Gastrointestinal Pathology- Esophagus Flashcards
A patient presents with dysphagia for poorly chewed food. You suspect that there might be a problem with his esophagus. What could it be? What does this increase the risk for? What syndrome is this defect present in?
Esophageal web which is a thin protrusion of esophageal mucosa, most often in the upper esophagus. Increased risk for esophageus squamous cell carcinoma. Associated with Plummer-Vinson syndrome which is characterized by severe iron deficiency anemia, esophageal web, and beefy-red tongue due to atrophic glossitis.
A newborn presents to the nursery with vomiting, polyhydraminos, abdominal distention and aspiration. What congenital defect could he have? What is the most common variant of this disease?
He has tracheesophageal fistula which is a defect in the connection between the esophagus and trachea. Most common variant consists of proximal esophageal atresia with the distal esophagus arising from the trachea.
A patient presents with dysphagia, obstruction and really bad breath. What kind of disorder could he have? Where does it arise from?
He has Zenker diverticulum which is an out-pouching of pharyngeal mucosa through an acquired defect in the muscular wall (false diverticulum). Arises above the upper esophageal sphincter at the junction of the esophagus and pharynx.
An alcoholic patient with a history of bulimia comes to your clinic with painful hematemesis. On Hx you note that the patient has a long history of severe vomiting. What could explain his presentation ? You decide to do imaging and notice that there is air in the mediastinum and subcutaneous emphesema. What led to this presentation?
He has Mallory-Weiss syndrome which is a longitudinal laceration of mucosa at the gastro esophageal (GE) junction. The air is due to Booerhave syndrome which is caused by his Mallory-Weiss syndrome.
What is the most common cause of death in cirrhosis? How does it present?
Esophageal varices. Asymptomatic but risk of rupture exists. Presents with painless hematesis.
What are esophageal varices and how do they arise?
Dilated submucosal veins in the lower esophagus. Arise secondary to portal hypertension, when the left gastric vein backs up into the esophageal vein, resulting in dilation (varices).
A patient presents to your hospital with complaints of difficulty swallowing solids and liquids. His breath is putrid. On imaging, you see a bird beak sign on barium swallow. Esophageal manometry shows high LES pressure. What disease is this disorder characteristic of? What could be the cause of it?
He has achalasia which is the disordered esophageal motility with inability to relax the lower esophageal sphincter (LES). Due to damage of ganglion cells of myenteric plexus. The damage could be due to idiopathic reasons or due to Trypanosoma cruzi in Chagas disease.
A former executive who had a history of alcohol and tobacco use presents to your clinic with complaints of heart burn. His teeth is discolored and he has a recent occurrence of asthma and cough. What does he have? What are the risk factors and what are some late complications that can arise due to this disease?
He has Gastro Esophageal Reflux Disease (GERD) which is acid reflux from the stomach due to reduced LES tone. Additional risk factors include obesity, caffeine and hiatal hernia.Ulceration with stricture and Barrett esophagus are late complications.
What happens to some GERD patients who have been exposed to acidic stress? What changes are noted on biopsy? What can it progress to?
They can get Barrett esophagus which is metaplasia of the lower esophageal mucosa from stratified squamous epithelium to non ciliated columnar epithelium with goblet cells. May progress to dysplasia and adenocarcinoma.
What is the most common esophageal cancer worldwide? Where does it usually arise and what are the major risk factors?
Squamous cell carcinoma which is a malignant proliferation of squamous cells. Usualy arises in upper or middle third of esophagus. Risk factors include 1. alcohol and tobacco 2. very hot tea 3. achalasia 4. Esophageal web and injury
What is the most common esophageal cancer in the west? Where does it usually arise from?
Adenocarcinoma which is a malignant proliferation of glands. Arises from preexisting Barrett esophagus, usually involves the lower one-thirs of the esophagus.
When does esophageal carcinoma usually present? How is its prognosis? What are some symptoms? Which of the carcinomas (squamous or adenocarcinoma) presents with hoarse voice and cough? Why?
Presents late with poor prognosis.Symptoms include progressive dysphagia, weight loss, pain and hematemesis. It may additionally present with hoarse voice (recurrent laryngeal nerve involvement) and cough due to tracheal involvement.
Which lymph nodes could esophageal carcinoma spread to ?
- Upper 1/3 - cervical nodes
- Middle 1/3 - mediastinal or tracheobronchial nodes
- Lower 1/3 - celiac and gastric nodes
A patient presents with Periumbilical pain, fever and nausea. The pain eventually localizes to the right lower quadrant. What is this area called? You make a diagnosis of acute appendicitis. What causes this in children and adults? What can rupture lead to? What is a common complication?
McBurney point.
Caused by lymphoid hyperplasia which obstructs the appendix in children and fecalith in adults.
Rupture results in peritonitis that presents with guarding and rebound tenderness.
Periappendical abscess is a common complication.
