Esophagus Pathology Flashcards
1
Q
Vascular diseases
A
- esophageal varices
2
Q
Infectious/inflammatory diseases
A
- achalasia, chemical esophagitis, infectious esophagitis, reflux esophagitis
3
Q
Traumatic diseases
A
- mallory-weiss syndrome
4
Q
Anatomic diseases (congenital/acquired)
A
C: atresia, diverticula, fistula, hiatal hernia, rings, stenosis, webs
A: diverticula, fistula, hiatal hernia, rings, stenosis, webs
5
Q
Idiopathic diseases
A
- achalasia
6
Q
Neoplastic diseases
A
- adenocarcinoma, barrett’s esophagus, benign tumors, squamous cell carcinoma
7
Q
Squamocoloumnar junction (SCJ)
A
Z line
8
Q
Anatomic gastroesophageal juction (GEJ)
A
defined as takeoff of gastric fold
9
Q
Relation of SCJ to GEJ
A
- normally SCJ approximates GEJ
10
Q
Anatomic disease: atresia & fistula
A
- congenital
- choking, coughing, cyanosis w/ feeding
- amenable to surgical correction
11
Q
Anatomic disease: achalasia
A
- failure of LES to relax: narrow distal segment, dilated proximal segment
- progressive destruction of myenteric plexus
- dysphagia
- increased risk of carcinoma
12
Q
Achalasia: primary vs. secondary
A
- primary: idiopathic
- secondary: Chagas disease, scleroderma
13
Q
Anatomic disease: hiatal hernia
A
- protrusion of stomach above diaphragm
- idiopathic and asymptomatic
- two types: sliding (95%), paraesophageal (rolling-5%)
- *PE hernia patients at risk for strangulation (infarction of incarcerated hernia)**
14
Q
Anatomic diseases: diverticula-types
A
- congenital vs. ACQUIRED
- true (contain all gut layers) vs. FALSE
- PULSION (peristalsis against a closed sphincter) vs. traction (extrinsic pull, secondary to inflammation)
15
Q
Zenker diverticula
A
- pulsion, from above UES
16
Q
Mid esophageal diverticula
A
traction
17
Q
Epiphrenic diverticula
A
- pulsion, from above LES
18
Q
Mallory-Weiss syndrome
A
- hematemesis from lacerations of GEJ mucosa/submucosa
- caused by forceful retching/coughing/vomiting
- alcoholics, persons with eating disorders
19
Q
Esophageal varices causes
A
- consequence of portal hypertension
20
Q
Stenosis, Webs, Rings
A
Web: shelf of tissue, congenital, post inflammation
Ring: circumfrential, example-Schatzki @ SCJ
21
Q
Chemical and pill esophagitis cause
A
- topical injury due to ingestion of alcohol, corrosive substances (acid,lye), hot liquids
- cytotoxic chemotherapy (radiation, GVHD)
- “stuck” pills: doxycycline (acne), aspirin, iron, alendronate
22
Q
Kissing ulcers
A
- ulcers facing each other
- seen with doxycycline
23
Q
Infectious esophagitis: who gets it, presentation
A
- seen in immunocompromised
- ODYNOPHAGIA
24
Q
Infectious esophagitis: causes & presentation
A
- candida: white plaques
- herpes: numerous punched out ulcers (3 Ms: multinucleation, margination, molding)
- cytomegalovirus: single deep ulcer, “owl’s eye”
25
GERD vs. reflux esophagitis (RE)
- GERD: condition that develops when reflux of stomach contents causes troublesome symptoms and or complications
- RE: endoscopic or histologic evidence of reflux associated injury
26
GERD: prevalence, pathophysiology, symptoms
- 10-20% in West,
27
GERD: diagnosis, treatment, complications
- diagnosis: clinical, further testing if not responding to treatment
- treatment: antacids, anti secretory (PPIs), surgical (nissen fundoplication)
- complications: stricture, barrett's esophagus, adenocarcinoma
28
Types of GERD
- erosive: mucosal break (40%)
| - non erosive (60%)
29
