L78

Question 1

3 narrowings in the esophagus

Answer 1

Cricoid cartilage
Aortic arch
LES // diaphragm

Question 2

4 normal histo layers of esophagus

Answer 2

Mucosa
Submucosa - has vessels + lymphatics, so this is when you get worried about tumor invasion
Muscularis propria
1. Circular = inner layer
2. Longitudinal
Adventita

Question 3

Achalasia has increased cancer risk. What type of cancer? Why?

Answer 3

Squamous cell cancer (aka normal epi lining)

Material sits around in esophagus b/c can’t go down past tight LES -> damages mucosa

Question 4

Histo changes for achalasia

Answer 4

Hypertrophic nerves lacking ganglion cells

Question 5

2 Histo for GERD

Answer 5

1. Decreased thickness over papillae surface

2. Basal stem cell layer is prominent b/c replicating

Question 6

Definition of Bennett’s esophogus

Answer 6

Endoscopic = pink columnar mucosa in the esophagus
AND
Histo = intestinal metaplasia (goblet cells)

Question 7

What feature in Bennett’s esophagus makes you worried about cancer? What type of cancer?

Answer 7

DYSPLASIA
Can be low grade or –> high grade
Final progression would be to adenocarcinoma

Question 8

What gene gets mutated for BE to progress to dysplasia?

Answer 8

p53
Normally:
1. Stops cell cycle
2. Initiates DNA repair
3. Initiates apoptosis when cell can't be saved

Question 9

What are the different features of low vs high grade BE dysplasia?

Answer 9

Low:
- Mucin depletion
- Nuclei are dark, weird looking but consistent
- Glands still look normal
High:
- Cribriforming change = swiss cheese = back to back gland crowding
- Nuclei change fromc ell to cell

Question 10

What are you looking for with adenocarcinoma?

Answer 10

Low esophagus (acid)
Flat lesions 
Mucin glands invade into underlying tissue

Question 11

What type of cancer is associated with GERD/acid?

Answer 11

GERD -> BE -> ADENOcarcinoma

Question 12

Risk factors for squamous cell carcinoma?

Answer 12

Smoking

Drinking

Question 13

Histo for SC dsplasia

Answer 13

Weird looking squamous cells

Question 14

Histo for SCC

Answer 14

Invading underlying tissues!!
Most often middle esophagus
Keratin

Question 15

How do you stage esophageal cancer?

Answer 15

DEPTH of invasion into submucosa

If has invaded surrounding structures, likely unresectable

Question 16

Histo for candida esophagitis. Do these lesions ulcer?

Answer 16

Superficial lesion w/ fungal forms (silver stain)

Endo: lesions are white, NO ulcer

Question 17

What virus can’t you find in the center of an esophageal ulcer?

Answer 17

Herpes has to have viable squamous cells to infect - find at periphery of ulcer not necrotic center

Question 18

Histo finding for esophogeal cells infected with herpes

Answer 18

Multinucleated cells

Question 19

What virus CAN you find centrally in an ulcer?

Answer 19

CMV

Question 20

Where in the esophagus would you expect to find eosinophilic esophagitis?

Answer 20

Mid

Question 21

What 2 systemic conditions can also cause esophagitis?

Answer 21

Crohn’s

GVHD post stem cell transplant

Question 22

Describe a Mallory Weiss tear.

Answer 22

@ GE jxn

Partial tear through mucosa, submucosa only

Question 23

Mallory Weiss tear
Presentation
Cause
Treat

Answer 23

Hematemesis = coughing up blood
B/c of states when you vomit a lot: alcohol, eating disorders
Resolve on own

Question 24

Describe a Boerhaave tear

Answer 24

Full thickness tear of esophagus

Question 25

Boerhaave tear
Presentation
Cause
Treat

Answer 25

Severe, tearing pain +/- pnemo-mediastinum
Trauma, etc
Immediate repair - can die from this