Esoph and Gastric Pathophys Flashcards
Esophageal Atresia
Esophagus closes before reachign stomach
Treacheal-esophageal fistula
Hole between the two structures
Duplication cyst
Embryologic abnormality where you have a pouch that is a duplication of the esophagus where food can get stuck, give bad breath, regurgitation
Duplication cyst increases your risk for…?
Increased risk for squamous cell carcinoma of the esoph due to stasis of food
Inlet patch
Patches of ciliated or gastric type epithelium in the esophagus of embryologic origin (since fetal esophagus is initially ciliated since its is derived from same embryonic origin as trachea)
-no consequences for pt
Esophagitis
Inflammatory injury to mucosal lining of the esophagus causing inflammation–neutrophils and eosinophils are never normal while lymphocytes are sometimes normal
Reflux esophagitis
Failure of LES causing gastric contents to come into the esophageal lumen. Often causes linear ulcerations
Herpes esophagitis
Ulcers caused by herpetic infection, generally only in immunocompromised people
Candida esophagitis
fungal infection that often causes white, cheesy plaques
Eosinophilic esophagitis
Allergic reaction that can be caused by food or seasonal allergies causing infiltration or eosinophils that can lead to rings and fibrosis of esophagus
Schatzki ring
- Muscular ring covered by squamous epithelium
- One of the most common causes of dysphagia
Achalasia
- Initially a hypermotility disorder where LES does not relax thereby impeding on the progression of food bolus into stomach.
- Over time, esophagus dilates to accommodate inc pressure and food
- This leads to food stasis, increasing risk of squamous dysplasia and squamous cell carcinoma progression
Scleroderma
Causes selective atrophy of inner circular muscle layer of muscularis propria (smooth muscle so it is just the distal part)
Mallory Weiss Tear
A rip in distal esophagus causing massive bleeding due to repeated wrenching vomiting
List the benign tumors
- Papilloma
- Granular cell
- Mixed
- Lieyomyoma
List the malignant tumors
- Squamous and adenomcarcinoma
- Malignant nerve sheath
- ADenoid cystic
- Lieyomyo-sarcoma
Most common tumor worldwide vs US?
World: squamous cell carcinoma
USA: adenocarcinoma
Risk factors for adenocarcinoma?
- *obesity
- reflux
- diet
- male
- microbiome
Precursor lesion for adenocarcinoma?
Barrett’s esophagus (intestinal metaplasia in esophagus)
Long vs short segment of intestinal metaplasia
- Short segments do not convert to long segments (ie length of metaplasia is static)
- Risk of cancer is greater in long segment than in short segment Barett
Risk factors for squamous cell carcinoma
Drinking, smoking, moldy foods, geography, achalasia, lye ingestion, NOT HPV
Gastritis
- Inflammatory disorder of stomach that can be acute (iron pills, NSAIDs etc) or chronic (h pylori, autoimmune)
- Ulcers can bleed or completely perforate the stomach
- With or without “Activity” means with or without neutrophils.
What does atrophic gastritis mean?
Atrophic means loss of parietal and chief cells in the oxyntic mucosa.
Can lead to carcinoma/lymphoma
Most commonly caused by autoimmune disease
Acute gastritis leads to…
Barrier/epithelial breakdown/bleeding and inflammation allowing HCL to back diffuse into the lamina propria
Where does h pylori preferentially infect?
Antrum
- binds to surface cells by receptors so need biopsy to see organism
- with prolonged infection and injury, epithelium may undergo intestinal metaplasia and h pylori will migrate up
- some inject toxic Cag A, which injures the cell
Describe long term injury associated with atrophic gastritis
- pH increases due so G cells produce more gastrin
- Gastrin levels get too high trying to stimulate parietal cells, but there are none to stimulate
- ECLs are still stimulated, so histamine is released and ECL cells proliferate causing carcinoid tumors
- Also have decreased intrinsic factor (as well as acid) which leads to bacterial overgrowth and vitamin B12 deficiency, cancer and pernicious anemia
Fundic gland polyps
Benign protrusions, no proliferation involved
Hyperplastic gastric polyp
- Benign, must define the underlying gastric pathology
- Can be a source of bleeding, arise in gastritis setting
- USually in antrum, but can be anywhere
- Little neoplastic risk
- Composed of inflamed and proliferating mucosa
Why may gastric folds become enlarged?
- Lymphoma
- Gastric cancer
- MEtastatic breast lobular carcinoma
- Diffuse gastritis
- hypertrophic gastrophathies (true increase in gastric epith)
Zollinger Ellison Syndrome
- Gastrin secreting tumor causes expansion of parietal cell compartment and hypertrophy or folds
- Increased acid production leads to gastric ulcers (not stomach ulcers since there is no perforation of epithelium)
- Low pH inactivated pancreatic enzymes
Extra nodal marginal zone b cell lymphoma
- Most common lymphoma in the stomach
- H pylori causes lymphocytic response and these can transform
Two types of gastric cancer
- Intestinal (Gland formation)
2. Signet rings (single cells)
Pathogenesis of intestinal gastric cancer
- Repeated injury/chronic gastritis (can be due to h py) leads to intestinal metaplasia, dysplasia, adenocarcinoma
- Vit C protective as is vegetable consumption
- No inc risk with alcohol use
- Inc risk with processed meat due to N-nitroso compounds
- Can present as a non-healing ulcer
PAthogenesis of signet ring intestinal gastric cancer
- No injury/gastritis, need two hit E cadherin mutation.
- Associated with lobular breast cancer
- Presents as giant folds or leather bottle stomach
