Esophagus Pathology

Question 1

What is achalasia?

Answer 1

a failure of smooth musclefibers to relax, which can cause a sphincter to remain closed and fail to open when needed.

Question 2

While priamry achalasia is primarily due to neuronal abnormalities, secondary achalasia is seen in ______

Answer 2

Chagas disease, in which T. cruzi destroys the myenteric plexus, which normally inhibits uninhibited LES contraction. Like Hirschsprung disease, proximal dilation follows

Question 3

Diseases that impede flow of venous blood through the liver can cause what?

Answer 3

portal HTN leading to the development of esophageal varices, extremely dilated sub-mucosal veins in the lower third of the esophagus

Question 4

Why are esophageal varices common in the lower 1/3rd?

Answer 4

The upper two thirds of the esophagus is drained via the esophageal veins, which carry deoxygenated blood from the esophagus to the azygos vein, which in turn drains directly into the superior vena cava. These veins have no part in the development of esophageal varices.

The lower one third of the esophagus is drained into the superficial veins lining the esophageal mucosa, which drain into the left gastric vein(coronary vein), which in turn drains directly into the portal vein. These superficial veins (normally only approximately 1 mm in diameter) become distended up to 1–2 cm in diameter in association with portal hypertension.

Question 5

Eosphageal varices develop in up to 90% of what pts.?

Answer 5

liver cirrhosis

Question 6

How do esophageal varices present?

Answer 6

typically asymptomatic, but can rupture when thinned and lead to massive hematemesis and death in ~50% of pts.

Question 7

Question 8

What are Mallory-Weiss tears?

Answer 8

these are esophageal lacerations associated with severe retching or vomiting, as may occur with acute alcohol intoxication (normally the esophageal relaxation that nromally occurs with vomitng is thought to fail during prolonged vomoting)

Question 9

How should Mallory-Weiss tears be managed?

Answer 9

they are superficial and do not generally require surgical intervention.

Question 10

What is Boerhaave syndrome?

Answer 10

Boerhaave’s syndrome is reserved for the 10% of esophageal perforations which occur due to vomiting

Question 11

What are some habits that increase the likelihood of GERD developing (either by decreasing LES tone or increasing intraabdominal pressure)?

Answer 11

alcohol and tobacco use

obesity

CNS depressants

hiatal hernia

Question 12

Answer 12

Question 13

How does GERD present?

Answer 13

-heartburn and dysphagia

Question 14

Describe eosinophilic esophagitis

Answer 14

An allergic esophagitis marked by symptoms similar to GERD but a higher density of eosinophils on biopsy

Question 15

What is the typical pt to get Barrett’s esophagus from GERD?

Answer 15

old, fat, white men

Question 16

T or F. GERD and Barrett’s Esophagus increase the risk of esophageal adenocarcinoma

Answer 16

T. Epithelial dysplasia occurs in about 1 of every 300 patient-years (so most pts with Barrett’s will NOT develop esophageal cancer)

Question 17

Question 18

T or F. Diagnosis of Barrett Esophagus requires endoscopy and biopsy

Answer 18

T. Usually prompted by GERD symptoms

Question 19

What are the main types of esophageal cancers?

Answer 19

SCC and adenocarcinoma

Question 20

Describe esophageal adenocarcinoma

Answer 20

This typically arises in a background of barrett’s esophagus and in those who chronically use tobacco and/or are obese

Question 21

What diets prevent esophageal adenocarcinoma?

Answer 21

fruits and veggies

Question 22

What pts typically get esophageal adenocarcinoma?

Answer 22

white men (men 7:1 to women)

Question 23

What mutations occur in progression of Barrett’s to adenocarcinoma?

Answer 23

p53

Question 24

Esophageal adenocarcinomas are more likely to occur in what part?

Answer 24

lower 1/3rd

Question 25

How do esophageal adenocarcinomas present?

Answer 25

most commonly with symptoms including dysphagia, progressive weight loss, chest pain, or vomitin. By the time symptoms occur, METs are likely to have occurred, leading to a poor prognosis in most

Question 26

Describe esophageal SCCs

Answer 26

These typically occur in adults 45+ in AA males mostly

Question 27

What are the risk factors for esophageal SCCs?

Answer 27

at least partially atributable to use of alcohol and tobacco, the effects of which are synergistic

• nutritional deficiencies
• achalasia
• Plummer-Vinson Syndrome

Question 28

Where do esophageal SCCs most commonly occur?

Answer 28

middle 1/3rd of the esophagus