esophageal pathology Flashcards
features of esophagitis
inflammation and injury of esophageal mucosa. Inury may lead to inflammation, or inflammation may lead to injury.
esophagitis histology
reactive epithelial changes with eosinophils or neutrophils
etiologies of esophagitis
Chemical injury: reflux, acids, alcohol, tobacco, meds. Infection: fungal or viral. Immune related: eosinophilic esophagitis. Radiation. Trauma.
Most prevalent form of esophagitis
reflux esophagitis
reflux esophagitis features
injury and inflammation that results from reflux of gastric contents into the esophagus. Results in GERD: heartburn, dysphagia, regurgitation
Pathophys of GERD
Hiatal hernia, decreased LES tone, increased abdominal pressure and delayed gastric emptying
GERD progression
erythema > erosion > ulceration. Few eosinophils at beginning.
Compare herpetic vs candida esophagitis
herpetic: pushed out ulcers and viral inclusions on histology. Candida: white plaques, and fungus on histology
What is eosinophilic esophagitis
caused by allergic and immunologic factors. Frequently coexists with allergic dz. Causes dysphagia, food impaction, and symptoms overlapping with GERD
Eosinophilic esophagitis scope and histology findings
scope: linear furrows and ringed esophagus. Histology: many eosinophils
List the various causes of esophageal obstruction
Functional: Nutcracker esophagus, Diffuse esophageal spasm, Hypertensive lower esophageal sphincter, Achalasia. Structural: Benign esophageal stenosis, Esophageal mucosal webs, Schatzki rings, Tumors
describe esophageal web
Web of tissue that partially obstructs esophagus
describe diffuse esophageal spasm
appears as a corkscrew esophagus
what is achalasia
area of constriction with megaesophagus above
common congenital anomalies of esophagus
atresia and fistulae
What are Mallory-Weiss tears
tears in esophagus from severe retching or vomiting, often associated with alcohol intoxication
What is Barrett esophagus
complication of chronic GERD. characterized by intestinal glandular metaplasia and confers increased risk of esophageal cancer
Histology of Barretts esophagus
epithelium is intestine like- columnar and glandular (metaplasia)
Progression of GERD
GERD > metaplasia (barretts) > dysplasia > adenocarcinoma
Histology of dysplasia in Barretts esophagus
low grade: elongated, dark nuclei. High grade: rounded nuclei, crowded glands
Most common types of esophageal tumors
adenocarcinomas and squamous cell carcinomas
Risk factors for adenocarcinoma
Most commonly arises from Barrett esophagus. associated with GERD, tobacco use, and radiation exposure. More common in men 7:1.
Adenocarcinoma histology
infiltrative, malignant glands
adenocarcinoma symptoms
dysphagia, odynophagia, weight loss, hematemesis
Squamous cell carcinoma risk factors
More common in Asia/africa. More common in men (4:1). Associated with alcohol, tobacco, dietary factors.
Squamous cell carcinoma symptoms
dysphagia, odynophagia, weight loss, hematemesis