Histologic features of reflux
- epithelial hyperplasia: basal zone hyperplasia, papillary elongation
- dilated intercellular spaces
- intraepithelial eosinophils
30
Epithelial hyperplasia
- compare height of papillaries and basal zone to entire squamous layer
- normal: PE=50%, BZH=13%
- abnormal: PE=84%, BZH=34%
31
Pathogenesis of heartburn in GERD
- erosive: mucosal breaks allow acid to get through
| - non erosive: dilated intercellular spaces allow acid to get through
32
Eosinophilic esophagitis: definition
- clinicopathologic disorder
- >15 intraepithelial eosinophils per high power field
- absence of pathologic GERD: normal pH, lack of response to high dose PPI medication
33
Eosinophilic esophagitis: frequency, symptoms
- frequency: increasingly recognized; 2-27/100,000 over 16 year period
- symptoms include FOOD IMPACTION, dysphagia (adults), GERD, feeding intolerance (children)
34
Eosinophilic esophagitis: diagnosis, treatment, complications
- esophageal symptoms + mucosal biopsy + exclusion of GERD (lack of response to PPI or normal pH monitoring)
- treatment: elimination and elemental diets, acid suppression, TOPICAL CORTICOSTEROIDS, dilatation of strictures
- complications: stricture
35
Endoscopy signs of eosinophilic esophagitis
- trachealization, linear furrowing
36
Histologic features of EoE
- >15 eos/HPF
| - eosinophilic MICROABSCESSES, SUPERFICIAL LAYERING, BZH, DIS
37
Barrett's Esophagus: definition
- endoscopically evident apparent columnar mucosa proximal to GEJ
- biopsy demonstrating intestinal metaplasia (GOBLET CELLS)
38
Barrett's esophagus: prevalence, etiopathogenesis, symptoms
- 10% of w/ symptomatic chronic GERD, many asymptomatic, 1.6% of general population
- etiopathogenesis: reflux, inflammation, induction of CDX2, METAPLASIA
- symptoms: GERD, asymptomatic, symptoms may improve in patients who develop BE
39
Barrett's Esophagus: diagnosis
- 2 EGD's with bx within 1 year (confirm dx; rule out PREVALEN DYSPLASIA)
40
Barrett's esophagus: treatment
- PPI for GERD; ENDOSCOPIC ABLATIVE Tx or surgery for dysplasia/carcinoma
41
Surveillance of Barrett's esophagus
- determined by absence or presence of dysplasia, grade of dysplasia
42
Complications of Barrett's esophagus
- adenocarcinoma: 1/200 patients/year (.5%/year), RR=30-60
43
Frequency of surveillance based on grade of dysplasia in BE
- no dysplasia: q 3-5 years
- indefinite for dysplasia: rebiopsy after tx underlying inflammation
- low grade dysplasia: q 6-12 months
- high grade dysplasia: q 3 months
44
Intramucosal carcinoma
- high grade dysplasia
- managed w/ esophagectomy due to 40% "cancer" risk
- 2/3 of these cancers are intramucosal, associated with
45
Categories of esophageal diseases
```
V: vascular
I: infectious/inflammatory
T: traumatic
A: anatomic
M: metabolic
I: idiopathic
N: neoplastic
```
46
Presentation of adenocarcinoma
- 95% present with advanced full blown adenocarcinoma rather than presenting and then progressing to it
47
Treatment for adenocarcinoma
- first do chemoradiation
| - second do esophagectomy
48
Incidence of esophageal cancer
- increasing at an alarming rate
| - due to obesity epidemic
49
Squamous cell carcinoma: gross & histology
- fungating, friable tumor mass
| - keratin pearls on histology
50
SCC vs. Adenocarcinoma
- SCC: etiology-tobacco, alcohol, hot beverages; not a major disease in the west
- adenocarcinoma: etiology-GERD, tobacco, obesity; much higher incidence
