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Pathology > Esophagus > Flashcards

Esophagus Flashcards

1
Q

Achalasia triad

Form of

A

incomplete LES relaxation
inc LES tone
esophageal aperistalsis

Functional esophageal obstruction

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2
Q

Most frequent site of ectopic gastric mucosa

A

upper third of esophagus:

inlet patch

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3
Q

Small patches of ectopic gastric mucosa in si and colon

A

Gastric heterotopia

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4
Q

Dilated coronary veins in lower esophagus due to portal hypertension
(cirrhosis, schistosomiasis)

Develop in 90% of cirrhotic px esp alcoholic liver disease
Second most common cause is hepatic schistosomiasis

Detected by angiography tortuous dilated coronary veins lying within submucosa of distal esophagus

Most common complication: hematemesis and rupture

Commonly collapse postmortem

A

Esophageal varices

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5
Q

Most common esophageal laceration assoc with severe retching and vomiting

Acute alcoholic intoxication

Failure of relaxation of esophagus preceding antiperistalsis leading to stretch and tear

Longitudinal lacerations across GEJ
superficial

Chronic vomiting with severe counter peristalsis

A

Mallory weiss tear

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6
Q

Transmural esophageal tear and mediastinitis

Severe

A

Boerhaave syndrome

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7
Q

Most common fungal pathogen in esophagitis

A

Candida

Mucormycosis
Aspergillosis

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8
Q

Punched out ulcers

nuclear viral inclusion within a rim of degenerating epithelial cell at ulcer edge

A

Herpes virus

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9
Q

Shallow ulcer with nuclear and cytoplasmic inclusion within capillary endothelium and stromal cell

A

CMV

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10
Q

Most frequent reason for esophagitis
Central to mucosal injury
Most common outpatient GI diagnosis

Causative mechanism:
Dec LES and inc abdominal pressure

A

reflux of gastric content

Reflux esophagitis

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11
Q

Hyperemia
Eosinophil in squamous mucosa followed by neutrophil
Basal zone hyperplasia exceeding 20%

A

GERD

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12
Q

Complications of GERD

A 
Melena
Hematemesis
Ulceration
Stricture
Barret’s
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13
Q

Separation of diaphragmatic crura and protrusion of stomach into the thorax through gap

Asymp in 90%

A

Hiatal hernia

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14
Q 
Food impaction
Dysphagia 
Feeding intolerance
Epithelial infiltration of eosinophil superficially at sites far from GEJ 
Atopic associated

Tx: avoidance of allergen

A

Eosinophilic esophagitis

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15
Q

Complication of GERD charac by intestinal metaplasia within the esophageal squamous mucosa
40-60 years
Confers greatest risk of esophageal adenocarcinoma
Premalignant
Preinvasive lesion:

A

Barrett’s esophagus

Dysplasia 0.2-1%

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16
Q

Complication of chronic GERD
Intestinal metaplasia within the esophageal squamous mucosa
Confers an increased risk of esophageal carcinoma

Tongues or patches of red velvety mucosa extending upward from GEJ
Metaplastic mucosa alternates with residual smooth pale squamous (esophageal) mucosa proximally and interfaces with light brown columnar gastric mucosa distally
Esophageal mucosa becoming metaplastic mucosa with goblet cell (squamocolumnar metaplasia)

A

Barrett esophagus

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17
Q

Invasion of neoplastic epithelial cell into lamina propria

Tx:

A

Intramucosal carcinoma

Surgical resection esophagectomy

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18
Q

Barrett’s dx

A

Endoscopy

Biopsy

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19
Q

Most common esophageal tumor worldwide

A

SCC

adeno in US

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20
Q

Arises from background of Barrett’s and GERD

Occurs in the distal third

inc by tobacco use, obesity, radiation and documented dysplasia
Dec in diet rich in fruit and vegetable
M, 7x

A

Esophageal adenocarcinoma

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21
Q

Associated with progression from dysplasia to invasive ca in esophageal adenocarcinoma

A

TP53 mutation

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22
Q

Most common location of adenocarcinoma

A

distal third of esophagus invading adjacent gastric cardia

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23
Q

Adults >45, M 4x
Alcohol, tobacco, poverty, caustic, achalasia, Plummer-Vinson, hot beverage, mediastinum radiation, polycyclic hydrocarbon, nitrosamine, HPV,tylosis

