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Systems Pathology II Midterm > Esophagus > Flashcards

Esophagus Flashcards

1
Q

Where does the esophagus lie in reference to the trachea?

A

Posterior

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2
Q

Which esophageal sphincter is more associated with pathologies?

A

Lower

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3
Q

Atresia, tracheal fistula, and stenosis are examples of what kind of esophageal lesions?

A

Mechanical (diagnosed just after birth)

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4
Q

What are two examples of functional lesions of the esophagus?

A

Aperistalsis

Achalasia

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5
Q

Ectopic gastric mucosa affects what portion of the esophagus?

A

Upper 1/3

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6
Q

What is the cause of irritation with ectopic gastric mucosa in the esophagus?

A

Gastric acid irritates the esophagus

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7
Q

What is the major concern with ectopic gastric mucosa in the esophagus?

A

Rick of cancer development

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8
Q

Is ectopic gastric mucosa usually symptomatic or asymptomatic?

A

Asymptomatic

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9
Q

Esophageal varices is secondary to what condition?

A

Portal hypertension (cirrhosis)

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10
Q

What is achalasia?

A

Failure of lower esophageal muscles to relax

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11
Q

What is the triad seen with achalasia?

A

1 Incomplete LES relaxation
2 Increased LES tone
3 Esophageal aperistalsis

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12
Q

What is the treatment for achalasia?

A

Botulinum toxin, pneumatic dilatation

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13
Q

What is the most common form of achalasia?

A

Primary (loss of inhibitory innervation to LES)

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14
Q

What is the cause of secondary achalasia?

A

Co-morbitidy that impairs esophageal functioning

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15
Q

Chagas disease, irradiation, diabetes, and polio would be examples of conditions that could lead to what form of achalasia?

A

Secondary

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16
Q

Where is the inflammation specifically seen in secondary achalasia?

A

Auerbach’s plexus

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17
Q

What is the specific location for esophageal varices?

A

Distal esophagus (closest to liver)

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18
Q

What disease develops in 90% of cirrhosis patients?

A

Alcoholic liver disease

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19
Q

What two conditions can result from liver cirrhosis?

A

Alcoholic liver disease

Hepatic schistosomiasis

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20
Q

What makes 50% of first-time bleed with esophageal varices lethal?

A

Possibility for hypovolemic shock

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21
Q

What condition can arise due to toxins accumulating in the CNS from liver failure and advanced cirrhosis?

A

Hepatic encephalopathy (hepatic coma)

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22
Q

What is unique about the symptomatology of esophagitis?

A

Symptoms do not correlate well with the degree of inflammation

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23
Q

What is the term for pain when swallowing?

A

Odynophagia

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24
Q

What are the symptoms of esophagitis?

A

Odynophagia and dysphagia

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25
Q

What is the most common cause of esophagitis?

A

Reflux esophagitis (GERD)

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26
Q

GERD affects what percent of U.S. adults?

A

25-40%

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27
Q

What kinds of things can lead to reflux esophagitis?

A

LES dysfunction, increased gastric volume, obesity, hiatal hernia, pregnancy, smoking, alcohol

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28
Q

What is the most common outpatient gastrointestinal complaint?

A

GERD (esophagitis)

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29
Q

What is the usual age of onset for GERD?

A

Over 40 years

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30
Q

“Sour brash” is associated with what condition?

A

GERD

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31
Q

What is the treatment for GERD?

A

PPIs (omeprazole)

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32
Q

What are the three forms of esophagitis?

A

1 GERD
2 Chemical
3 Infectious

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33
Q

What kinds of things can lead to chemical esophagitis?

A

Tobacco, alcohol, pill-induced, hot liquids, irradiation, chemotherapy, increased consumption of acidic or alkaline foods

34
Q

Infectious esophagitis most commonly develops secondary to what condition?

A

Ulcer

35
Q

What kind of esophagitis arises in immunosuppressed patients?

A

Infectious

36
Q

What are viruses that can cause infectious esophagitis?

A

HSV, CMV, fungal viruses

37
Q

What kind of esophagitis arises secondary to AIDS?

A

Candida esophagitis

38
Q

Which is a worse condition: esophageal varices or esophageal lacerations?

A

Esophageal varices

39
Q

What is the most common type of esophageal laceration?

A

Mallory-Weiss tear

40
Q

How can one develop an esophageal laceration?

A

Trauma, severe coughing/vomiting, primal scream therapy

41
Q

What is the most common location for an esophageal laceration?

A

Gastroesophageal junction

42
Q

Mallory-Weiss syndrome involves the relaxation of what muscles?

A

Lower esophageal sphincter (LES)

43
Q

What visual and painful sign is seen in 50% of upper G.I. bleeds?

