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Pathoma - Gastrointestinal Pathology > Esophagus > Flashcards

Esophagus Flashcards

1
Q

What is a fistula?

A

Abnormal connection between two tubes.

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2
Q

What is a Tracheoesophageal Fistula?

A

Congenital defect resulting in a connection between the esophagus and trachea.

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3
Q

What is the most common variant of Tracheoesophageal Fistula?

A

Proximal esophageal atresia and distal esophagus arising from the trachea.

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4
Q

What does the most common variant of Tracheoesophageal Fistual present with?

A

Vomiting, Polyhydramnios (excess amniotic fluid), Abdominal distension (air in stomach), and Aspiration (stomach contents)

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5
Q

What is an Esophageal Web?

A

Thin protrusion of esophageal mucosa

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6
Q

Where does Esophageal Web most often occur?

A

In the upper esophagus

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7
Q

What does Esophageal Web present with?

A

Dysphagia for poorly chewed food

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8
Q

What are people with Esophageal Web at an increased risk for?

A

Esophageal squamous cell carcinoma

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9
Q

What is Plummer-Vinson syndrome characterized by?

A
  • Severe iron deficiency anemia
  • Esophageal web
  • Beefy-red tongue due to atrophic glossitis
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10
Q

What is Zenker Diverticulum?

A

Outputting of pharyngeal mucosa through an acquired defect in the muscular wall (false diverticulum)

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11
Q

What causes the protrusion in Zenker Diverticulum?

A

Abnormal pressure in back of pharynx –> protrusion of mucosa in muscular wall

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12
Q

What is a False Diverticulum?

A

Only protruded one part of wall through the entire wall

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13
Q

Where does Zenker Diverticulum arise?

A

Above the upper esophageal sphincter at the junction of the esophagus and pharynx

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14
Q

What does Zenker Diverticulum present with?

A
  1. Feels like there’s something in the back of the throat
  2. Dysphagia
  3. Obstruction
  4. Halitosis (bad breath)
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15
Q

What is Mallory-Weiss Syndrome?

A

Longitudinal laceration of mucosa at the gastroesophageal (GE) junction.

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16
Q

What causes Mallory-Weiss Syndrome?

A

Severe vomiting, usually due to alcoholism or bulimia.

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17
Q

What does Mallory-Weiss Syndrome present with?

A

Painful hematemesis (vomiting blood)

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18
Q

What does Mallory-Weiss create a risk for?

A

Boerhaave Syndrome

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19
Q

What is Boerhaave Syndrome?

A

Rupture of esophagus leading to air in the mediastinum and subcutaneous emphysema

20
Q

What do you see in the patient with subcutaneous emphysema?

A

Air bubbles beneath the skin, when pressed on, they make a crackling noise

21
Q

What are Esophageal Varices?

A

Dilated submucosal veins in the lower esophagus

22
Q

What doe Esophageal Varices arise secondary to?

A

Portal hypertension

23
Q

What are two ways esophageal blood drains?

A
  1. Most drains via azygous vein to the vena cava

2. Some drains via left gastric vein into portal vein

24
Q

How does the distal esophageal vein normally drain?

A

Into the portal vein via the left gastric vein

25
Q

What happens to the left gastric vein in portal hypertension?

A

The left gastric vein back up into the esophageal vein, resulting in dilation (varices).

26
Q

What might Esophageal Varices present like in a patient?

A

Asymptomatic

27
Q

What risk exists with Esophageal Varices?

A

Risk of rupture

28
Q

What does esophageal rupture present with?

A

Painless hematemesis

29
Q

What is the most common cause of death in cirrhosis?

A

Esophageal rupture

30
Q

What is not produced in cirrhosis/portal hypertension?

A

The liver does not produce coagulation factors and this causes coagulopathy

31
Q

What is Achalasia?

A
  1. Disordered esophageal motility with

2. Inability to relax lower esophageal sphincter (LES)

32
Q

What causes Achalasia?

A

Due to damaged ganglion cells in the myenteric plexus.

33
Q

Where are ganglion cells of the myenteric plexus located?

A

Between the inner circular and outer longitudinal layers of the muscular propria

34
Q

What are the ganglion cells of the myenteric plexus important for?

A

Regulating bowel motility and relaxing the LES.

35
Q

What can cause damage to the ganglion cells of the myenteric plexus?

A
  1. Idiopathic

2. Secondary to known insult (Trypanosome cruzi infection in Chagas disease)

36
Q

What are the clinical features of Achalasia?

A
  1. Dysphagia for solids and liquids

2. Putrid breath

37
Q

What is seen in Achalasia on Esophageal Manometry?

A

High LES pressure

38
Q

What is seen in Achalasia on Barium Swallow Study?

A

‘Bird-beak’ sign

39
Q

What does Achalasia increase the risk for?

A

Esophageal squamous cell carcinoma

40
Q

What is GERD (Gastroesophageal Reflux Disease)?

A

Reflux of acid from the stomach due to reduced LES tone

41
Q

What are risk factors for GERD?

A
  • Alcohol
  • Tobacco
  • Obesity
  • Fat-rich diet
  • Caffeine
  • Hiatal Hernia
42
Q

What does acid cause in a general sense in GERD?

A

Acid leads to stressed cells of the lower esophagus. These cells then undergo metaplasia.

43
Q

What are the clinical features of GERD?

A
  1. Heartburn (mimics cardiac chest pain)
  2. Asthma (adult onset) and cough
  3. Damage to enamel of teeth
  4. Ulceration with stricture and Barrett esophagus are late complications.
44
Q

What causes the Ulceration and Barrett esophagus with GERD?

A

Acid damage

45
Q

What does the stress from acid in GERD cause in the lower esophagus (detailed)?

A
  1. Non-keratinizing Squamous Epithelium (NKSE)
  2. Stress
  3. Changes in cell type
  4. Non-ciliated columnar cells with goblet cells [Metaplasia]
46
Q

What is a Sliding Hiatal Hernia?

A
  • Very common
  • Stomach herniates up above diaphragm in a half circle
  • Allows for reflux (no sphincter) –> increases risk for GERD
  • Hourglass appearance of the stomach
47
Q

What is a Paraesophageal Hiatal Hernia?

A
  • Much less common than sliding
  • Bowel sounds are heard in the lower lung fields
  • Stomach herniates up on one side of the esophagus
  • If it develops congenitally –> may cause lung hypoplasia
  • NO GERD

Pathoma - Gastrointestinal Pathology (3 decks)

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