Esophagus Flashcards
What is a fistula?
Abnormal connection between two tubes
TE Fistula
Describe the basic defect
Congenital defect resulting in connection between esophagus and trachea
Proximal esophagus undergoes atresia (blind pouch)
Distal esophagus connects to trachea
TE Fistula
Describe some clinical consequences and associations of the defect
Any consumed food going into the atretic esophagus will project back out.
Polyhydramnios
Abdominal distension
Some stomach contents will be aspirated into trachea
Often associated with congenital heart disease
Esophageal Web
What is the basic defect?
Thin protrusion of esophageal mucosa, most often in upper esophagus
Presents with dysphagia of poorly chewed food
Esophageal Web
Causes a higher risk of….
Esophageal squamous cell carcinoma
Plummer Vinson Syndrome
What are the 3 cardinal symptoms?
Severe iron deficient anemia
Esophageal web
Beefy red tongue due to atrophic glossitis
Zenker Diverticulum
Describe the basic pathologic issue
Outpouching of pharyngeal mucosa through acquired defect in muscle wall, mostly at junction of esophagus and pharynx
It is a false diverticulum
Zenker Diverticulum
Presenting symptoms
Dysphagia
Obstruction
Halitosis
Mallory Weiss Syndrome
What is the basic pathologic issue?
Severe vomiting (alcoholics or bulimics) causes a longitudinal laceration of mucosa and submucosa at the GE junction
Mallory Weiss Syndrome
Presenting symptoms
Painful hematemesis (due to laceration)
Mallory Weiss Syndrome
High risk of progressing to…
Boerhaave syndrome
What kind of epithelium is normal for the esophagus?
Stratified nonkeratinized squamous epithelium
When is TE fistula most commonly identified?
At birth (whereas pyloric stenosis is identified at 2-6 weeks of age)
What is Boerhaave syndrome? What is a clinical consequence/sign of it?
Rupture of the esophagus through the entire wall, resulting in air in mediastinum
(Medical emergency)
May cause subcutaneous emphysema (crackling noise when you press on air beneath skin- rice krispies)
Esophageal Varices arise secondary to…
Portal HTN
Esophageal Varices
What is the main risk of this condition?
Asymptomatic, but there is a risk of rupture that would cause painless hematemesis
Rupture of esophageal varices is most common cause of death in cirrhosis patients
Achalasia
What is the pathogenesis and the ultimate problem?
Damage to the ganglion cells of the myenteric plexus results in disordered esophageal motility and inability to relax LES
Achalasia
Clinical Features
Dysphagia for solids and liquids
Putrid breath
High LES pressure on esophageal manometry
Bird beak sign on barium swallow
Increased risk esophageal squamous cell caricnoma
GERD
Basic pathogenesis
Reflux of acid from stomach due to reduced LES tone
May lead to intestinal metaplasia and Barrett’s esophagus over time
GERD
Risk factors
Alcohol Tobacco Obesity Fat-rich diet Caffeine Sliding hiatal hernia
Describe the basic pathogenesis of hiatal hernias
Esophagus plugs into stomach after traversing the diaphragm
Classified as sliding or paraesophageal
Describe a sliding hiatal hernia
Cardia of stomach is above the diaphragm, allowing for reflux and increasing GERD risk
Hourglass appearance of stomach due to normal LES tone below hernia
Describe a paraesophageal hital hernia
Small outpouching to the side of the esophagus
LES is in place and there are no reflux symptoms, but could cause obstruction and cut off blood supply
GERD
Symptoms
Heartburn Asthma/cough Damage to tooth enamel Ulceration with stricture (fibrotic healing of ulcer in esophagus, narrowing esophageal lumen) Barrett esophagus
What is Barrett esophagus?
Nonciliated columnar cells and goblet cells are present in the esophagus
Response of esophageal epithelium to acidic stress
Could progress to dysplasia and adenocarcinoma
Infectious esophagitis is commonly caused by what 3 agents?
Candida
Herpes simplex virus
Cytomegalovirus
Candida Esophagitis
What is commonly seen grossly? Histologically?
White depositions down the esophagus (psuedomembranes)
May see pseudohyphae on PAS stain
Herpes Esophagitis
What is seen on histology?
3 M’s of herpes –
Molding- nuclei are spooning eachother
Multi-nucleation
Marginization- chromatin in nucleus is being pushed to the edge
CMV Esophagitis
What is seen on histology?
Characteristic owl eye inclusions
Eosinophilic Esophagitis
Most commonly seen in what patients? Why?
Children with food allergies
Eosinophilic Esophagitis
What is the most common treatment?
Dietary restrictions
Chemical/Pill-induced esophagitis may be caused by…
Mucosal irritants, such as... Alcohol Corrosive acids/alkalis Hot fluids Smoking Meds Cytotoxic chemotherapy Uremia
Adenocarcinoma
What is the most important risk factor?
Barrett’s esophagus
How is Barrett esophagus diagnosed?
Endoscopy- salmon colored area is Barrett’s
Histology- presence of goblet cells and intestinal metaplasia (columnar epithelium present)
Adenocarcinoma
Where in the esophagus does it primarily occur?
Distal esophagus, where the GERD would have its most pronounced effect
Adenocarcinoma
What are the malignant cells?
Malignant proliferation of glands arising from preexisting Barrett esophagus
Adenocarcinoma
Symptoms
Difficulty swallowing Progressive weight loss Bleeding Vomiting Chest pain with normal EKG
Squamous Cell Carcinoma
Where in the esophagus does it tend to arise?
Upper and middle 2/3 of esophagus
Squamous Cell Carcinoma
Clinical Symptoms
Insidious onset
Patient changes diet slowly from solids to liquids due to dysphagia
Weight loss
Squamous Cell Carcinoma
Risk Factors
Irritation of the mucosa Alcohol Tobacco Hot tea Achalasia Esophageal web Esophageal injury
Squamous Cell Carcinoma
What is the diagnostic histological feature?
Keratin pearls
Where would cancer spread from the upper 1/3 of esophagus? Middle? Lower?
Upper 1/3 - cervical nodes
Middle 1/3 - mediastinal or tracheobronchial nodes
Lower 1/3 - celiac and gastric nodes
Scleroderma
What is the CREST syndrome?
Calcinosis- calcium deposits in skin
Raynaud phenomenon
Esophageal dysmotility- atrophy of esophageal smooth muscle in lower 2/3
Sclerodactyly
Telangiectasia
Scleroderma
Cause
Connective tissue autoimmune disorder.
Damage to small blood vessels and progressive fibrosis of the skin
