PATH - Esophageal pathologies

Question 1

Achalasia

Answer 1

Failure of relaxation of LES due to loss of *myenteric (Auerbach) plexus

High LES resting pressure and uncoordinated or absent
peristalsis

progressive dysphagia to solids and liquids

*“Bird’s beak” on barium swallow

2° achalasia may arise from *Chagas disease (T cruzi infection) or extraesophageal
malignancies (mass effect or paraneoplastic)

Associated with INC risk
of *esophageal cancer, especially *squamous cell
carcinoma.

Question 2

Boerhaave syndrome

Answer 2

• Transmural, usually *distal esophageal rupture with *pneumomediastinum due to
• violent retching

pneumomediastinum-abnormal air in mediastinum

surgical emergency

Question 3

Eosinophilic esophagitis

Answer 3

Infiltration of eosinophils in the esophagus often in atopic patients.

Food allergens–>dysphagia,
food impaction.

Esophageal rings and linear furrows often seen on endoscopy.

Question 4

Esophageal strictures

Answer 4

Associated with *caustic ingestion and *acid reflux

Question 5

Esophageal varices

Answer 5

*Dilated submucosal veins in lower 1⁄3 of esophagus 2° to *portal hypertension.

Common in cirrhotics, may be source of life-threatening hematemesis

Question 6

Esophagitis

Answer 6

Associated with reflux, infection in IC (*Candida: white pseudomembrane;
*HSV-1: punched-out ulcers; *CMV: linear ulcers), caustic ingestion, or medications.

Question 7

Gastroesophageal reflux disease (GERD)

Answer 7

Commonly presents as heartburn, regurgitation, dysphagia.

May also present as chronic cough, hoarseness (laryngopharyngeal reflux).

Associated with *asthma.

Transient *decreases in LES tone.

Question 8

Mallory-Weiss syndrome

Answer 8

*Mucosal lacerations at the *gastroesophageal junction due to *severe vomiting.

Leads to *hematemesis
that can be *painful

Usually found in alcoholics and bulimics.

Question 9

Plummer-Vinson syndrome

Answer 9

Triad of Dysphagia, Iron deficiency anemia, and Esophageal webs.

May be associated with
*glossitis.

Increased risk of *esophageal squamous cell carcinoma

“Plumbers” DIE

Question 10

Sclerodermal esophageal dysmotility

Answer 10

Esophageal smooth muscle atrophy–>DEC LES pressure and dysmotility–>acid reflux and dysphagia–>stricture, Barrett esophagus, and aspiration.

Part of *CREST syndrome

Question 11

Barrett esophagus

Answer 11

Specialized intestinal metaplasia

replacement of nonkeratinized stratified squamous epithelium with intestinal epithelium (nonciliated columnar with goblet cells) in distal esophagus

Due to *chronic reflux esophagitis (GERD).

Associated with INC risk of
*esophageal adenocarcinoma