GI- 1 Flashcards
What are the layers of the esophagus?
Mucosa, submucosa, and muscularis propria
Where does most important pathology occur?
GE junction, where the squamous epithelium gives way to the glandular epithelium
The GE junction is AKA
The z-line
What is the most common congenital anomaly?
A tracheo-esophgeal fistula
Tracheo-esophageal fistula is associated with what in 90% of cases?
Esophageal atresia in the middle third
When does tracheo-esophageal fistula present itself and how can it lead to death?
During the neonatal period
Death by aspiration pneumonia
What are the 2 major types of hernias?
Hiatal and paraesophageal
What is a hiatal hernia?
When the entire proximal stomach protrudes into the mediastinum
What is a paraesophageal hernia?
Rolling when part of the fundus protrudes into the mediastinum
What is the most important cause of esophagitis?
Reflux
What happens in reflux esophagitis?
There is passage of gastric and duodenal contents through the lower esophageal sphincter
What are common elements of reflux esophagitis?
Elongation of rete, basal cell hyperplasia, and intraepithelial eosinophils
Intraepithelial eosinophils are seen in what other type of esophagitis? The pattern seen endoscopically is called?
Hypersensitivity esophagitis
Feline or trachealization
Intestinalization of glandular epithelium occurs in?
Barret’s esophagus
How does the color of the mucosa in barret’s compare to normal?
Red, velvety vs. pale pink
Intestinalization refers to presence of what cells?
Goblet cells
What is the most common cause of infectious esophagitis?
Candida like albicans or tropicalis
How does candida related esophagitis present itself and how is it treated?
Dysphagia, treated with antifungals like fluconazole
What is the 2nd most common cause of infectious esophagitis?
Herpes simplex virus
Who gets infected with HSV related IE?
Immunocompromised adults and children
HSV can cause what other then IE?
Ulcers
How do you treat HSV?
Antivirals like acyclovir
Cytomegalovirus is seen in who? What can it lead to?
Always in immunocompromised patients and leads to ulcers that resemble HSV ulcers
CMV cells possess what type of nucleus?
Owl eye
What is Mallory-Weiss syndrome?
When there are longitudinal tears in the lower esophagus that may also extend into the upper stomach
What does MW syndrome lead to and who gets it?
Leads to hematemesis or vomiting blood, seen in alcoholics
Are the tears perforating or superficial?
Superficial
A syndrome that has transmural tears is?
Boerhaave syndrome
Esophageal varices are a complication of?
Portal hypertension
What is the cause of varices and what can it result in?
Caused by alcohol and leads to hematemesis and death
Which vein is a major player in the formation of esophageal varices?
The left gastric vein or the cardiac vein
What are the two types of esophageal carcinoma?
Squamous cell and adenocarcinoma
Which type of esophageal carcinoma is most common the US? Worldwide?
In the US the numbers are about the same due to genetic and environment. Worldwide SCC is 90%
What are the main causes of esophageal carcinoma in the US? Who gets it more often, men or women?
Smoking and alcohol, men get it 4x as often
Almost all esophageal adenocarcinomas occur in the presence of?
Barret’s esophagus
Describes types A-E of atresia and fistulas
A is atresia without fistula B is atresia with proximal fistula C is atresia with distal fistula D is atresia with proximal and distal E is fistula without atresia
Esophageal varices result from?
Increase in pressure in the portal vein which shunts blood into associated veins not meant to withstand the increased pressure
