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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
Define hiatal hernia
separation of diaphragmatic crura and widening of space between muscular crura and esophageal wall
26
What are the two types of hiatal hernias?
1) sliding (entire stomach pushes up - get reflux symptoms) | 2) paraesophageal (rolling) LES still in place, no reflux symptoms)
27
______________ is a predisposing factor for mallory weiss tears
hiatal hernias
28
mallory weiss tears only affect which layers of the esophagus?
mucosa and submucosa
29
What are some complications of mallory weiss tears?
reflux, ulcerations, painful vomiting
30
Why do mallory weiss tears not require surgical repair?
because they only affect the mucosa and submucosa, not the muscular layer
31
What is the prognosis for esophageal varices once they rupture?
BAD 50% die from first bleed and 50% of survivors will bleed again within a year
32
What are the 2 medical emergencies associated with the esophagus?
1) esophageal varices | 2) boerhaave syndrome
33
What is Boerhaave syndrome and why is it a medical emergency?
transmural rupture of esophagus (affects all layers and leads to severe vomiting and bleeding) FATAL without surgical treatment
34
Boerhaave is associated with what kind of lung disease?
subcutaneous emphysema | pneumomediastinum
35
What are some causes of reflux esophagitis?
- decreased efficacy of LES - sliding hiatal hernia - slowed esophageal clearance of reflux material - delayed gastric emptying and increased gastric volume
36
What does reflux esophagitis look like on scoping?
redness, mucosal breaks
37
What are the 3 causes of infectious esophagitis?
1) fungal (candida) | 2) viral (CMV, HSV)
38
What are the layers of the esophagus?
``` squamous epithelium lamina propria muscularis submucosa outer muscular layers ```
39
What is the hallmark of candida infection of the esophagus?
pseudomembrane formation
40
What does herpes simplex virus infection look like in the esophagus?
punched out ulcers molding of nuclei multinucleation (more than 1 nuclei) marginization
41
What is the hallmark of CMV infection?
owl eye inclusions
42
What is eosinophilic esophagitis
not sure? more commonly occurs in kids (GERD like symptoms) see lots of eosinophils
43
What does chemical or pill induced esophagitis look like on endoscopy?
well defined border (very red) and see edema
44
List the histological clues associated with the various forms of esophagitis
infectious: pseudomembranes, cytopathic changes chemical/pill: edema reflux: inflammation and reactive changes eosinophilic: lots of eosinophils
45
What is the single most important risk factor for adenocarcinoma?
Barrett's esophagus (30-40x rate)
46
what percentage of people with GERD develop barretts?
10%
47
What does Barrett's look like on endoscopy?
salmon/red velvet colored mucosa (columnar epithelial lining) long segment > 3cm short segment
48
What is the histologic evidence of intestinal metaplasia?
goblet cells
49
Barrett's ---> low grade dysplasia ---> high grade --> __________
adenocarcinoma
50
True or false: SCC is the most common cancer worldwide
TRUE
51
What are some clinical symptoms of SCC?
change diet from solids to liquids
52
What things can cause SCC?
hot tea, alcohol, smoking, achalasia, webs, p53 mutations, etc
53
Where is SCC normally found in the esophagus?
middle > upper third upper 1/3 --> cervical lymph nodes middle 1/3 --> mediastinal/tracheobronchial nodes lower 1/3 --> celiac and gastric nodes
54
What are the diagnostic histological features of SCC?
keratin pearls
55
What are the early changes leading to adenocarcinoma?
p53 mutation | allelic loss of cyclin
56
What are the later changes in adenocarcinoma?
amplification of c-ERB and cyclin
57
Adenocarcinoma is associated with ____________ and _________ while SCC is associated with ____________ and __________.
obesity and Barrett's smoking and heavy alcohol use

Pathophysiology (26 decks)

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