Esophagus pathology Flashcards
This upper GI symptom strongly suggests GERD
Heart burn (pyrosis) - retrosternal burning sensation
Dyspepsia is pain/discomfort in this part of the body
Has a broad differential (GI, neuro, endocrine, psychosocial, etc)
Upper abdomen
Bleeding of this part of the GI tract produces emesis that is bright red, fresh blood
Esophagus
Bleeding of this part of the GI tract produces emesis with “coffee ground” appearance
Stomach
(due to acidic environment)
Does a proximal or distal lower GI bleed tend to produce melena (black stool)?
Proximal
(more distal tends to be recognizable blood)
This is an abnormal communication between trachea and esophagus
Tracheoesophageal fistula
Displacement of stomach into mediastinum through diaphragmatic hiatus
Hiatal hernia
The majority of hiatal hernias are this type
sliding (8 shaped stomach)
Slides up with abdominal pressure (obesity, pregnancy, swallowing, respiration)
A complication of this type of hiatal hernia is GERD, and is difficult to control due to anatomic predisposition
Sliding
Volvulus and incarceration and/or strangulation are complications of this type of hiatal hernia
Paraesophageal
What are the two types of hiatal hernias?
Sliding
Paraesophageal
This type of hiatal hernia begins with gastric cardia herniation into mediastinum
Entire stomach, other abdominal viscera may follow
Paraesophageal
What causes early satiety in a paraesophageal hiatal hernia?
Reduced gastric emptying
What can cause chest pain, shock, and circulatory collapse in a paraesophageal hiatal hernia?
Infarction
Outpouchings of esophageal wall due to increased pressure, mural weakness, outflow obstruction
Esophageal diverticuli
A false esophageal diverticulum lacks some layers of the esophageal wall, usually this
Muscularis
Zenker’s diverticulum occurs at this location of the esophagus
Hypopharyngeal
Hypopharyngeal outpouching is usually caused by this type of diverticulum
Zenker’s diverticulum
A Midesophagus outpouching is usually this type of diverticulum
Traction diverticulum
Epiphrenic diverticulum is associated with increased tone of this structure
Lower esophageal sphincter
Diverticulum at this location is associated with increased lower esophageal sphincter tone
Epiphrenic
This is a hypopharyngeal esophageal diverticulum
Zenker’s diverticulum
Zenker’s diverticulum is formed at a point of weakness in this
Killian’s triangle
This muscle is stenotic in Zenker’s diverticulum
Cricopharyngeal muscle
(of the upper esophageal sphincter)
This type of diverticulum is often asymptomatic, but may present with food entrapment, dysphagia, regurgitation, aspiration, and halitosis
Zenker’s diverticulum
In this type of diverticulum, mucosa and submucosa herniate through Killian’s triangle
A pseudodiverticulum
Zenker’s diverticulum
This type of diverticulum is classically associated with tuberculosis
Traction diverticulum (such as midesophageal diverticulum)
Traction diverticulum (such as midesophageal diverticulum) is classically associated with this condition
Tuberculosis
This type of diverticulum is caused by increased intraluminal pressure and/or distal obstruction
Also a pseudodiverticulum
Epiphrenic diverticulum
This type of disorder should be considered with unexplained dysphagia, chest pain, obstruction
Diagnosis of exclusion
Esophageal motility disorders
(ex: diffuse esophageal spasm; hypercontractile esophagsu)
Diffuse esophageal spasm pain is often relieved with this drug
Nitroglycerin
Is regurgitation common in Diffuse esophageal spasm?
Less common
In this condition, barium esophagography will show uncoordinated simultaneous non-propulsive contractions with segmentation
Diffuse esophageal spasm
“Corkscrew esophagus” is a classic sign of this esophageal motility disorder
Diffuse esophageal spasm
In this condition, peristalsis is interrupted by tertiary contractions
Contents are pushed in both directions
Usually with chest pain and dysphagia
Diffuse esophageal spasm
This condition is also known as Nutcracker esophagus
Hypercontractile esophagus
In this condition, there are high pressures but normal peristalsis
Normal barium swallow
Increased manometry pressure
Chest pain, dysphagia, reflux
Hypercontractile esophagus
Is peristalsis normal in Hypercontractile esophagus?
Yes
(pressures are high)
Is peristalsis normal in Diffuse esophageal spasm?
