GI pathology: oral; esophageal

Question 1

Define leuokoplakia and cause

Answer 1

white plaques on oral mucosa;

produced by hyperkeratosis of epithelium

Question 2

Leukoplakia assoc w/ cancer?

Answer 2

10% have epithelial dysplasia (precancerous)

Question 3

Predisposing factors to leukoplakia

Answer 3

smoking, chewing tobacco, alcohol abuse, chronic friction, irritants

Question 4

Define erythroplakia

Answer 4

flat, smooth, red plaques

Question 5

How is erythroplakia found microscopically?

Answer 5

significant numbers of atypical epithelial cells

Question 6

Cancer risk w/ erythroplakia

Answer 6

high risk of malignant transformation

Question 7

define hairy leukoplakia

Answer 7

wrinkled surface w/ patches on side rather than middle of tongue

Question 8

cancer risk w/ hairy leukoplakia

Answer 8

no malignant transformation

Question 9

Define lichen planus

Answer 9

white reticulate lesions on buccal mucosa and tongue

Question 10

What are benign tumors of oral cavity?

Answer 10

hemangiomas; hamartomas; fibromas; lipomas; adenomas; papillomas; neurofibromas; nevi

Question 11

What is the most common malignant tumor of oral cavity? when does it present?

Answer 11

squamous carcinoma => ages 40-70

Question 12

What is squamous carcinoma of oral cavity associated w/?

Answer 12

tobacco and alcohol use when used together

Question 13

What is the most common site of squamous carcinoma of oral cavity?

Answer 13

lower lip => may affect floor of mouth and tongue

Question 14

What causes achalasia?

Answer 14

lack of relaxation of LES => 2’ to loss of myenteric plexus

Question 15

When and how does achalasia present?

Answer 15

ages 30-50;

Sx: dysphagia, regurg, aspiration, chest pain

Question 16

What causes the lack of relaxation of LES?

Answer 16

idiopathic;
may be 2’ to Chagas Dx (Trypanosoma cruzi);
malignancy

Question 17

What changes in Barrett esophagus?

Answer 17

gastric or intestinal columnar epithelium replaces normal squamous epithelium

Question 18

What causes Barrett esophagus?

Answer 18

chronic insult usually reflux

Question 19

cancer risk w/ Barrett esophagus?

Answer 19

increases risk of adenocarcinoma 30-40x

Question 20

Define Boerhaave syndrome

Answer 20

violent retching causes potentially fatal esophageal rupture

Question 21

What is a Diverticula?

Answer 21

sac-like protrusions of 1 or more layers of pharyngeal or esophageal wall

Question 22

Define traction diverticula and Sx associated

Answer 22

true diverticula in mid-esophagus => A-Sx

Question 23

Sx w/ Zenker diverticula

Answer 23

dysphagia and regurgitation of undigested food soon after ingestion

Question 24

Where do Zenker diverticula occur?

Answer 24

at jxn of pharynx and esophagus in elderly men

Question 25

Where do esophageal carcinomas occur?

Answer 25

northern Iran and Central Asia

Question 26

When do most esophageal carcinomas occur? and sex prevalence

Answer 26

after 50 => male 4x

Question 27

What is esophageal carcinoma associated w/?

Answer 27

smoking, alcohol, nitrosamines, achalasia, Barrett esophagus, vitamin A deficiency

Question 28

How will Esophageal carcinoma present w/?

Answer 28

dysphagia (1st to solids)

Question 29

What is the metastatic site and Px?

Answer 29

liver and lung are most common sites; poor Px

Question 30

Define esophageal strictures

Answer 30

narrowing of esophagus => resulting in fibrosis after severe inflammation

Question 31

What causes esophageal strictures?

Answer 31

reflux; herpes virus; CMV; Candida; chem burns

Question 32

What is important in Dx of esophageal strictures?

Answer 32

carcinoma should be ruled out

Question 33

Define esophageal varices and result

Answer 33

dilated tortuous vessels of esophageal venous plexus;

=> PORTAL HTN

Question 34

Why are esophageal varices life threatening?

Answer 34

esophageal varices are prone to *bleeding

Question 35

What causes esophagitis?

Answer 35

reflux is most common cause;

other causes are infections (HHV, CMV, candida) and eosinophilic esophagitis

Question 36

What are the types of esophageal hernias?

Answer 36

sliding;

paraesophageal

Question 37

Where does sliding hernias occur? what are they associated w/?

Answer 37

90% cases have GE jxn above diaphragm

=> associated w/ *reflux

Question 38

Where does paraesophageal hernias occur?

Answer 38

gastric cardia above diaphragm => GE jxn remains in abdomen

Question 39

What is a paraesophageal hernia at risk for?

Answer 39

herniated organ will be at risk for strangulation and infarction

Question 40

Where do Mallory Weiss tears occur? who are they seen in?

Answer 40

GE jxn 2’ to recurrent forceful vomiting

=> *alcoholics

Question 41

Define schatzki rings

Answer 41

mucosal rings at squamocolumnar jxn below aortic arch

Question 42

define tracheoesophageal fistula

Answer 42

usually esophgeal blind pouch w/ fistula bw lower segment of esophagus and trachea

Question 43

What are TE fistulas associated w/?

Answer 43

congenital heart disease; GI malformation

Question 44

Define esophageal webs

Answer 44

mucosal folds in upper esophagus above aortic arch

Question 45

What syndrome is associated w/ esophageal webs? what are associations w/ this syndrome?

Answer 45

Plummer-Vinson syndrome=>

dysphagia; glossitis; Fe-deficiency anemia; esophageal webs