Esophageal Disorders Flashcards
what is the characteristic appearance of squamous cell carcinoma on histo slide?
solid clusters of cells
what is the difference between erosion and ulcer?
erosion is superficial necrosis that heals with regeneration while ulcer is deep necrosis that heals with fibrosis
what are three ways GI malignancies can grow?
fungating
infiltration
ulceration
what is fungating malignancy growth?
when it grows up
what is infiltrating malignancy growth?
when it grows to sides
what is ulcerating malignancy growth?
when it grows down and chews out some tissue
what is another GI issue that fibrosis or scarring can actually lead to?
a stricture
what are the two causes of achalasia?
lack of peristalsis in smooth muscle of esophagus and non relaxation of LES
what bug can cause achalasia? where does the bug infiltrate?
T cruzi
myenteric plexus ganglion
what will you see with barium swallowing with achalasia?
dilated esophagus and a BIRD BEAK narrowing at distal end
how to treat achalasia?
botox or dilatation with balloon
what is jackhammer esophagus?
hypercontractility of esophagus
what are two symptoms with jackhammer esophagus?
chest pain and dysphagia
what is ineffective esophageal motility? what disease does it occur with?
peristalsis happening just not effective..like CHF…happens with reflux disease
what is a scleroderma esophagus? when does this occur?
lack of peristalsis in the esophagus due to scleroderma autoimmune disease
what happens to the LES with scleroderma esophagus?
sphincter hypotension so you get regurg
name three infectious agents that cause esophagitis
candida
herpes simplex 1
CMV
what three things are seen in candida plaques in esophagitis?
candida pseudohyphae
necrotic debris
PMNs
with HSV1 what are the three Ms you see on histo slides in the esophagus?
margination
multinucleation
molding
what cells does HSV1 infect in esophagus?
epithelial cells
CMV leads to what gross pathology in the esophagus?
ulcers or erosions
what cell does CMV infect in the esophagus?
endothelial and fibroblasts
what are two findings on histo slides of CMV in the esophagus?
nuclear intrusions and cytomegaly
what can stuck pills causes grossly in esophagus?
inflammation and ulcer/erosion
what is eosinophilic esophagitis? how does it look grossly?
infiltration of eosinophils in the esophagus…leads to ring like structures that cause dysphagia
what is a hiatal hernia?
protrusion of stomach into the thorax through an enlarged diaphragmatic hiatus
what are the two types of hiatal hernias? which is most common?
sliding or rolling…sliding is most common
what is a common issue associated with hiatal hernias?
GERD bc LES not working well
is a hiatal hernia acquired or congenital?
acquired usually
what two cells are commonly seen in distal esophageal epithelium with GERD?
PMNs and eosinophils
what are extraesophageal symptoms of GERD?
chronic cough, laryngitis asthma and tooth decay
what are esophageal symptoms of GERD?
heartburn
acid regurg
chest pain
what can GERD lead to if it is persistent?
a stricture
what do you give to treat GERD as empiric therapy?
PPI
what are fivered flags of GERD?
weight loss vomiting bleeding anemia jaundice
what is the surgery for GERD called?
fundoplication…where they wrap part of the stomach around the esophagus
GERD can lead to Barrett metaplasia…what is this?
when distal esophagus starts to change into simple intestinal columnar epithelium
in Barretts…why does it change to intestinal columnar epithelium?
because it is used to stomach contents and has mucus to protect from the acid
what are the two types of neoplastic injuries of the esophagus?
squamous epithelium and metaplasia intestinal adenocarcinoma
what is the main cause of adenocarcinoma in the esophagus?
GERD/Barretts
what are two risk factors for squamous cell carcinoma of esophagus?
tobacco and alcohol
Barrett metaplasia has to go through one other step before it becomes adenocarcinoma…what is that step?
dysplasia…big pleomorphic nuclei
what is the pattern of adenocarcinoma of esophagus?
fungating ulcerating or infiltrating…any of them
where can squamous cell carcinoma occur in the esophagus?
any portion!
how does esophageal cancer present? 2 things
dysphagia with solids progressing to liquids…and weight loss
what appearance will esophageal cancer have on barium swallow?
raggedy appearance
if you have esophageal dysphagia with intermittent issues with solid food only…what do you likely have?
lower esophageal ring…schatzki ring
what is the cause of a lower esophageal ring?
unknown
if you have esophageal dysphagia with progressive issues with solid food only and chronic heartburn…what do you likely have?
peptic stricture
does a peptic stricture appear smooth or raggedy on barium swallow test?
smooth
if you have esophageal dysphagia with progressive issues with solid food only and weight loss…what do you likely have?
carcinoma of esophagus
if you have esophageal dysphagia with intermittent issues with solid and liquid food and chest pain…what do you likely have?
diffuse esophageal spasms
what is the cause of esophageal spasms?
unknown
if you have esophageal dysphagia with progressive issues with solid and liquid food and heartburn…what do you likely have?
scleroderma
if you have esophageal dysphagia with progressive issues with solid and liquid food and bland regurg/weight loss…what do you likely have?
achalasia
does scleroderms or achalasia have GERD? or both?
just scleroderma
if you have progressively worsening dysphagia with solid or liquid food and there are rings in the esophagus on upper endoscopy…what do ya have?
eosinophilic esophagitis
if you have iron deficiency and esophageal webs…what do you have?
plummer vinson syndrome
