non-cancer esophagus Flashcards
Describe the common presenting symptoms of esophageal motility disorders and what they mean pathologically. Describe the structural pathology of the esophagus and their common associations Describe the esophageal pathophysiology associated with alcoholism and cirrhosis Describe the common causes of esophagitis (infectious, eosinophilic, reflux) Describe the pathophysiology of reflux esophagitis, its outcomes and associations
common sx of esophageal disorders
dysphagia odynophagia (painful swallowing) heartburn hematemesis melena (blood in stools)
difficulty swallowing solids can indicate
stricture, obstruction, carcinoma
difficulty swallowing solids can indicate
motility problem
most common hernia
sliding
hourglass hernia where GE is displaced through diaphram
sliding
GE junction is below diaphram, cardia moves into the thorax
paraesophageal
newborn with aspiration, pnemonia, and feeding problems
espophageal fistula/atresia
most common espophageal fistula/atresia
atresia of the upper esophagus with a fistula between the trachea and lower esophagus (type “C”).
Protrusions of mucosa into the esophageal lumen
esophageal webs
squamous mucosa and a vascularized submucosal core
esophageal webs
causes of esophageal webs
congenital
long standing reflux
GVHD
blistering skin disease
Paterson-Brown-Kelly or Plummer-Vinson syndrome
upper esophageal web accompanied by iron deficiency anemia, glossitis, cheliosis
long term risk of Paterson-Brown-Kelly or Plummer-Vinson syndrome
postcricoid esophageal carcinoma
achalasia
Failure of the lower esophageal sphincter to relax following swallowing
causes of achalasia
Functional obstruction
Dilation of upper esophagus
Primary vs. secondary (i.e. Chagas’ disease, DM, infiltrative disorders)
sx of achalasia
Dysphagia, nocturnal regurgitation, aspiration
long term risk of achalasia
Increased risk of squamous cell carcinoma
Absent myenteric (Auerbach’s) ganglia from the esophageal body will cause
achalasia
birds beak on barium swallow
achalasia
painful tears in the LES from retching and vomiting
mallory-weiss tears
risk factors of mallory-weiss tears
alchoholics and underlying hiatal hernia
complications of mallory-weiss tears
infection and massive hemorrage
Boerhaave syndrome
mallory-weiss syndrome with rupture
causes esophageal varices
portal hypertension
mortality of esophageal varices
50%
esophageal varices found in pts with
cirrosis (2/3)
types of esophagitis
reflux corrosives/irratants radiation/chemo infection eosinophillic
giant multinucleated cells with inclusions
herpes
silver stains candida…
black
PAS stains candida
pink
GERD with no response to medications
eosinophillic esophagitis
other sx seen with eosinophillic esophagitis
general allergies (asthma, exzema, chronic rhinitis)
24 hour probe testing for eosinophillic esophagitis returns…
normal
eosinophillic esophagitis appearance on endoscopy
felinization
sequalae of eosinophillic esophagitis
stricture
causes of reflux
incompetent LES, sliding hiatal hernia, delayed gastric emptying, increased gastric volume
microscopic signs of reflux
Eosinophils +/- other inflammatory cells (neutrophils and lymphocytes)
Elongation of vascular papillae
Basal layer hyperplasia
risk of barrett’s esophagus
esophageal adenocarcinoma
barrett’s esophagus changes what to what
normal distal stratified squamous mucosal to intestinal-type glandular mucosa