No - is interrupted by tertiary contractions
Condition of esophageal dilation due to dysmotility and/or increased LES tone
Achalasia
The primary form of Achalasia is acquired loss of this
Inhibitory nitric oxide producing ganglion cells at LES
The secondary form of Achalasia is acquired loss of this
Myenteric plexus in esophageal body
Bird-beak seen on barium swallow is characteristic of this condition
Achalasia
This condition can commonly cause secondary form of Achalasia, along with diabetic autonomic neuropathy and amyloidosis
Chagas disease
Chagas disease can characteristically cause this condition of esophageal dilation
Achalasia
Morphology of this condition includes hypertonic muscle with absent ganglia
Late stage will show fibrosis with muscle attenuation
Dilated tortuous esophagus (sigmoidization)
Achalasia
Condition that presents with progressive dysphagia, regurgitation, chest pain, weight loss, and high pressure at LES on manometry
Achalasia
The triad of this condition that can cause mechanical esophageal obstruction is:
Upper esophageal web
Iron deficiency anemia
Atrophic glossitis
Plummer-Vinson syndrome
Patients with Plummer-Vinson syndrome have a risk of this carcinoma
Squamous cell carcinoma
What is the triad seen in Plummer-Vinson syndrome?
Upper esophageal web
Iron deficiency anemia
Atrophic glossitis
Acquired eccentric/concentric narrowing of esophageal lumen
Thin band of mucosal tissue
Common in older female patients
Produce food impaction, dysphagia, odynophagia
Treatment: dilation if symptomatic
Esophageal webs/rings
Are Esophageal webs/rings more common in males or females?
Females (older age)
Lower esophageal mucosal ring indenting esophageal lumen at esophagogastric junction
Schatzki ring
Is Schatzki ring of the upper or lower esophagus?
Lower
(at esophagogastric junction)
This esophageal ring is associated with GERD and eosinophilic esophagitis
Schatzki ring
This is formed by mucosal redundancy, resulting in concentric narrowing of the esophagus
Presents as dysphagia with food
Treatment is dilation or incision
Schatzki ring
Fibrosing process due to repair of damaged segment
Esophageal stricture
Is Esophageal stricture thicker or thinner than an esophageal ring/web?
Thicker and longer
Esophageal stricture caused by GERD occurs at this part of the esophagus
Distal esophagus
Esophageal stricture caused by eosinophilic esophagitis occurs at this part of the esophagus
May be entire length
Esophageal stricture is a fibrosing process due to this
Repair of damaged segment
Systemic autoimmune disorder with frequent esophageal involvement
Leads to fibrosis of muscularis propria and dysmotility
Scleroderma / CREST
Manometry of this condition will show absent peristalsis and incompetent EG junction
Scleroderma / CREST
What are the 5 key features of Scleroderma / CREST syndrome?
Calcinosis
Raynaud’s
Esophageal dysmotility
Sclerodactyly
Telangiectasias
Dysphagia and pyrosis (heartburn) are seen in this autoimmune disorder with other systemic findings
Scleroderma / CREST
Fibrosis of muscularis propria and dysmotility occur in scleroderma (CREST), leading to failure of the LES to contract and this condition
Refractory GERD
Longitudinal superficial mucosal/submucosal laceration of the esophagus
Mallory-Weiss tear
Mallory-Weiss tear is associated with this
Severe vomiting (most often alcoholism)
This condition is associated with severe vomiting, most often alcoholism
Produces painful hematemesis
Heal without intervention
Mallory-Weiss tear
In a Mallory-Weiss tear, is hematemesis painful or painless?
Painful
In an esophageal varices, is hematemesis painful?
