsy shows basal hyperplasia, papillae, squamous hyperplasia, and inflammation.
Reflux esophagitis.
Seen with sliding hiatal hernias frequently or through incompetent lower esophageal sphincter. Alcohol, chocolate, fatty foods, cigarette smoking, CNS depressants, pregnancy, estrogen therapy.
Hyperemiam, mucosal erosions and ulcers (vertical linear streaks), cell swelling (hydropic change), squamous hyperplasia.
A elderly patient is evaluated for long-standing GERD. Endoscopy with biopsy demonstrate intestinal metaplasia - specifically, replacement of esophageal squamous epithelium by columnar epithelium.
Barrett esophagus. Males, smoking, age.
Distinctive salmon pink color,goblet cells intersperced with gastric foveolar cells. Risk of transforming into adenocarcinoma correlates with length of esophagus involved and degree of dysplasia.
Shown below is high grade dysplasia. Dysplastic glands predominate with hyperchromatic nuclei and architectural distortion.
A patient presents complaining of a sensation of particular foods “sticking” upon swallowing. Standard antireflux therapy fails to improve symptoms.
Endoscopy reveals characteristic transverse ridges (trachealization) and small white plaques.
Eosinophilic esophagitis - allergic?
Intense eosinophilic infiltrate within squamous mucosa on biopsy.
A patient with cirrhosis presents in shock. The following specimens are shown at biopsy.
Esophageal varices. Blue venous channels beneath the mucosa of the everted esophagus.
Section shows dilated submucosal veins.
A smoker presents with difficulty swallowing and blood in the vomit.
Esophageal squamous cell carcinoma. Ulcerated mass.
Usually in upper-middle thirds.
Pearls -> poorly differentiated. Some have dominant spindle cell population (metaplastic)
A patient with a history of Barrett esophagus presents with worsening dysphagia.
Endoscopy reveals the following lesion.
Adenocarcinoma of the esophagus.
Most commonly inactivation of INK4A/CDKN tumor suppressor gene p16.
p53 loss, inactivation of RB, aneuploidy, amplification of cell cycle related genes.
