Lec 2 Flashcards
What is the order of layers from in to out of esophagus?
- mucosa
- muscularis mucosa / submucosa
- muscularis propria
What structures are in esophagus submucosa?
veins, nerves [meissner’s plexus], salivary glands, elastic fibers
What is the z line?
the line demarcating esophagus from stomach
esophagus = shinier, lighter color stomach = not shiny, not squamous
What is an especially dangerous cause of chemical esophagitis
alkalis = odorless and tasteless + rapid injury
What is effect of akalis on esophagus short and long term?
immediately = necrosis, saponification, perforation
long term = chronic ulcer, stricture, squamous cell carcinoma
How do pills cause esophagitis?
during sleep pill sandwiched in collapsed esophagus w/ no secretions
What are “kissing ulcers” a sign of?
sign of esophagitis due to pill
What are some chemical causes of esophagitis?
- alkalis
- pills taken at night
- bisphosphonates
What does candida esophagitis suggest?
early sign of immunocompromised states
What do you see on endoscopy with candida esophagitis?
whitish plaques
What does CMV esophagitis indicate?
- immunocompromised state
- indicates viremia [esophagus not usually involved alone]
What cells does CMV infect?
mesenchymal cells [endothelial, fibroblasts, myocytes]
NOT squamous cells
What cells does herpes infect?
squamous cells
What is the mucosal lining of the esophagus?
stratified squamous not normally keratinized
Who gets esophageal varices?
patients with portal hypertension
What is structure of muscularis propria?
2 muscle layers with myenteric nerve plexus sandwiched between
Is esophagus smooth or skeletal?
upper 1/3 skeletal; bottom 2/3 smooth
What 3 things do you see microscopically with HSV esophagitis?
- cell cell detachment
- multinucleation
- ground glass nuclei
What are symptoms of infectious esophagitis?
odynophagia = painful swallowing
Should you biopsy from ulcer or squamous epithelium to find CMV? What about herpes?
ulcer to find CMV
normal squamous epithelium to find herpes
What are risk factors for reflux esophagitis?
- LES incompetence [due to hernia, drug, food, scleroderma]
- high ab pressure [obesity, pregnancy]
- reduced saliva [smoking]
- bulimia
What substance cause injury to esophagus in reflux esophagitis?
- gastric acid
- pepsin
- duodenal contents [trypsin, bile]
What do you see under microscope in reflux esophagitis?
- dilated capillaries
- edema
- ballooning of squmaous cells
- eosinophils, neutrophils
- increased height of basal cell zone
What is eosinophilic esophagitis? treat?
infiltration of eosinophils in esophagus in person w/ allergy
treat by dietary restriction and steroids –> GERD therapies won’t work
What are symptoms of eosinophilic esophagitis?
dysphagia, food impaction
What is pathogenesis of eosinophilic esophagitis?
IgE and cell mediated injury
Where in esophagus can you get eosinophilic esophagitis? GERD?
EoE = pan esophageal
GERD = distal esophagus usually
What age group gets EoE? GERD?
children and adults get EoE
usually just adults get GERD
What stain can you use to pick up goblet cells?
alcian blue
How fast is progression of barrett’s to cancer?
very slow progression takes many years
How do you diagnose barrett’s esophagus?
do endoscopy + biopsy –> can’t visualize dysplasia just by endoscopy need to do biopsy
What factors increase risk of barrett adenocarcinoma?
- duration of BE
- length of Barrett segment
- dysplasia
- genetics
What is treatment of barretts esophagus?
surgical or by local ablation
Who usually gets barretts adenocarcinoma?
middle age white males
What are symptoms of barretts adenocarcinoma?
progressive dysphagia + weight loss
What is 5 year survival of barretts adenocarcinoma?
15-20%
Is squamous or adenocarcinoma of esophagus more common?
squamous is more common world wide
adenocarcinoma is more common in the US
Who is at risk for squamous cell carcinoma of esophagus?
in underdeveloped regions: dietary deficiencies, indoor coal burning
industrialized: alcohol, smoking
other: achalasia, lye stricture, celiac
Who gets squamous cell carcinoma?
males > females age > 50 smoking + alcohol urban environments more in african americans
What does squamous cell esophageal carcinoma look like grossly?
mid or distal esophagus
invades surrounding organs and lymph nodes
tumor tissue grey and cheesy due to keratin content
What are micro features of squamous cell esophageal carcinoma?
- vaguely resembles normal squamous epithelium
- invasive pattern
- polygonal cells arranged in sheets
- lots of pink cytoplasm
- if well differentiated have intercellular bridges and keratin pearls
Is sliding or rolling hiatal hernia more common?
sliding ?90%
What are esophageal webs and rings?
- fibromucosal membranes that project into lumen
upper esophagus = web
lower esophagus = ring
What is plummer-vinson syndrome?
triad of dysphagia [due to esophageal webs], iron deficiency anemia], and glossitis
What is mallory weis syndrome?
longitudinal tear across esophagogastric junction due to severe vomitting; leads to hematemesis
usuually in bulemia and alcoholics