No - painless
Full thickness laceration with access to mediastinum
Medical emergency
Boerhaave syndrome
In this esophageal laceration, air and bacteria have access to the mediastinum
Can result in crepitus, Hammond’s crunch, and septic shock
Boerhaave syndrome
This esophageal laceration occurs in patients with cirrhosis, in which a portosystemic shunt develops
High volume, low pressure vein ruptures
Painless
Lots of bleeding without ability to tamponade
Esophageal variceal bleeding
This type of viral esophagitis is seen in healthy patients
Punched out ulcers and vesicles
Classic Cowdry inclusions of squamous cell
Herpetic esophagitis
This type of viral esophagitis is seen in immunocompromised patients
Linear ulcers
Owls-eye inclusions of endothelium and epithelium
CMV esophagitis
Does this describe herpetic or CMV esophagitis:
Punched out ulcers and vesicles
Herpetic
Does this describe herpetic or CMV esophagitis:
Seen in healthy patients
Herpetic
Does this describe herpetic or CMV esophagitis:
Immunocompromised patients
CMV
Does this describe herpetic or CMV esophagitis:
Linear ulcers
CMV
Esophagitis caused by this organism will morphologically show white, cheesy plaques, exfoliated squames, and yeast with pseudohyphae
Candida
Esophagitis associated with atopy
Eosinophilic esophagitis
Does a patient with Eosinophilic esophagitis have an increased risk for Barrett’s esophagus or Adenocarcinoma?
No
Esophagitis of this type has a high association with atopy (eczema, asthma, food allergy)
Eosinophilic esophagitis
Is Eosinophilic esophagitis limited to the distal esophagus?
No
In Eosinophilic esophagitis, there are many intraepithelial eosinophils. Do these tend to be superficial or deep?
Superficial
(also tend to form microabscesses)
A child that presents with dysphagia and food impaction, with a history of eczema, may have this condition
Eosinophilic esophagitis
Spectrum of diseases and symptoms caused by gastric contents in esophagus
Gastroesophageal reflux disease (GERD)
Heartburn and chest pain that is worse when lying down are seen in this condition
Gastroesophageal reflux disease (GERD)
GERD pathogenesis occurs due to this type of injury
Acid injury; pepsin, bile
Acid injury in GERD can result in decreased tone in this part of the esophagus
Lower esophageal sphincter
Do patients with GERD have an increased risk of Barrett’s and Adenocarcinoma?
YES
In reflux esophagitis, there is variable length of this part of the esophagus
Distal
Adaptive glandular (intestinal) metaplasia of lower esophagus
Usually due to erosive reflux esophagitis
Barrett’s esophagus
Barrett’s esophagus is adaptive glandular metaplasia of this part of the esophagus
Lower
Is Barrett’s esophagus more common in males or females?
Males
(also caucasians, 40-60 years old)
Barrett’s esophagus is a risk factor for this type of neoplasm
Esophageal adenocarcinoma
Barrett’s esophagus is clinically seen with this condition
GERD
Endoscopically in this condition, see “salmon colored” patches >1 cm above GEJ
Barrett’s esophagus
Pathogenesis of this condition involves repeated squamous epithelial injury
Bile and acid
Epithelial regeneration
Eventual glandular metaplasia
Barrett’s esophagus
Are goblet cells normally found in the esophagus?
No - indicate intestinal metaplasia
(seen in Barrett’s esophagus)
Morphology of this condition shows columnar metaplasia with goblet cells in the esophagus
Looks like normal intestinal epithelium
Barrett’s esophagus
Does GERD without Barrett’s esophagus have a risk for adenocarcinoma?
No
Are patients with esophageal carcinoma symptomatic?
Often asymptomatic; found at screening
Squamous cell carcinoma occurs in this part of the esophagus
Upper 2/3
Squamous cell carcinoma of the esophagus is more common in males or females?
Males
Morphology of this condition will show exophytic bulky tumors in the esophagus, often present late in course
Invades through wall into mediastinum
Frequent lymph node metastases
Squamous cell carcinoma of the esophagus
Squamous cell carcinoma of the esophagus invades through the wall into this
Mediastinum
Does Squamous cell carcinoma of the esophagus frequently metastasize?
Yes - frequent lymph node metastases
Adenocarcinoma commonly occurs in this part of the esophagus
Distal 1/3
Is Squamous cell carcinoma more common in the proximal 1/3 or middle 1/3 of the esophagus?
Middle
(but occurs in both)
Does adenocarcinoma of the esophagus typically metastasize?
Yes - frequent lymph node metastasis
(45% of tumors in deep submucosa)
Is an epithelial tumor in the proximal 2/3 or distal 1/3 of the esophagus more likely to be a squamous carcinoma?
Proximal
Is an epithelial tumor in the proximal 2/3 or distal 1/3 of the esophagus more likely to be an adenocarcinoma?
Distal
Is gastric atrophy a risk factor for adenocarcinoma in the esophagus?
No - is actually protective (negative associated)
