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Pathophysiology > GI: Esophagus > Flashcards

GI: Esophagus Flashcards

1
Q

What is the breakdown of muscle distribution in the esophagus?

A

upper 1/3 = striated muscle

lower 2/3 = smooth muscle

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2
Q

Define achalasia

A

related to partial of incomplete relaxation of the LES resulting in dilated esophagus and birds beak deformity on barium swallow

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3
Q

What autoimmune can lead to esophageal dysmotility?

A

scleroderma

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4
Q

What are the 2 most common types of malignancies associated with the esophagus and what are the risk factors for them?

A

1) squamous cell carcinoma (alcohol and tobacco)

2) adenocarcinoma (barrett’s esophagus, tobacco, and obesity)

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5
Q

What is the medical emergency that is associated with massive hematemesis following retching and vomiting?

A

Boerhaave Syndrome

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6
Q

Esophageal varices are commonly associated with __________ and _____________

A

cirrhosis and portal hypertension

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7
Q

What is the one main histological criteria for Barrett’s esophagus?

A

goblet cells (intestinal metaplasia)

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8
Q

What are the 2 viruses associated infectious esophagitis?

A

CMV

HSV

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9
Q

What fungus is associated with infectious esophagitis?

A

candida

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10
Q

What is the epithelium subtype of the esophagus?

A

stratified non-keratinized squamous epithelium (barrier to blood absorbing things from food)

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11
Q

_______ has squamous epithelium while __________ has columnar epithelium

A

esophagus, gastrum

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12
Q

Define atresia

A

a thin cord-like non-canalized segment of esophagus associated with proximal blind pouch and lower pouch leading to the stomach

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13
Q

What is an esophageal fistula?

A

communication between trachea and esophagus

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14
Q

What does the most common TE fistula look like?

A

esophagus is connected to the end of the trachea

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15
Q

TE fistulas are commonly associated with _________

A

cardiac abnormalities

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16
Q

What is the prognosis for TE fistulas?

A

100% survival in the absence of other abnormalities (surgically repaired)

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17
Q

When does congenital pyloric stenosis present?

A

2-6 weeks old

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18
Q

What are the 3 identifying characteristics of achalasia?

A

1) anti-peristalsis
2) relaxation of LES with swallowing
3) increased resting tone of LES

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19
Q

What is the cause of primary achalasia?

A

UNKNOWN, idiopathic

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20
Q

What are some secondary causes of achalasia?

A 
chagas
polio
surgical ablation
diabetes
sarcoid
malignancy
amyloid
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21
Q

bird’s beak sign on barium swallow is associated with ____________

A

achalasia

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22
Q

What are some of the complications of achalasia?

A
  • 5% develop SCC
  • candida
  • diverticula
  • aspiration pneumonia
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23
Q

histologically, ___________ ____ __________ _________ is associated with achalasia

A

inflammation of the myentereic plexus

destroying the nerve cells causing problems with peristalsis

24
Q

Scleroderma leads to atrophy of what part of the esophagus?

A

smooth muscle in the lower 2/3 of the esophagus

leading to dysphagia

25
Q

Define hiatal hernia

A

separation of diaphragmatic crura and widening of space between muscular crura and esophageal wall

26
Q

What are the two types of hiatal hernias?

A

1) sliding (entire stomach pushes up - get reflux symptoms)

2) paraesophageal (rolling) LES still in place, no reflux symptoms)

27
Q

______________ is a predisposing factor for mallory weiss tears

A

hiatal hernias

28
Q

mallory weiss tears only affect which layers of the esophagus?

A

mucosa and submucosa

29
Q

What are some complications of mallory weiss tears?

A

reflux, ulcerations, painful vomiting

30
Q

Why do mallory weiss tears not require surgical repair?

A

because they only affect the mucosa and submucosa, not the muscular layer

31
Q

What is the prognosis for esophageal varices once they rupture?

A

BAD 50% die from first bleed and 50% of survivors will bleed again within a year

32
Q

What are the 2 medical emergencies associated with the esophagus?

A

1) esophageal varices

2) boerhaave syndrome

33
Q

What is Boerhaave syndrome and why is it a medical emergency?

A

transmural rupture of esophagus (affects all layers and leads to severe vomiting and bleeding)

FATAL without surgical treatment

34
Q

Boerhaave is associated with what kind of lung disease?

A

subcutaneous emphysema

pneumomediastinum

35
Q

What are some causes of reflux esophagitis?

A
  • decreased efficacy of LES
  • sliding hiatal hernia
  • slowed esophageal clearance of reflux material
  • delayed gastric emptying and increased gastric volume
36
Q

What does reflux esophagitis look like on scoping?

A

redness, mucosal breaks

37
Q

What are the 3 causes of infectious esophagitis?

A

1) fungal (candida)

2) viral (CMV, HSV)

38
Q

What are the layers of the esophagus?

A 
squamous epithelium
lamina propria
muscularis
submucosa
outer muscular layers
39
Q

What is the hallmark of candida infection of the esophagus?

A

pseudomembrane formation

40
Q

What does herpes simplex virus infection look like in the esophagus?

A

punched out ulcers

molding of nuclei
multinucleation (more than 1 nuclei)
marginization

41
Q

What is the hallmark of CMV infection?

A

owl eye inclusions

42
Q

What is eosinophilic esophagitis

A

not sure? more commonly occurs in kids (GERD like symptoms)

see lots of eosinophils

43
Q

What does chemical or pill induced esophagitis look like on endoscopy?

A

well defined border (very red) and see edema

44
Q

List the histological clues associated with the various forms of esophagitis

A

infectious: pseudomembranes, cytopathic changes
chemical/pill: edema
reflux: inflammation and reactive changes
eosinophilic: lots of eosinophils

45
Q

What is the single most important risk factor for adenocarcinoma?

A

Barrett’s esophagus (30-40x rate)

46
Q

what percentage of people with GERD develop barretts?

A

10%

47
Q

What does Barrett’s look like on endoscopy?

A

salmon/red velvet colored mucosa (columnar epithelial lining)

long segment > 3cm
short segment

48
Q

What is the histologic evidence of intestinal metaplasia?

A

goblet cells

49
Q

Barrett’s —> low grade dysplasia —> high grade –> __________

A

adenocarcinoma

50
Q

True or false: SCC is the most common cancer worldwide

A

TRUE

51
Q

What are some clinical symptoms of SCC?

A

change diet from solids to liquids

52
Q

What things can cause SCC?

A

hot tea, alcohol, smoking, achalasia, webs, p53 mutations, etc

53
Q

Where is SCC normally found in the esophagus?

A

middle > upper third

upper 1/3 –> cervical lymph nodes
middle 1/3 –> mediastinal/tracheobronchial nodes
lower 1/3 –> celiac and gastric nodes

54
Q

What are the diagnostic histological features of SCC?

A

keratin pearls

55
Q

What are the early changes leading to adenocarcinoma?

A

p53 mutation

allelic loss of cyclin

56
Q

What are the later changes in adenocarcinoma?

A

amplification of c-ERB and cyclin

57
Q

Adenocarcinoma is associated with ____________ and _________ while SCC is associated with ____________ and __________.

A

obesity and Barrett’s

smoking and heavy alcohol use

Pathophysiology (26 decks)

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