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Pathology II Exam II > Esophagus > Flashcards

Esophagus Flashcards

1
Q

What do each of the letters in ‘VITAMIN’ of the surgical sieve categories of disease discussed in lecture stand for?

A
  • Vascular
  • Infectious/Inflammatory
  • Traumatic
  • Anatomic
  • Metabolic
  • Idiopathic
  • Neoplastic
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2
Q

Auerbach’s myenteric plexus is located in the muscularis propria or mucosal layer?

A

Muscularis propria

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3
Q

Which sphincter approximates the gastroesophageal junction (GEJ)?

A

Lower esophageal sphincter

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4
Q

The squamocolumnar junction (SCJ) is also called what?

A

Z line

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5
Q

How is the anatomic GEJ defined?

A

Takeoff of gastric folds

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6
Q

Normally the SCJ approximates the GEJ, but what happens in Barrett’s esophagus?

A

Proximal displacement of SCJ off GEJ

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7
Q

Name 3 ways to visualize the esophagus

A
  1. Gross exam (autopsy)
  2. Barium swallow (diagnostic)
  3. Endoscopy (diagnostic and therapeutic)
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8
Q

What is pyrosis in relation to the esophagus? What is water brash? What is globus? Eructation?

A

pyrosis: heartburn
water brash: hyper salivation
Globus: lump in the throat
Eructation: belching

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9
Q

If an infant has choking, coughing, cyanosis with onset of feeding, what should you check for?

A

Tracheo-esophageal fistula

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10
Q

Achalasia is a failure of the LES to relax with progressive destruction of the myenteric plexus. It results in dysphagia and an increased risk of what cancer?

A

carcinoma

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11
Q

Secondary achalasia is associated with what diseases (2)?

A

Chaga’s disease (trypanosome cruzi)

Scleroderma

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12
Q

Scleroderma results in fibrosis of which muscular layer of the esophagus?

A

INNNER CIRCULAR LAYER

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13
Q

If you have scleroderma, you will get unopposed reflux and have a greater propensity to develop what?

A

Barrett’s esophagus

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14
Q

T/F- a hiatal hernia (protrusion of the stomach above diaphragm) is usually symptomatic

A

False, most patients are asymptomatic but some have reflux symptoms, bleeding, ulceration, perforation

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15
Q

What type of hernia (sliding or paraesophageal (PE)) is more common?

A

Sliding (95%)

Paraesophageal (rolling) (5%)

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16
Q

What is a serious complication of paraesophageal hernias?

A

strangulation (infarction of incarcerated hernia)

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17
Q

Name the most common characteristic of diverticula in each category

  1. congenital or acquired
  2. True (all gut layers) or false
  3. Pulsion (peristalsis against a closed sphincter or traction (extrinsic pull secondary to inflammation)
A
  1. acquired>congential
  2. False>true
  3. Pulsion>traction
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18
Q

What is a zenker diverticulum?
Midesophageal?
Epiphrenic?

A
  • zenker- usually pulsion type which forms above UES
  • midesophageal- usually due to traction
  • epiphrenic- pulsion, forms above LES
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19
Q

What symptoms would you expect in a zenker diverticulum?

A

Dysphagia, globus, food impaction, regurgitation, aspiration, HALITOSIS

20
Q

Mallory Weiss syndrome is hematemesis from laceration of GEJ mucosa/submucosa, what causes this and who is at greatest risk?

A

Cause: forceful retching/coughing/vomiting
Risks: alcoholics, eating disorders

21
Q

T/F- ruptured varices (dilated submucosal veins) are a frequent cause of death in alcoholics

A

True

22
Q

What is an esophageal web and what condition is it associated with?

A
  • web: shelf of tissue (eccentric) that can be congenital or post-inflammatory
  • Plummer-vinson syndrome (sideropenic dysphagia): glossitis, dysphagia, iron deficiency
23
Q

What is an esophageal ring?

A
  • ring: circumferential (“Schatzki” if at SCJ)

- esophagitis related

24
Q

Stenosis/stricture of the esophagus is commonly due to what factor?

