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Gastrointestinal System > EXAM #1: PATHOLOGY OF THE ESOPHAGUS > Flashcards

EXAM #1: PATHOLOGY OF THE ESOPHAGUS Flashcards

1
Q

What is the definition of odnophasia?

A

Painful swallowing

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2
Q

What should you think when a patient complains of odnophasia?

A

Infectious cause

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3
Q

What is the pathologic feature of Achalasia?

A

Failure of relaxation of the LES

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4
Q

What are the symptoms of Achalasia?

A

Progressive dysphagia

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5
Q

What causes Achalasia?

A

1) Idiopathic
2) Degenerative changes leading to decreased myenteric ganglia
3) Secondary causes

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6
Q

What morphology is seen in Achalasia?

A

Dilated esophagus proximal to the LES

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7
Q

What are patients with Achalasia at risk for?

A

1) SCC
2) Aspiration
3) Esophagitis
4) Diverticula formation
5) Obstruction

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8
Q

What disease can cause Secondary Achalasia?

A

Chagas Disease

Trypanosoma cruzi –parasite– that destroys ganglion cells

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9
Q

List the secondary causes of Achalasia.

A

1) Chagas Disease
2) Disorders of the vagal dorsal motor nuclei
3) Diabetic neuropathy
4) Infiltration disorders

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10
Q

What are the two types of Hiatal Hernias?

A

1) Sliding*
2) Paraesophageal

*Most common

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11
Q

Which of the hiatal hernias is more dangerous?

A

Paraesophageal–risk of strangulation

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12
Q

What are the symptoms of a hiatal hernia?

A

GERD

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13
Q

What is the definition of a diverticula?

A

Outpouching of the GI tract

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14
Q

What are the three different types of diverticula seen in the esophagus? Which are false and which are true?

A

1) Zenker- False
2) Traction- True
3) Epiphernic- True

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15
Q

Where is a Zenker diverticula?

A

Proximal–immediately above the UES

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16
Q

Where are Traction diverticula?

A

Midportion of the esophagus

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17
Q

Where are Epiphrenic diverticula?

A

Distal–just above the LES

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18
Q

What is the primary presenting symptom of an esophageal diverticula?

A

Halatosis

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19
Q

What can cause a Traction Diverticula?

A

Mediastinal lymph nodes in TB “pulling” the esophagus out

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20
Q

What is a Mallory-Weiss tear?

A

Longitudinal tear at the gastroesophageal junction

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21
Q

What are the common causes of Mallory-Weiss tears?

A

1) Alcoholics
2) Bulemia nervosa
3) Hyperemesis gravidarum

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22
Q

What happens when there is rupture of a Mallory-Weiss tear?

A

Booerhave Syndrome

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23
Q

What is the primary symptom of Mallory Weiss tear?

A

Hematemesis

24
Q

Outline the anatomy of an esophageal varice.

A

N/A

25
Q

What are the most common causes of esophageal varices?

A

1) Alcoholism

2) Schistosmiasis

26
Q

What are the symptoms of an esophageal varice?

A

Non prior to rupture, then rapidly fatal with SEVERE hematemesis

27
Q

What is esophagitis?

A

Inflammation of the esophagus

28
Q

What are the symptoms of esophagitis?

A

Dysphagia
GERD
Hematemesis
Melena

29
Q

List the specific causes of Esophagitis.

A

1) Reflux esopagitis
2) Barrett’s Esophagus
3) Infections/ chemical causes
4) Eosinophilic esophagitis

30
Q

What causes reflux esophagitis?

A

Decreased efficacy of antireflux mechanisms i.e. LES tone

31
Q

What are the risk factors for GERD?

A 
Alcohol 
Tobacco 
Obesity 
Fat-rich diet 
Caffeine 
Hiatal hernia
32
Q

What is the normal epithelium of the esophagus?

A

Nonkeratinized stratified squamous epithelium

33
Q

What is the normal epithelium of the stomach?

A

Non-ciliated simple columnar epithelium with goblet cells

34
Q

Describe the progression of the histologic morphology in GERD.

A

1) Eosinophilia
2) Basal zone hyperplasia
3) Elongation of lamina propria papillae
4) Superficial necrosis/ ulceration

35
Q

What is Barrett’s Esophagus?

A

Replacement of normal distal squamous mucosa with metaplastic columnar epithelium

36
Q

How much does Barrett’s Esophagus increase the risk for carcinoma?

A

30-40x

37
Q

How does Barrett’s Esophagus appear grossly?

A

Velvety salmon spotting above the GE junction

38
Q

Histologically what is the hallmark of low grade dysplasia in Barett’s Esophagus?

A

“Picket Fence Nuclei”

39
Q

What marks the progression from dysplasia to carcinoma in Barett’s Esophagus?

A

Invasion of the basement membrane

40
Q

What does radiation of the esophagus lead to?

A

Fibrosis (healing) of the esophagus, which can cause dysphagia and impaired peristalsis

41
Q

In HIV patients, what virus can lead to very painful swallowing?

A

HSV-1 associated esophageal ulcers

42
Q

What is the most common cause of esophageal strictures?

A

Irritation/ trauma and subsequent healing

43
Q

What foods will patients with esophageal strictures have difficulty with?

A

Solids

44
Q

What is Scleroderma?

A
  • Autoimmune disease leading to vascular obliteration and fibrosis of smooth muscle
  • Major cause of stricture/ dysphagia
45
Q

What is the most common benign tumor of the esophagus?

A

Leiomyoma–a tumor of smooth muscle

46
Q

What are the two most common malignant tumors of the esophagus?

A

1) Adenocarcinoma

2) Squamous Cell Carcinoma

47
Q

What is an Adenocarcinoma?

A

Neoplastic proliferation of glands

48
Q

What is a Squamous Cell Carcinoma?

A

Neoplastic proliferation of epithelium

49
Q

What is the most common cause of cancer in the esophagus worldwide? What about in the US?

A 
Worldwide= SCC 
US= Adenocarcinoma
50
Q

What are the risk factors for SCC?

A

1) Chronic esophagitis
2) Alcohol
3) Smoking
4) Achalasia
5) Carcinogens in food
6) HPV

51
Q

What are the clinical features of SCC?

A
  • Late diagnosis
  • Progressive dysphagia
  • Extreme weight loss
52
Q

What are the three types of SCC of the esophagus?

A

1) Protruding
2) Flat
3) Evacuated (ulcers)

53
Q

Where do adenocarcinomas typically arise?

A

Distal 1/3 of the esophagus

54
Q

Where do SCCs typically arise?

A

Middle 1/3 of the esophagus

55
Q

What form of esophageal cancer is associated with a “signet ring” appearance microscopically?

A

Poorly differentiated adenocarcinoma

Gastrointestinal System (42 decks)

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