esophageal pathology

Question 1

features of esophagitis

Answer 1

inflammation and injury of esophageal mucosa. Inury may lead to inflammation, or inflammation may lead to injury.

Question 2

esophagitis histology

Answer 2

reactive epithelial changes with eosinophils or neutrophils

Question 3

etiologies of esophagitis

Answer 3

Chemical injury: reflux, acids, alcohol, tobacco, meds. Infection: fungal or viral. Immune related: eosinophilic esophagitis. Radiation. Trauma.

Question 4

Most prevalent form of esophagitis

Answer 4

reflux esophagitis

Question 5

reflux esophagitis features

Answer 5

injury and inflammation that results from reflux of gastric contents into the esophagus. Results in GERD: heartburn, dysphagia, regurgitation

Question 6

Pathophys of GERD

Answer 6

Hiatal hernia, decreased LES tone, increased abdominal pressure and delayed gastric emptying

Question 7

GERD progression

Answer 7

erythema > erosion > ulceration. Few eosinophils at beginning.

Question 8

Compare herpetic vs candida esophagitis

Answer 8

herpetic: pushed out ulcers and viral inclusions on histology. Candida: white plaques, and fungus on histology

Question 9

What is eosinophilic esophagitis

Answer 9

caused by allergic and immunologic factors. Frequently coexists with allergic dz. Causes dysphagia, food impaction, and symptoms overlapping with GERD

Question 10

Eosinophilic esophagitis scope and histology findings

Answer 10

scope: linear furrows and ringed esophagus. Histology: many eosinophils

Question 11

List the various causes of esophageal obstruction

Answer 11

Functional: Nutcracker esophagus, Diffuse esophageal spasm, Hypertensive lower esophageal sphincter, Achalasia. Structural: Benign esophageal stenosis, Esophageal mucosal webs, Schatzki rings, Tumors

Question 12

describe esophageal web

Answer 12

Web of tissue that partially obstructs esophagus

Question 13

describe diffuse esophageal spasm

Answer 13

appears as a corkscrew esophagus

Question 14

what is achalasia

Answer 14

area of constriction with megaesophagus above

Question 15

common congenital anomalies of esophagus

Answer 15

atresia and fistulae

Question 16

What are Mallory-Weiss tears

Answer 16

tears in esophagus from severe retching or vomiting, often associated with alcohol intoxication

Question 17

What is Barrett esophagus

Answer 17

complication of chronic GERD. characterized by intestinal glandular metaplasia and confers increased risk of esophageal cancer

Question 18

Histology of Barretts esophagus

Answer 18

epithelium is intestine like- columnar and glandular (metaplasia)

Question 19

Progression of GERD

Answer 19

GERD > metaplasia (barretts) > dysplasia > adenocarcinoma

Question 20

Histology of dysplasia in Barretts esophagus

Answer 20

low grade: elongated, dark nuclei. High grade: rounded nuclei, crowded glands

Question 21

Most common types of esophageal tumors

Answer 21

adenocarcinomas and squamous cell carcinomas

Question 22

Risk factors for adenocarcinoma

Answer 22

Most commonly arises from Barrett esophagus. associated with GERD, tobacco use, and radiation exposure. More common in men 7:1.

Question 23

Adenocarcinoma histology

Answer 23

infiltrative, malignant glands

Question 24

adenocarcinoma symptoms

Answer 24

dysphagia, odynophagia, weight loss, hematemesis

Question 25

Squamous cell carcinoma risk factors

Answer 25

More common in Asia/africa. More common in men (4:1). Associated with alcohol, tobacco, dietary factors.

Question 26

Squamous cell carcinoma symptoms

Answer 26

dysphagia, odynophagia, weight loss, hematemesis