GI Pathology - Congenital Abnormalities, Esophagus and Stomach Flashcards
What occurs in esophageal atresia?
Where does atresia occur most often? What is it often associated with it?
What is a less common type of atresia? What does it involve usually?
A thin, noncanalized cord replaces a segment of the esophagus, leading to obstruction.
At the tracheal bifurcation; associated with fistula that connects the upper and lower esophageal pouches to the trachea/bronchus.
Intestinal atresia which frequently involved the duodenum.
What is ectopia in terms of GI?
What are some examples?
Developmental rests
Ectopic gastric mucosa in the upper 1/3 of esophagus (inlet patch)
Ectopic pancreatic tissue occurs less often and is found in the esophagus and stomach
What causes an Omphalcele?
How is Gastroschisis different?
Incomplete closure of the abdominal musculature and the abdominal viscera herniates into the ventral membranous sac. They can be fixed surgically, but 40% of pts. have other congenital problems.
Gastroschisis includes all of the layers of the abdominal wall, from the peritoneum to the skin.
What is a Meckel diverticulum?
What causes it?
What is the “rule of 2”? (5)
A true diverticulum (blind outpouching that communicated with the parent lumen) in the ileum.
Failure of involution of the vitelline duct (connects developing gut to the yolk sac).
2% of the pop. 2 ft. from IC valve 2 in. long 2x more common in males Symptomatic by age 2 (but only 4% are symptomatic)
What sex is more likely to have pyloric stenosis? How common are they?
When does it present?
What is found on PE?
What is the treatment?
3-5x M>F; monozygotic twins; 1 in 300-900 live births.
3-6 wks into life with regurgitation, projectile vomiting after feeding, needs for re-feeding, etc.
Firm, ovoid mass (1-2 cm) in the abdomen.
Surgical splitting of the muscularis (myotomy) is curative.
What disease does Hirschsprung Dz have a 10% association with?
How common is it?
What is the pathogenesis?
What is a classic sign on XR?
What is the initial presentation?
Down syndrome
1/5000 live births
NCCs don’t migrate from the cecum to the rectum normally, leading to absence of the Meissner and Auerbach plexus and does not allow for coordinated contractions.
Megacolon.
Inability to pass meconium in the immediate neonatal period.
What is the blood supply to the regions of the esophagus?
How long is the esophagus?
Upper 1/3: inferior thyroid a.
Middle 1/3: branches of the thoracic aorta
Lower 1/3: left gastric a.
18-22 cm.
What are the 3 major causes of functional obstruction of the esophagus?
Nutcracker esophagus: high-amplitude contractions of the distal esophagus due to loss of normal coordination of the inner and outer layers of SM.
Diffuse esophageal spasm: repetitive, simultaneous contractions of the distal esophageal SM.
CREST syndrome
What are causes of mechanical obstruction of the esophagus? (3)
Stricture, stenosis, mass
- esophageal stenosis
- esophageal mucosal webs
- esophageal rings (Schatzki rings)
What is a Zenker diverticulum and when do they develop?
A diverticulum developed due to impaired relaxation of the cricopharyngeus muscle, which can be a trap for food and lead to bad halitosis. Most develop after age 50.
Achalasia is characterized by what triad?
What is primary vs. secondary?
Incomplete LES relaxation, increased LES tone, aperistalsis of the esophagus.
Primary is due to distal esophageal inhibitory neuronal (ganglion cell) degeneration. Secondary arises in Chagas disease, which causes destruction of the myenteric plexus, failure of peristalsis and esophageal dilation.
What GI bleed is more common: UGIB or LGIB?
UGIB is 4x more common
Reflux esophagitis is most commonly due to…
It is the…
Transient lower esophageal sphincter relaxation
Most common cause of esophagitis
Eosinophilic esophagitis symptoms…
Incidence is…
What is the usual cause?
Food impaction, dysphagia and feeding intolerance (infants).
Increasing significantly since 1978
Allergies to foods, asthma, rhinitis, atopic dermatitis, etc.
What is the pathogenesis of esophageal varices?
What is the major concern?
Portal HTN leads to development of collateral channel at sites where portal and caval systems communicate.
A variceal bleed, which is a medical emergency.
What is the only way to identify Barrett’s esophagus?
Endoscopy and biopsy, usually prompted by GERD
What 3 infections can pertain to the esophagus?
HSV
CMV
Candida albicans
What is Barrett’s esophagus characterized by?
What ages are most common?
What is the major risk?
Intestinal metaplasia within esophageal squamous mucosa
40-60 yo, more common in white males
Development of Adenocarcinoma
Which countries is Adenocarcinoma of the esophagus most common? (4)
Which group is at the highest risk?
What are risk factors?
What part of the esophagus is most common?
What histopathology is most common?
US, UK, Canada, Australia
7x more common in men
GERD, obesity, diet, etc.
Distal 1/3
Mucinous adenocarcinoma histopathology
Which countries is SCC of the esophagus most common? (3)
Who is at a greater risk?
50% occur where in the esophagus?
What are some risk factors? (8)
Iran, central China, Hong Kong
Adults > 45 yo; M>F 4:1; AA have 8x increased risk
Mid 1/3 of esophagus
Tobacco and alcohol Chemical/thermal injury (hot drinks) Esophageal disorders: achalasia/Plummeer-Vinson syndrome Radiation (5-10 yrs prior) Tylosis (RHBDF2 mutation) HPV +/- HIV
Normally, what are 2 damaging factors of the gastric mucosa?
What are protective factors? (5)
Gastric acidity, Peptic enzymes
Surface mucous secretion HCO3- secretion Mucosal blood flow Epithelial barrier function PGs
Mucosal gastric injury can be caused by what mediators? (6)
What can impair the submucosa? (3)
H pylori NSAID Tobacco EtOH Increased H+ Duodenal reflux
Ischemia, shock, NSAIDs
What is the difference of acute gastritis and gastropathy?
If neutrophils are present = acute gastritis
Few immune cells = gastropathy
What is the most common cause of chronic gastritis? Secondary most common?
H pylori is most common
10% are from autoimmune dz
