GI pathology: oral; esophageal Flashcards
Define leuokoplakia and cause
white plaques on oral mucosa;
produced by hyperkeratosis of epithelium
Leukoplakia assoc w/ cancer?
10% have epithelial dysplasia (precancerous)
Predisposing factors to leukoplakia
smoking, chewing tobacco, alcohol abuse, chronic friction, irritants
Define erythroplakia
flat, smooth, red plaques
How is erythroplakia found microscopically?
significant numbers of atypical epithelial cells
Cancer risk w/ erythroplakia
high risk of malignant transformation
define hairy leukoplakia
wrinkled surface w/ patches on side rather than middle of tongue
cancer risk w/ hairy leukoplakia
no malignant transformation
Define lichen planus
white reticulate lesions on buccal mucosa and tongue
What are benign tumors of oral cavity?
hemangiomas; hamartomas; fibromas; lipomas; adenomas; papillomas; neurofibromas; nevi
What is the most common malignant tumor of oral cavity? when does it present?
squamous carcinoma => ages 40-70
What is squamous carcinoma of oral cavity associated w/?
tobacco and alcohol use when used together
What is the most common site of squamous carcinoma of oral cavity?
lower lip => may affect floor of mouth and tongue
What causes achalasia?
lack of relaxation of LES => 2’ to loss of myenteric plexus
When and how does achalasia present?
ages 30-50;
Sx: dysphagia, regurg, aspiration, chest pain
What causes the lack of relaxation of LES?
idiopathic;
may be 2’ to Chagas Dx (Trypanosoma cruzi);
malignancy
What changes in Barrett esophagus?
gastric or intestinal columnar epithelium replaces normal squamous epithelium
What causes Barrett esophagus?
chronic insult usually reflux
cancer risk w/ Barrett esophagus?
increases risk of adenocarcinoma 30-40x
Define Boerhaave syndrome
violent retching causes potentially fatal esophageal rupture
What is a Diverticula?
sac-like protrusions of 1 or more layers of pharyngeal or esophageal wall
Define traction diverticula and Sx associated
true diverticula in mid-esophagus => A-Sx
Sx w/ Zenker diverticula
dysphagia and regurgitation of undigested food soon after ingestion
Where do Zenker diverticula occur?
at jxn of pharynx and esophagus in elderly men
Where do esophageal carcinomas occur?
northern Iran and Central Asia
When do most esophageal carcinomas occur? and sex prevalence
after 50 => male 4x
What is esophageal carcinoma associated w/?
smoking, alcohol, nitrosamines, achalasia, Barrett esophagus, vitamin A deficiency
How will Esophageal carcinoma present w/?
dysphagia (1st to solids)
What is the metastatic site and Px?
liver and lung are most common sites; poor Px
Define esophageal strictures
narrowing of esophagus => resulting in fibrosis after severe inflammation
What causes esophageal strictures?
reflux; herpes virus; CMV; Candida; chem burns
What is important in Dx of esophageal strictures?
carcinoma should be ruled out
Define esophageal varices and result
dilated tortuous vessels of esophageal venous plexus;
=> PORTAL HTN
Why are esophageal varices life threatening?
esophageal varices are prone to *bleeding
What causes esophagitis?
reflux is most common cause;
other causes are infections (HHV, CMV, candida) and eosinophilic esophagitis
What are the types of esophageal hernias?
sliding;
paraesophageal
Where does sliding hernias occur? what are they associated w/?
90% cases have GE jxn above diaphragm
=> associated w/ *reflux
Where does paraesophageal hernias occur?
gastric cardia above diaphragm => GE jxn remains in abdomen
What is a paraesophageal hernia at risk for?
herniated organ will be at risk for strangulation and infarction
Where do Mallory Weiss tears occur? who are they seen in?
GE jxn 2’ to recurrent forceful vomiting
=> *alcoholics
Define schatzki rings
mucosal rings at squamocolumnar jxn below aortic arch
define tracheoesophageal fistula
usually esophgeal blind pouch w/ fistula bw lower segment of esophagus and trachea
What are TE fistulas associated w/?
congenital heart disease; GI malformation
Define esophageal webs
mucosal folds in upper esophagus above aortic arch
What syndrome is associated w/ esophageal webs? what are associations w/ this syndrome?
Plummer-Vinson syndrome=>
dysphagia; glossitis; Fe-deficiency anemia; esophageal webs