Occurs in middle third or the esophagus

6x in Africans

A

SCC of esophagus

24
Q

SCC of esophagus occurs

A

Middle third

25
Q

SCC begins as small gray plaquelike thickening

Invades respiratory tree, aorta, exsanguination

A

in situ squamous dysplasia

26
Q

SCC metastasizes frequently bec of invasion of

A

submucosal lymphatic network promoting circumferential and longitudinal spread

27
Q

Cancers on upper third metastasize to

A

cervical LN

28
Q

Cancer in middle third metastasize to

A

mediastinal
paratracheal
tracheobronchial

29
Q

Cancers in lower third metastasize to

A

gastric and celiac nodes

30
Q

Thin, noncanalized cord replaces a segment of esophagus, causing a mechanical obstruction

Most common at or near the tracheal bifurcation

Usually associated with a tracheoesophageal fistula

A

Esophageal atresia

31
Q

Occurs when incomplete formation of the diaphragm allows the abdominal viscera to herniate into the thoracic cavity

Displaced viscera can cause pulmonary hypoplasia that is incompatible with life

A

Diaphragmatic hernia

32
Q

Left posterolateral hernia

A

Bochdalek’s hernia

33
Q

Anterior, right diaphragmatic hernia

A

Morgagni

34
Q

Most common type of esophageal atresia and TEF

A

Type C then

A

35
Q

Gives rise to central tendon of diaphragm

A

Septum transversum

36
Q

Gives rise to muscular part of diaphragm

A

Pleuroperitoneal membrane

37
Q 
More common type of esophageal diverticula
Esophago-pharyngeal junction
Above cardia
Unknown etiology
Killian’s triangle
A

Pulsion type (Zenker’s)

38
Q

Less common
Lower 1/3, near hilum
Rarely collect food
Tuberculous lymphadenitis

A

Esophageal diverticula

39
Q 
Achalasia
Idiopathic muscular hypertrophy
Progressive systemic sclerosis
Plummer-Vinson Syndrome
Leiyomatosis
A

Esophageal dysmotility

40
Q

Primary esophageal motility disorder
Failure of LES smooth muscle relaxation leading to high pressure
Absence of peristalsis

Dysphagia
Vomiting
Regurgitation
Heartburn

A

Achalasia

Megaesophagus

41
Q

Achalasia/Megaesophagus

A

Primary: idiopathic
Secondary: T cruzi (amastigotes damage the ganglion cells)

42
Q

Vasculitis with muscle wall degeneration

Part of CREST syndrome

A

Progressive Systemic Sclerosis

43
Q 
Esophageal web
Atrophic glossitis, dysphagia
Hypochromic, microcytic anemia
Esophagitis in upper 1/3
Most common in middle-aged females 
Increased risk of CA in upper 1/3 esophagus, oropharynx and tongue
A

Plummer-Vinson Syndrome

44
Q

Adenoma of esophagus arises from

A

Barett’s esophagus

45
Q

Associated with leiomyomas

A

GIST

46
Q

Portal vein is formed by union of

A

SMV

Splenic vein

47
Q

Presinusoidal block of portal vein

A

Schistosomiasis

48
Q

Benign tumors of esophagus

A

Adenoma
GIST
Granular cell tumor
Localized amyloidosis

49
Q 
80-85% of all esophageal carcinomas
10% of all GIT cancers
More common in blacks and males
12% upper 
56% middle 
32% lower portion
A

Squamous Cell Carcinoma of Esophagus

50
Q

Tributaries of portal vein

A

Left gastric
Periumbilical
Superior Rectal Vein

51
Q

The rectal veins that drain into inferior vena cava

A

Inferior rectal

Middle rectal

52
Q

Secondary causes of Esophageal Motility Disorder

A

GERD
Scleroderma
Chagas disease
Post-operative

53
Q

Hypermotility disorder of esophagus

A

Achalasia

54
Q

Hypermotility disorders of esophagus

A

Diffuse Esophageal Spasm
Nutcracker esophagus
Hypertensive LES

55
Q

Antibody in CREST

A

anti centromere

56
Q

Antibody in tropical sprue

Gluten enteropatht

A

Anti-gliadin

Pathology (24 decks)

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