GI Pathology of Oral and Esophagus.

Question 1

Sialolithiasis is most common to which salivary gland and its duct?

Answer 1

Wharton’s duct of the Submandibular gland is most common location of salivary gland stones. Periprandial pain bc duct wants to secrete saliva when you’re about to eat or eating.

Question 2

Tx of Sialolithiasis

Answer 2

Usually self resolve. Massage gland and hydration is important. NSAIDs for pain.

Suck on sour candy to stimulate saliva to push stone.

Question 3

If Sialolithiasis progresses to inflammation, what is it called?

Answer 3

Sialoadentitis.

Question 4

Most salivary tumors are benign but which gland’s tumors are 75% malignant?

What type of tumor is benign?

Answer 4

Sublingual. While Submandibular are 50% and Parotid are 25%.

Pleiomorphic Adenomas are made of mixed cell lines and are benign. Annoyingly these recur if not completely excised.

Question 5

What structure that plows through the Parotid gland feels pain from malignancy?

Answer 5

Facial Nerve. CN VII

Question 6

What are the 3 types of salivary tumors and which is most malignant?

Answer 6

Mucoepidermoid carcinoma are malignant. Warthin tumors are only 10% malignant (like Pheochromocytoma of the face). Pleiomorphic adenomas are benign.

Warthin tumors are more associated with smokers.

Question 7

Dysmotility of the Lower Esophageal Sphincter is known as…

Answer 7

Achalasia. Won’t unclench. Loss of myenteric plexus neurons.

Question 8

What is the progression of Achalasia in a pt?

Answer 8

First can’t eat solids, then liquids, then even their own saliva is obstructed.

Question 9

Achalasia increases risk of which type of cancer?

Answer 9

Squamous Esophageal Cancer.

Question 10

Primary Achalasia is idiopathic. What are secondary causes?

Answer 10

Chagas disease (dilated colon, esophagus, heart - DCM) from Trypanosoma cruzii. Malignancy.

Question 11

Tx of Achalasia is usually surgical.

Answer 11

Endoscopic botox, surgical myotomy, balloon dilation.

Question 12

Most Common treatments of Primary Achalasia.

Answer 12

Medical approaches to achalasia include using a CCB, nitroglycerin, or Botox in the LES. Nifedipine decreases the availability of calcium to the myosin-actin complex, leading to smooth muscle relaxation.

Nitroglycerin works through a cGMP-mediated mechanism to dephosphorylate and inactivate myosin light chains.

Botulinum toxin causes muscle paralysis by inhibiting the exocytosis of acetylcholine from presynaptic neurons. Surgical corrections include pneumatic dilation and esophageal myotomy.

Question 13

How would Chagas disease Trypanosoma cruzii Achalasia be treated?

Answer 13

Benznidazole.

Question 14

Squamous cell carcinoma of the larynx with its hoarsness commonly arises due to excessive use of…

Answer 14

Alcohol and tobacco. Long-term exposure leads to irritation that causes dysplastic lesions in the mucosa. These lesions have a mutated overexpressed p53 gene, which allows for unregulated cell growth

Question 15

Adenocarcinoma of the esophagus usually occurs where?

Answer 15

Distal third of the esophagus due to long-standing GERD.

Question 16

Plummer-Vinson Syndrome triad

Answer 16

triad of Dysphagia, IDA, and esophageal webs.

And beefy red tongue (glossitis). I knew it!

Question 17

Esophageal varices.

Answer 17

Veins in the esophagus that are abnormally dilated as result of portal hypertension. They are usually asymptomatic until they rupture, causing hematemesis.

Question 18

Hirschsprung disease is the loss of which plexus? How does it present?

Answer 18

Loss of Meissner plexus in the rectosigmoid colon is the underlying cause of Hirschprung disease. Failure of the neural crest cells to properly migrate and is associated with Down syndrome.

Pts present with bilious emesis, abdominal distention, and failure to pass meconium within the first few days of life.

Question 19

Scleroderma and CREST lead to decreased LES - opposite of Achalasia. What other symptoms are part of this disease? Which antibody do we look for?

Answer 19

CREST syndrome is characterized by Calcinosis cutis, Raynaud phenomenon, Esophageal dysmotility, Sclerodactyly, and Telangiectasia and is associated with the presence of an anti-centromere antibody.

Question 20

Feeling of a bolus in the throat but with no medical explanation is considered which psychological disorder?

Answer 20

globus sensation - esp after a stressful or traumatic event.

Question 21

Types of Esophagitis

Answer 21

GERD, EoE (eosinophilic esophagitis), Infectious Esophagitis

Question 22

How does esophagitis present?

Answer 22

Epigastric chest pain, odynophagia, sometimes dysphagia.

Question 23

GERD is worse at what time of day?

Answer 23

Worse when waking up.

Question 24

EoE requires what along with acid suppression?

Answer 24

Topical steroids because it is an allergic rxn. Often associated with asthma. Bx required to see eosinophils.

Question 25

3 infectious agents usually in immunocompromised pts which may cause esophagitis. Describe the look of each.

Answer 25

Candida esophagitis has white yeasty patches. HSV esophagitis has round punched out lesions in the esophagus. CMV esophagitis has longitudinal ulcers.

Question 26

MC Cx of esophagitis.

Answer 26

Strictures or scarring of the esophagus.

Question 27

Precancerous metaplasia at the GE junction due to GERD is known as... What is the metaplasia that occurs?

Answer 27

Barrett Esophagus. From non-keratinized squamous (like the mouth and vagina) to columnar and glandular.

Question 28

3 causes of Hematemesis...which are life threatening?

Answer 28

Mallory-Weiss tears have mild to moderate blood. Boerhaave's is perforation/rupture of esophagus. Esophageal varices from Portal HTN will have copious amts of blood. All have a relationship to alcoholics. Boerhaave is more common in iatrogenic endoscopy. Latter 2 are life threatening while MW tears often self resolve.

Question 29

Which part of the esophagus is subject to squamous cell carcinoma? Which part is adenocarcinoma?

Answer 29

SCC is laryngeal and upper 2/3rds. Associated with smoking and EtOH and hot liquids, Achalasia. AdenoCA is GERD associated.

Question 30

Why does esophageal cancer have such a poor Px?

Answer 30

Esophagus does not have the serosa lining so it is easy for cancer to invade the mediastinum. It is often caught late when it is already invasive.

Question 31

Causes of Acute Gastritis. Please explain how each is caused.

Answer 31

1. NSAIDs by blocking the protection given by Prostaglandins. 2. Alcohol is a direct irritant. 3. Curling iron ulcer gastritis. 4. Cushing ulcer.

Question 32

Chronic gastritis is from either H. Pylori or Autoimmune. What enzyme does H. Pylori have?

Answer 32

H. Pylori has Urease to break down urea to ammonia in the stomach and mucolytic corkscrew enzymes and a flagella.

Question 33

Where does H. Pylori start and spread to? What type of cancer is it associated with?

Answer 33

Usually begins in the Antrum and spreads to the Body of the stomach. MALT (Mucosa associated lymphoid tissue) lymphoma. Also causes PUD.

Question 34

Weak spot in the Inferior Pharyngeal Constrictor muscle can lead to which diverticulum?

Answer 34

Zenker at Killian's Triangle. False diverticulum. Gross little pouch of rotting food causing neck mass, bad breath, dysphagia when mass gets big enough to push on esophagus. Can cause reflux which is a major risk factor for aspiration.