Path basis of esophageal disease [3] Flashcards
Features of esophagitis
- how common is it?
inflammatory cells (eosinophils or neutrophils) + thickening of basal layer (reactive epithelial changes) → Basal cell hyperplasia
Grossly: reddening/inflammation/hyperemia (still have vascularization, but white mucosa is gone)
Very common: 5% of US adult
Causes of Esophagitis
- Chemical injury
- Infxn
- Immune related
- Radiation
- Trauma
How can chemical injury → esophagitis?
reflux of gastric contents into LE
Acids, alkalis, alcohol, tobacco
Medications
What types of infxn can lead to esophagitis?
Fungal (candida): white plaques
Viral (HSV): Punched out ulcer
How can immune related diseases → esophagitis?
EoE Dermatologic diseases (lichen planus)
Describe the features of the prevalent form of esophagitis, reflux esophagitis
if left untreated, what complications can develop?
injury/inflammation from gastric contents into esophagus (GERD)
Typical presentation: Heartburn + regurgitation
Severe ulcerations
Strictures
Barretts esophagus (salmon color)
Adenocarcinoma
Clinical features of EoE
Vomiting
Pain
dyspepsia (indigestion) → odynophagia (painful swallowing)
stenosis
*recall: caused by allergic/immunologic factors
GERD-Barrett esophagus-dysplasia-esophageal adenocarcinoma sequence.
GERD → metaplasia → low grade dysplasia → high grade dysplasia → adenocarcinoma
If high grade dysplasia gets necrosis and get complexity of glands, rounded nuclei → can progress
(7M:1F for adeno - glandular epi malignancy)
Zenkers diverticulum
- where
- sx
- associated with?
Uppermost portion of Eso
Regurg, halitosis, aspiration
Assoc w/ reduced UES compliance
Esophageal webs and rings
- sx?
- population?
- associated with?
Mostly asymptomatic
Dysphagia + choking sensation
dysphagia → odynphagia
assoc. with Plummer-Vinson syndrome
(gross: mucosal folds or indentations, dx by post inflammatory stenosis)
Boerhaave syndrome
exacerbation of esophageal laceration (mallory weiss tears) → rupture
- can see air in mediastinum
associated with alcohol intox, but not as life threatening as varices
Esophageal varices
why is it a medical emergency?
Cirrhosis of liver → portal HTN →
Blood back up into L gastric and up the Esophageal vasculature →
distention of esophageal vasculature →
Outpouches/varices in eso
Trauma can tear + Cirrhosis pts have ↓ clot factors → excessive bleeding → medical emergency
Most common type of esophageal atresia + tracheoesophageal fistula
Esophageal atresia with distal TEF
- drooling
How does the H shape tracheoesophageal (TE) fistula usually present?
in older children with repeated bouts of pneumonia
- no drooling