A

radiation

25
Q

Name common causes of esophagitis

A
  1. topical injury (alcohol, corrosive substances (acid, lye), hot liquids
  2. cytotoxic chemo (radiation, GVHD)
  3. stuck pills (doxycycline, aspirin, iron, alendronate)
  4. Infectious (see next flashcard)
26
Q

Review Characteristics of infectious esophagitis

A
  • Immunocompromised (DM, post-chemotherapy, transplant, HIV, older) vs. immunocompetent
  • Odynophagia is a common symptom!!!!!!!!!!!!!!!!!!
  • Candida – white plaques; PMN’s; parakeratosis
  • Herpes – punched out ulcers; squamotropic; cytopathic effect (CPE) at edge of ulcers
  • Cytomegalovirus (CMV) – single deep ulcer; endothelial/ stromal cells, columnar epithelium; CPE in depth of ulcer
27
Q

Distinguish GERD vs reflux esophagitis (RE)

A

GERD: “condition that develops when reflux of stomach contents causes troublesome symptoms and/or complications”
RE: endoscopic or histologic evidence of reflux-associated injury

28
Q

T/F- GERD is more prevalent in the west than in Asia

A

True (10-20% in west vs <5% in asia)

29
Q

Name 3 causes of GERD

A

LES dysfunction, decreased acid clearance, defective barrier function

30
Q

Name 3 symptoms of GERD

A

heartburn, regurgitation, dysphagia

31
Q

Name 3 complications of GERD

A

stricture, Barrett’s esophagus, adenocarcinoma

32
Q

Name 2 important histologic features of reflux

A
  • Epithelial hyperplasia (basal zone and papillary elongation)
  • Dilated intercellular spaces
33
Q

Name the normal cutoff percentages for papillary height (PE) and basal zone height (BZH)

A

PE: 67%
BZH: 15%

34
Q

What is the key inflammatory cell you will see histologically in reflux?

A

intraepithelial eosinophils

35
Q

Define eosinophilic esophagitis

A

primary clinicopathologic disorder of the esophagus characterized by esophageal and/or upper GI tract symptoms in association with esophageal mucosal biopsy specimens containing ≥15 intraepithelial eosinophils per high-power field in 1 or more biopsy specimens and absence of pathologic GERD as evidenced by a normal pH monitoring study of the distal esophagus or lack of response to high-dose PPI medication

36
Q

Name the symptoms of eosinophilic esophagitis

A

Symptoms include food impaction, dysphagia (adults); GERD type symptoms, feeding intolerance (children)

37
Q

How would you diagnose eosinophilic esophagitis? How would you treat it?

A
  • Diagnosis – esophageal symptoms + mucosal biopsy + exclusion of GERD (lack of response to PPI or normal pH monitoring)
  • Treatment – elimination and elemental diets, acid suppression, topical corticosteroids, dilatation of strictures
38
Q

Define Barrett’s esophagus

A

Definition (US): Endoscopically evident apparent columnar mucosa proximal to the anatomic GEJ with biopsy demonstrating intestinal metaplasia (i.e., goblet cells)

39
Q

How is Barrett’s esophagus diagnosed?

A

Diagnosis – 2 EGD’s with bx within 1 yr (confirm dx; rule out prevalent dysplasia)

40
Q

How is Barrett’s esophagus treated?

A

Treatment – PPI for GERD; endoscopic ablative tx or surgery for dysplasia/carcinoma

41
Q

What factors is the need for “surveillance” of the barrett’s esophagus determined by?

A

Determined by absence or presence of dysplasia, grade of dysplasia

42
Q

Name 2 advanced techniques for treating Barrett associated neoplasia?

A
  • endoscopic mucosal resection

- radiofrequency ablation

43
Q

T/F- The Incidence of Esophageal Cancer Increasing at Alarming Rate due to Adenocarcinoma

A

True

44
Q

Compare the etiology of adenocarcinoma and squamous cell carcinoma

A
  • adenocarcinoma: GERD, tobacco, obesity

- Squamous cell carcinoma: tobacco, alcohol, hot beverages

45
Q

What determines a tumor “grade”?

A

-Based on microscopic features
-Refers to how well or poorly a tumor resembles the normal cells it recapitulates
-Correlates with outcome (but less so than STAGE)
(well-differentiated=low grade)

46
Q

What determines tumor “stage”?

A
  • Refers to anatomic extent of disease
  • Assigned at the time of diagnosis: clinical and/or pathologic
  • Most powerful predictor of outcome

T(umor)
N(ode)
M(etastasis)

Pathology II Exam II (16 decks)

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