GI pathology (Mid-term exam content) Flashcards
What is Melena?
Dark-black feces because it contains blood.
What are the mechanical obstructive esophageal diseases?
Atresia Agenesis Fistula Stenosis Diverticula
What is the functional obstructive esophageal disease?
Achalasia
What are the mechanical obstructive esophageal disease that could be congenital or acquired?
Tracheoesophageal fistula
Where is the location tracheoesophageal fistula?
near the tracheal bifurcation
What are the causes of esophageal stenosis?
caused by: Epithelial damage Submucosal fibrous thickening Muscularis propria atrophy (due to inflammation and scaring.)
What obstructive mechanical esophageal Disease causes regurgitation?
Esophageal diverticula ( acid trapped in diverticula)
what are the triad characteristics of Achalasia?
Incomplete (LES) relaxation. Increase LES tone Esophageal aperistalsis.
What is the pathophysiology behind Achalasia?
Destruction of the esophageal neurons and subsequent loss of their inhibitory motor function.
Secondary Achalasia caused by?
-SIIM- 1. Infectious: like Chagas disease 2. An infiltrative tumor (malignancy): like SCC. 3. Material deposition: like Amyloidosis. 4. Systemic diseases involving the esophagus: like DM and Sarciodosis.
How would you diagnosis Achalasia?
- presented as progressive dysphagia. - Radiologically & endoscopically: Progressive dilation of the esophagus above LES. - Manometry: Aperistalsis. - Microscopically: Absence of myenteric ganglia ± mucosal inflammation and ulceration proximal to the LES.
What are esophageal varices?
Obstruction to the flow that will lead to portal
hypertension.
Dilated tortuous veins at the distal part of the esophagus
What are the commonest causes of esophageal varices?
Liver cirrhosis, (caused by alcoholic abuse, schistosomiasis, and HCV.)
How would you diagnosis esophageal Varices?
by endoscopy (Dilated and tortuous veins) & angiography (Tortuous vein & Varices)
.
What will esophageal varices cause clinically?
massive hematemesis and even death.
1/2 hemorrhagic cases die: due to hypovolemic shock or due to the hepatic coma.
What is an esophageal laceration?
longitudinal tear in the esophageal wall usually
at the gastroesophageal junction.
An example of an esophageal laceration?
Mallory-Weiss tears (laceration due to sever stretching & vomiting.)
Associated with alcohol abuse.
Can cause hematemesis.
Causes of injurious esophagitis?
- Chemicals.
- Pill-induce.
- Radiotherapy.
- Endoscopic injury.
- Graft versus host disease: grafted T-cells attacking host epithelial cells.
How would you diagnosis Injurious Esophagitis?
NO specific morphology under the microscope, just by finding an inflammation.
What are the causes of Infectious Esophagitis?
- Viral: Cytomegalovirus & Herpes simplex virus
- Bacterial.
- Fungal: Candida (commonest), Aspergillus, and, Mucormycosis.
How would you diagnosis infectious esophagitis?
Identify the specific microorganism.
What are the hallmark symptoms of Infectious Esophagitis?
ODYNOPHAGIA, dysphasia, chest pain, and fever.
What are the histological features of CMV Esophagitis?
- Non-specific ulcers.
- Large cells at the base.
- Large intranuclear inclusion.
- Basophilic → intracytoplasmic inclusion.
What are the histological features of HSV Esophagitis?
- vesicle or punched-out ulcer.
3M:
- Multinucleated squamous cells. (dark eosinophilic + intranuclear inclusions)
- Molding nuclei.
- Marginal chromatin.
What are the histological/endoscopic features of Candida Esophagitis?
fungal hyphae and inflammatory cells.
endoscopic: gray-white pseudomembrane with an underlying erythematous mucosa.
What are the protective mechanisms of the esophagus?
- The continuous peristaltic movement of the esophagus.
- Continuous LES tone.
- Submucosal glands secretions: bicarbonate and mucus.
What diseases will occur due to the progressive condition of reflux esophagitis (GERD)?
Barrett Esophagus and eventually carcinoma.
What can cause a decrease in LES tone leading to GERD?
- Hiatal hernia.
- CNS depressants
What can cause an increase in abdominal pressure leading to GERD?
- Oral intake: e.g (alcohol, tobacco, fatty meals, & soft drinks.)
- Obesity.
- Pregnancy.
- Delayed gastric emptying.
- increased gastric volume.
- Increase acid production: Zollinger–Ellison syndrome. (tumors form in your pancreas or the duodenum.)
How would you diagnosis Reflux Esophagitis (GERD)?
Endoscopically: hyperemia. (In the lower esophagus part)
Microscopically, there is NO single histologic diagnostic criterion had been made.
In severe cases we can see the triad:
- Spongiosis with elongated lamina propria papillae.
- Thickened basal layer: > 15% of epithelial thickness.
- intra-epithelial T-cell lymphocytes, eosinophils, & neutrophils.
What is the treatment of Reflux Esophagitis (GERD)?
Antihistamine, Proton pump inhibitors (omeprazole), or surgery.
What is the difference between Eosinophilic Esophagitis and GERD?
characterized by eosinophilic infiltration without any explanation.
Presence of epithelial infiltration by large numbers of eosinophils that are away from the GEJ (mid-esophagus).
What is the treatment of Eosinophilic esophagitis?
steroids.
How would you diagnosis Barrett Esophagus (endoscopic + microscopic.)?
(salmon-pink velvety mucosa) above GEJ proved by a biopsy to be intestinal metaplasia.
What disease is associated with Barrett Esophagus?
BE associated with an increase risk of adenocarcinoma.
What is the pathogenesis of Barrett Esophagus?
Recurrent GERD → inflammation of mucosa → healing by ingrowths of stem cells that give columnar epithelium (instead of squamous) due to the effect of abnormal environmental pH level.
What are the histological features Barrett Esophagus?
- Goblet cell.
- Glands with abnormal hyperchromatism,
- Enlargement, crowding, and stratification of nuclei of the columnar lining cells.