GIT, Oral Cavity and Esophagus Path 1 Flashcards
what is achalasia?
- absence of relaxation;
it is a FUNCTIONAL esophageal obstruction due to partial or incomplete relaxation of the LES (lower esophageal sphincter)
what are some differences between oral leukoplakia and oral hairy leukoplakia
- dysplasia is seen in oral leukoplakia but NOT in oral hairy leukoplakia
- oral leukoplakia has malignant potential but oral hairy does not
- oral Leukoplakia is associated with HPV while oral hairy is HIV + EBV
what infections are associated with Oral hairy Leukoplakia
- almost always seen only in patients with HIV who have a superimposed infection with EBV
esophageal varices is the cause of death in 50% of patients with ______
advanced cirrhosis; esophageal varicies is associated with portal hypertension
dilation above the LES is seen in ______
achalasia
tracheal esophageal fistula is commonly associated with _____
esophageal atresia; the fistula occurs distal to the atresia
what are 3 common biopsy findings in someone with reflux esophagitis that are due to reactive changes
- basal zone hyperplasia
- elongation of lamina propria papillae (due to the basal zone hyperplasia)
- hyperemia: dilated blood vessels in mucosa
what is the triad of symptoms in Plummer Vinson Syndrome?
- esophageal webs
- glossitis
- iron deficiency anemia: koilonychia and splenomegaly
achalasia is associated with increased risk for ______ carcinoma
squamous cell
what are some secondary causes of achalasia (psudoachalasia)
- Chagas disease
- diabetic autonomic neuropathy
- malignancy, amyloidosis, sarcoidosis
- Down syndrome
“serpingous salmon colored path” in the esophagus is used to describe ______
Barrett’s esophagus
describe the epithelial cells in esophageal webs?
- upper: squamous mucosa with vascularized core
- only covered by mucosal epithelium
_____ infection is associated with oral leukoplakia
HPV
what are esophageal webs and rings?
protrusions of mucosa into the lumen
webs: upper
rings: lower
what is the most common malignant neoplasm in the esophagus?
worldwide: squamous cell
US and Africa: adenocarcinoma
what are the requirements for diagnosing someone with Barrett’s esophagus
- columnar mucosa AND goblet cells in histology (intestinal type of columnar epithelium)
- presence of dysplasia
describe the epithelial cells in esophageal rings?
- Lower: undersurface have columnar epithelium and covered by mucosal AND submucosal epithelium
in achalasia, the resting tone of the LES is ______
↑
what are 3 growth patterns of squamous cell carcinoma of the esophagus?
- exophytic (narrows lumen)
- diffusely infiltrative
- ulcerated/excavated
describe the metastasis of barrel’s esophagus
esophageal squamous mucosa → metaplastic columnar epithelium with goblet cells (like those in the intestine)
due to proliferation of stem cells for healing which then differentiate into columnar cells because they are resistant to peptic acid
SCC of the esophagus can direct spread to: (2)
adjacent mediastinal structures:
- trachea
- heart
what are some infectious causes for infectious esophagitis?
- fungal: candida
- viral: CMV and herpes (both are AIDS defining illnesses)
what is a pathognomonic finding in biopsy for reflux esophagitis?
presence of intraepithelial (squamous epithelium) inflammatory cells: eosinophils, neutrophils and lymphocytes
usually wont see the in the epithelial layer
“layers of keratitis squares over underlying mucosal acanthosis (hyperkartotic)”
- oral hairy leukoplakia which is hyperkeratotic thickenings
- all layers of the squamous epithielium is undergoing hyperplasia
the loss of ________ innervation of the _____ is a common cause of primary achalasia
loss of inhibitory innervation of the LES
longitudinal _______ tears at the ________ is seen in Mallory Weiss Syndrome
longitudinal mucosal tears in the esophagogastric junction
most often limited to the mucosa and heal by themselves
squamous cell carcinoma of the esophagus most commonly occurs in ________
middle 1/3
describe the white patches seen on oral leukoplakia
well defined what patch or plaque that cannot be removed by scarping and is found on the buccal mucosa, tongue or floor of the mouth
↓ in LES tone is seen in _____
GERD (reflux esophagitis)
↑ tone is seen in achalasia
what are some complications of reflux esophagitis
- bleeding
- strictures (due to fibrosis from inflammation)
- aspiration pneumonitis: reflux contents during sleep can go up tot he esophageal trachea junction and go into lungs
- Barrett’s esophagus and adenocarcinoma
dysphagia to mainly liquids and/or both solids and liquids is seen with ______
achalasia
dysphagia to solids → liquids is seen with which upper GI condition
adenocarcinoma
arrange the following in order of least to most malignant potential:
- oral leukoplakia, oral hairy leukoplakia, erythroplakia
oral hairy > oral > erythroplakia
white patches in the mouth that are easily scraped out is most likely ______
candidiasis
_______ has white patch or plaques that CANNOT be removed by scraping
Oral Leukoplakia
Barrett’s esophagus is a precursor lesion for ______
adenocarcinoma
what are some associations with oral leukoplakia
- tobacco use
- chronic friction such as from ill fitting dentures
- HPV infection
adenocarcinoma occurs in the ______ part of the esophagus
lower 1/3
- most common in white men
histologic hallmark of eosinophilic esophagitis is abundant eosinophils in squamous layer due to ______
allergies (moves distal → proximal)
what are some primary causes of achalasia?
- loss in intrinsic INHIBITORY innervation of the LES → absence of relaxation
- loss or absence of ganglion cells in the myenteric plexus
esophageal atresia is commonly associated with what other abnormality?
tracheo-esophageal fistula
Plummer Vinson syndrome has a high risk for _________ carcinoma of the esophagus
squamous cell carcinoma of the upper esophagus and lower pharynx
______ is a premalignant lesion to _______ that can be caused by reflux esophagitis
Barret’s esophagus → adenocarcinoma
discuss the malignant potential of oral leukoplakia and oral hairy leukoplakia
- oral hairy leukoplakia DOES NOT have malignant potential
- oral leukoplakia has small malignant potential
hematemesis due to _________ is usually painless
esophageal varices
what are some infections that are commonly seen in esophagitis
- HSV, CMV and candidiasis
what inflammatory molecules can you find in the biopsy of someone with reflux esophagitis?
- eosinophils
- neutrophils
- lymphocytes
what would you seen on a H&E slide of a biopsy of a white plaque seen with oral leukoplakia
- dysplasia (can progress to squamous cell)
