Esophageal and Gastric Pathology

Question 1

In early development, the trachea and the esophagus are lined by what kind of epithelium?

Answer 1

CILIATED, stratified columnar

Question 2

Describe the epithelial changes the esophagus goes through

Answer 2

Ciliated stratified columnar –> less stratified columnar –> columnar with mucinous secretion –> non-keratinized stratified squamous epithelium

Question 3

What is gastric ectopia?

Answer 3

A piece of the esophagus epithelium does not change to stratified squamous but remains as columnar

Question 4

What is congenital/infantile hypertrophic pyloric stenosis?

Answer 4

Muscles in pylorus are so thick they look like an abdominal mass

Presents early in life with new-onset regurgitation, projectile, non-bilious vomiting after feeding

Question 5

What are esophageal webs? Where are they located? How do they present?

Answer 5

eccentric, thin membranes of tissue in the esophagus

Proximal region

Asymptomatic

Question 6

What are esophageal rings? Where are they located? How do they present?

Answer 6

Concentric, thin diaphragm of tissue in the esophagus

Distal Esophagus

Asymptomatic

Question 7

What are pulsion diverticula? Where are they located? How do they present?

Answer 7

Out-pouching caused by increased intraluminal pressure

Location: proximal and distal esophagus

Secondary to motility disturbances such as achalasia

Question 8

What are traction diverticula? Where are they located? How do they present?

Answer 8

Extrinsic inflammation retracts or pulls bowel wall outwards

Location: mid-esophagus

Not as common as pulsion diverticula

Question 9

Is the appearance of eosinophils in the esophagus normal?

Answer 9

NO

Question 10

Name all the etiologies that can cause esophagitis

Answer 10

Mechanical (Achalasia)
Trauma
Reflux (GERD)
Corrosive Injury
Pills/Drugs
Infections (Viral, Fungal)
Allergies
Radiation Injury
Graft-Versus Host Disease
Systemic Disorders

Question 11

What is Boerhaave Syndrome?

Answer 11

Rupture of esophagus post vomiting (due to sudden increase in intraluminal esophageal pressure)

Question 12

What are Mallory-Weiss Tears?

Answer 12

Mucosal lacerations (tears) in distal esophagus and proximal stomach (due to retching, vomiting, straining, coughing, etc. most commonly after heavy alcohol use)

Question 13

Describe development of esophagus and trachea in early life.

Answer 13

Esophagus and trachea lie within a single tube –> laryngotracheal diverticulum develops –> formation of primitive septum –> trachea and esophagus separate, formation of lung buds

Question 14

How does scleroderma cause esophageal problems?

Answer 14

generalized GI dysmotility due to complete loss/atrophy of inner muscularis propria layer (outer layer is still preserved).

inner muscle layer is replaced by fibrotic collagenous tissue AND the LES is defective

Question 15

What are the three types of benign esophageal tumors?

Answer 15

Epithelial
Granular Cell
Leiomyoma (tumor of smooth muscle)

Question 16

What is the most common malignancy of esophagus? (general answer)

Answer 16

Carcinoma
(squamous cell is one type, adenocarcinoma is another type)
(Western world, adenocarcinomas are most common)
(in the rest of the world, squamous cell is most common)

Question 17

In squamous cell carcinoma of the esophagus, what part of the esophagus is most commonly affected?

Answer 17

Middle third (NOT associated with reflux)

Question 18

Risk of developing adenocarcinoma is higher in which type (long segment or short segment)

Answer 18

Long segment

Question 19

Glands in cardia are composed of …..?

Answer 19

mucin producing cells

Question 20

Glands in antrum are composed of …?

Answer 20

G cells that secrete gastrin
D cells that secrete somatostatin
Enterochromaffin cells that secrete serotonin

Also have mucus secreting cells

Question 21

Glands in fundus and body are composed of …?

Answer 21

Chief cells

Parietal cells

Question 22

What are the benign tumors of the stomach?

Answer 22

Fundic gland polyp
Hyperplastic polyp
Hypertrophic gastropathy

Question 23

What are the malignant tumors of the stomach?

Answer 23

Lymphoma

Gastric adenocarcinoma

Question 24

What are the types of gastric adenocarcinoma?

Answer 24

Intestinal type
Signet ring type
Diffuse type

Question 25

Differentiate between intestinal and signet ring type primary gastric adenocarcinoma

Answer 25

Intestinal type:
chronic gastritis, intestinal metaplasia –> dysplasia –> adenocarcinoma

Signet ring:
no chronic gastritis, mutation in E-cadherin

Question 26

What are Gastroinstestinal Stromal Tumors (GIST)

Answer 26

arise from intestinal pacemaker cells of Cajal (ICC)

Defined by immunoreactivity to c-KIT (CD117), a tyrosine kinase growth factor receptor

All GIST tumors carry a malignant risk potential