A

Hematemesis (vomiting of blood)

44
Q

What are the treatments used to treat an esophageal laceration?

A

Vasoconstrictive medications, transfusions, balloon tamponade

45
Q

What procedure is used to diagnose an esophageal laceration?

A

Esophagoscopy (endoscopy)

46
Q

What is the clinical term for a widening of the esophageal hiatus allowing the stomach to protrude into the thorax?

A

Hiatal hernia

47
Q

What is the most common type of hiatal hernia making up 95% of cases?

A

Axial (SLIDING down midline)

48
Q

What type of hiatal hernia involves a “bell-shaped” dilation?

A

Axial

49
Q

What is the less common type of a hiatal hernia?

A

Non-axial (ROLLING slightly off midline)

50
Q

Are hiatal hernias common?

A

Yes, 20% of all adults

51
Q

What is the age bias for a hiatal hernia?

A

70% of those with them are >70 years old

52
Q

What type of hiatal hernia is most likely to be symptomatic?

A

Non-axial

53
Q

What are the symptoms of a hiatal hernia when they’re present (usually asymptomatic at 90%)?

A

GERD-like esophagitis

Perforation and bleeding

54
Q

What differential diagnoses are associated with a hiatal hernia?

A

GERD

Angina pectoris

55
Q

How could on differentiate between angina pectoris and a hiatal hernia?

A

Pain from angina pectoris would be triggered by physical activity

56
Q

What kind of preneoplastic lesion can be caused by overfilling the stomach and is associated with esophageal metaplasia?

A

Barrett esophagus

57
Q

What is the cellular change seen in Barrett esophagus?

A

Stratified squamous changing to columnar epithelia

58
Q

Why is the change to columnar epithelia with Barett esophagus detrimental?

A

Goblet cells are then present and able to secrete gastric mucosa which damages tissues in the esophagus (possibly leading to cancer)

59
Q

What is the location for Barrett esophagus?

A

Distal esophagus

60
Q

In what country to we see an increased risk of Barrett esophagus?

A

U.S.A.

61
Q

What is the gender, race, and age bias for Barrett esophagus?

A

Males (4X) who are Caucasian and 40-60 years old

62
Q

What are other risk factors for Barrett esophagus?

A

Obesity and familial history

63
Q

What percentage of symptomatic GERD patients will have Barrett esophagus?

A

10%

64
Q

What condition involves red, velvety mucosa developing in the esophagus that appear as bands or “tongues” that extend superiorly as pre-cancerous metaplasia?

A

Barrett esophagus

65
Q

A failure of closure of which esophageal sphincter is usually to blame with Barrett esophagus?

A

LES

66
Q

Barrett esophagus increases the risk of what kind of cancer by 30-100X?

A

Esophageal adenocarcinoma

67
Q

What is the treatment for Barrett esophagus?

A

Stop irritants, omeprazole (PPIs), surgery, laser ablation

68
Q

How does omeprazole (PPI) treat Barrett esophagus?

A

Slows gastric acid production

69
Q

What is the term for a benign, smooth muscle tumor?

A

Leiomyoma

70
Q

Why is a leiomyoma in the esophagus detrimental?

A

Interferes with peristalsis

71
Q

What type of tumor makes up 50% of U.S. esophageal cancers?

A

Esophageal adenocarcinoma

72
Q

What are the risks for developing an esophageal adenocarcinoma?

A

U.S., Barrett esophagus, GERD, Caucasians, males (7X), obesity, irradiation, tobacco

73
Q

What is the most common type of esophageal cancer WORLDWIDE?

A

Squamous cell carcinoma (90%)

74
Q

Increased consumption has shown to decrease the risk of which esophageal tumor?

A

Adenocarcinoma

75
Q

Are esophageal carcinomas usually diagnosed early or late?

A

Late (poor prognosis due to early invasion of lymphatics)

76
Q

What genetic mutation is commonly seen with an esophageal adenocarcinoma?

A

TP53

77
Q

What type of esophageal tumor is seen in the distal 1/3 of the esophagus?

A

Esophageal adenocarcinoma

78
Q

What type of esophageal tumor is seen in the middle 1/3 of the esophagus?

A

Squamous cell carcinoma

79
Q

What is the age, race, and gender bias for esophageal squamous cell carcinoma?

A

> 45 years of age, African Americans males

80
Q

What viral infection can irritate the esophagus and lead to squamous cell carcinoma?

A

HPV

81
Q

Nitrosamines can irritate the esophagus and lead to which type of esophageal cancer?

A

Squamous cell carcinoma

Systems Pathology II Midterm (7 decks)

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