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Gastrointestinal > Path-Esophagitis > Flashcards

Path-Esophagitis Flashcards

1
Q

what are the histology layers of the digestive tract?

A

epithelium, lamina propria, muscularis mucosa, submucosa, muscularis propria (with auerbach’s plexus), serosa/adventitia

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2
Q

what components of the digestive tract epithelium are stratified squamous?

A

esophagus, anus

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3
Q

which components of the digestive tract are connective tissue?

A

lamina propria, mubmucosa, serosa/adventitia

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4
Q

describe the muscle layers inside the digestive tract

A

two layers of muscularis propria are perpendicular to one another; skeletal muscle in top of esophagus and anus, smooth mm in between

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5
Q

auerbach’s plexus is made up of _____ ganglia

A

parasympathetic

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6
Q

where are blood vessels found within the wall of the GI tract?

A

inside the connective tissue always (lamina propria, submucosa)

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7
Q

where are immune cells found within the GI tract?

A

scattered immune cells within the mucosa (epithelium+lamina propria) (GALT) where they can respond to antigen in the lumen

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8
Q

neoplastic disorders of the gut usually affect this layer of the GI tract

A

epithelium

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9
Q

infectious and inflammatory conditions of the gut start in what later of the GI tract

A

mucosa (epithelium + lamina propria + muscularis mucosa) because this is where inflammatory cells are

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10
Q

most bleeding comes from the ____ layer of the GI tract

A

submucosa

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11
Q

motility disorders are pathologic processes of the ____ layer

A

muscularis propria

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12
Q

pathogenesis of GI erosion

A

surperficial necrosis involving mucosa only; heals by regeneration without fibrosis or scar

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13
Q

pathogenesis of GI ulcer

A

deeper necrosis involving mucosa + deeper layers; heals with granulation tissue leading to fibrosis and scar formation

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14
Q

causes of GI stenosis

A

congenital, stricture (necrosis = circumferential fibrosis/scar which contracts), neoplasms

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15
Q

presentation with GI stenosis

A

causes obstruction of movement of lumen contents; dysphagia if esophagus

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16
Q

what nerves surround the esophagus?

A

vagus and recurrent laryngeal nerves

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17
Q

___ are found within the mucosa of the esophagus

A

mucous glands

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18
Q

the vast majority of hiatal hernias are (sliding/paraesophageal)

A

sliding (95%)

19
Q

hiatal hernias are usually (congenital/acquired)

A

acquired

20
Q

hiatal hernias increase likelihood of GERD due to?

A

development of an incompetent lower esophageal sphincter

21
Q

name 5 categories of etiology for esophagitis

A
  1. infectious, 2. drug/pill, 3. corrosive/chemical, 4. eosinophilic, 5. GERD
22
Q

what is the pathogenesis of esophagitis?

A

etiology -> mucosal necrosis -> erosion or ulceration (+/- stricture)

23
Q

three common sources of infectious esophagitis; who is at risk for it?

A

candida, CMV, herpes; immunocompromised, DM, EtOH, increased age, systemic ABX

24
Q

esophageal candidiasis is an overgrwoth of (normal/abnormal) GI flora, which looks like?

A

normal; superficial white plaques “pseudomembranes” on roof of mouth and esophagus

25
Q

esophageal candidiasis can be seen histologically with a ____ stain and looks like?

A

PAS stain; “spaghetti with meatballs” – spaghetti is pseudohyphae and meatballs are budding yeast (?PMNs)

26
Q

what is seen on gross pathology of HSV I (herpetic esophagitis)?

A

superficial vesicles, erosions/ulcers, plaques

27
Q

what type of cell does HSV infect?

A

keratinocytes in the epithelium

28
Q

describe the histopath of HSV

A

ground glass (viral material), chromatin margination, multinucleation with nuclear molding

29
Q

gross pathology of CMV esophagitis

A

erosions/ulcers only

30
Q

what cell types are infected by CMV?

A

lamina propria (endothelial + fibroblasts)

31
Q

histopath of CMV

A

nuclear- and cyto-megaly; nuclear inclusions (classic owl eye effect)

32
Q

histopath of pill esophagitis

A

localized inflammation +/- erosion/ulceration

33
Q

chemical esophagitis is usually due to ____ in adults, and ____ in children

A

suicide; accidental ingestion

34
Q

what agents can cause chemical/corrosive esophagitis?

A

strong alkaline agents or strong acids (cleaning products) – lye, sulfuric acid or HCl

35
Q

what chemical agent causes the worst chemical esophagitis?

A

alkaline solutions (liquid)

36
Q

alkali cause ____ necrosis, and acids cause _____ necrosis

A

liquefactive; coagulative (protective eschar)

37
Q

chemical esophagitis can be 1st, 2nd, or 3rd degree – how deep and what are the consequences of 2nd degree?

A

injury to submucosa/muscularis propria leading to ulceration, granulation tissue, and fibrosis (can cause stricture)

38
Q

what is the pathogenesis of eosinophilic esophagitis?

A

chronic allergic rxn -> infiltration of eosinophils in epithelium (can see on histo)

39
Q

the gross pathology of eosinophilic esophagitis?

A

varies (normal, microabscesses, strictures)

40
Q

pathogenesis of GERD

A

reflux of gastric contents (acid, pepsin, +/- bile) into esophagus -> chemical injury to mucosa

41
Q

gross pathology of GERD

A

distal esophagus shows erythema +/- erosions/ulcers; ulcers can cause strictures

42
Q

histopath of GERD

A

intraepithelial inflammation with neutrophils and eosinophils

43
Q

long-term acid exposure from GERD causes the normal _____ epithelium of the esophagus to turn into _____ epithelium like that seen in the _____

A

stratified squamous; simple columnar epithelium with crypts and villi; stomach/intestine

44
Q

eventually, Barrett’s esophagus could cause?

A

adenocarcinoma of the esophagus

Gastrointestinal (40 decks)

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