Mouth & Oesophageal Pathology Flashcards
What differentiates between the oesophageal and gastric mucosa?
- Gastro-oesophageal junction (GOJ)
- Also known as the Z-Line
What can cause acute oesophagitis?
- Corrosive following chemical ingestion
- Infective in immunocompromised pts
e. g. candidiasis, herpes, CMV
acute oesophagitis = RARE
What can cause chronic oesophagitis?
- Reflux disease ( called: ‘reflux oesophagitis’)
= COMMON - Rare causes include Crohn’s disease
What can potentially cause reflux oesophagitis?
- Defective sphincter mechanism +/- Hiatus hernia
- Abnormal oesophageal motility
- Increased intra-abdominal pressure (pregnancy)
How does Reflux Oesophagitis appear microscopically?
- Basal zone epithelial expansion (basal cell expansion)
- Intraepithelial neutrophils, lymphocytes and eosinophils
What are the main complications of reflux?
- Ulceration (bleeding)
- Stricture
- Barrett’s Oesophagus
What happens in Barretts oesophagus?
- persistent reflux of acid or bile
- causes squamous to columnar metaplasia
OR expansion of gastric/ submucosal glands up into oesophagus - protective response from the body
- pre-malignant oesophageal cancer
Allergic oesophagitis is also known as what?
‘Eosinophillic’ oesophagitis
pH probe negative for reflux
Increased eosinophils in blood
Corrugated (feline) or ‘spotty’ oesophagus
Who is most at risk of allergic/ eosinophilic oesophagitis?
- Personal/family history of allergy
- Asthma
- Young
- Males > females
How is allergic oesophagitis diagnosed?
- pH probe negative for reflux
- Increased eosinophils in blood
- Corrugated (feline) or ‘spotty’ oesophagus
What treatments can be used for allergic oesophagitis?
- steroids
- chromoglycate
- montelukast
What oesophageal tumours are considered benign?
- Leiomyomas (smooth muscle)
- Lipomas
- Fibrovascular polyps
- Granular cell tumours
Squamous papilloma of the oesophagus is related to which virus?
HPV related
What malignant tumours can arise in the oesophagus?
Squamous cell carcinoma
Adenocarcinoma
What can cause Squamous cell carcinomas in the oesophagus?
- Vitamin A, Zinc deficiency
- Tannic acid/ Strong tea
- Smoking, Alcohol
- HPV
- Oesophagitis
- Genetic
What complications can malignancy of the oesophagus cause?
Obstruction
Stricture`
Dysphagia
What groups are most at risk of oesophageal adenocarcinoma?
- Commoner in caucasians
- Males > females
- obesity
Where in the oesophagus does adenocarcinoma usually occur?
Commonest in lower 1/3 oesophagus
What is the pre-malignant lesion to adenocarcinoma of the oesophagus?
Barrett’s Oesophagus
How do carcinomas of the oesophagus present clinically?
Dysphagia
– due to tumour obstruction
OR General symptoms of malignancy
- Anaemia,
- Wt. Loss/ Lack of energy
(effects of metastases)
What are oesophageal varices?
Swollen blood vessels (like varicose veins) in the lower oesophagus
- usually due to portal hypertension
When would a patient be at risk of a Mallory-Weiss Tear?
Repetitive Vomiting
> 90% of oral cancers are what type?
Squamous Cell Carcinoma
How do oral cancers present?
white/red
speckled
ulcer
lump
