Path-Esophagitis Flashcards
what are the histology layers of the digestive tract?
epithelium, lamina propria, muscularis mucosa, submucosa, muscularis propria (with auerbach’s plexus), serosa/adventitia
what components of the digestive tract epithelium are stratified squamous?
esophagus, anus
which components of the digestive tract are connective tissue?
lamina propria, mubmucosa, serosa/adventitia
describe the muscle layers inside the digestive tract
two layers of muscularis propria are perpendicular to one another; skeletal muscle in top of esophagus and anus, smooth mm in between
auerbach’s plexus is made up of _____ ganglia
parasympathetic
where are blood vessels found within the wall of the GI tract?
inside the connective tissue always (lamina propria, submucosa)
where are immune cells found within the GI tract?
scattered immune cells within the mucosa (epithelium+lamina propria) (GALT) where they can respond to antigen in the lumen
neoplastic disorders of the gut usually affect this layer of the GI tract
epithelium
infectious and inflammatory conditions of the gut start in what later of the GI tract
mucosa (epithelium + lamina propria + muscularis mucosa) because this is where inflammatory cells are
most bleeding comes from the ____ layer of the GI tract
submucosa
motility disorders are pathologic processes of the ____ layer
muscularis propria
pathogenesis of GI erosion
surperficial necrosis involving mucosa only; heals by regeneration without fibrosis or scar
pathogenesis of GI ulcer
deeper necrosis involving mucosa + deeper layers; heals with granulation tissue leading to fibrosis and scar formation
causes of GI stenosis
congenital, stricture (necrosis = circumferential fibrosis/scar which contracts), neoplasms
presentation with GI stenosis
causes obstruction of movement of lumen contents; dysphagia if esophagus
what nerves surround the esophagus?
vagus and recurrent laryngeal nerves
___ are found within the mucosa of the esophagus
mucous glands
the vast majority of hiatal hernias are (sliding/paraesophageal)
sliding (95%)
hiatal hernias are usually (congenital/acquired)
acquired
hiatal hernias increase likelihood of GERD due to?
development of an incompetent lower esophageal sphincter
name 5 categories of etiology for esophagitis
- infectious, 2. drug/pill, 3. corrosive/chemical, 4. eosinophilic, 5. GERD
what is the pathogenesis of esophagitis?
etiology -> mucosal necrosis -> erosion or ulceration (+/- stricture)
three common sources of infectious esophagitis; who is at risk for it?
candida, CMV, herpes; immunocompromised, DM, EtOH, increased age, systemic ABX
esophageal candidiasis is an overgrwoth of (normal/abnormal) GI flora, which looks like?
normal; superficial white plaques “pseudomembranes” on roof of mouth and esophagus
esophageal candidiasis can be seen histologically with a ____ stain and looks like?
PAS stain; “spaghetti with meatballs” – spaghetti is pseudohyphae and meatballs are budding yeast (?PMNs)
what is seen on gross pathology of HSV I (herpetic esophagitis)?
superficial vesicles, erosions/ulcers, plaques
what type of cell does HSV infect?
keratinocytes in the epithelium
describe the histopath of HSV
ground glass (viral material), chromatin margination, multinucleation with nuclear molding
gross pathology of CMV esophagitis
erosions/ulcers only
what cell types are infected by CMV?
lamina propria (endothelial + fibroblasts)
histopath of CMV
nuclear- and cyto-megaly; nuclear inclusions (classic owl eye effect)
histopath of pill esophagitis
localized inflammation +/- erosion/ulceration
chemical esophagitis is usually due to ____ in adults, and ____ in children
suicide; accidental ingestion
what agents can cause chemical/corrosive esophagitis?
strong alkaline agents or strong acids (cleaning products) – lye, sulfuric acid or HCl
what chemical agent causes the worst chemical esophagitis?
alkaline solutions (liquid)
alkali cause ____ necrosis, and acids cause _____ necrosis
liquefactive; coagulative (protective eschar)
chemical esophagitis can be 1st, 2nd, or 3rd degree – how deep and what are the consequences of 2nd degree?
injury to submucosa/muscularis propria leading to ulceration, granulation tissue, and fibrosis (can cause stricture)
what is the pathogenesis of eosinophilic esophagitis?
chronic allergic rxn -> infiltration of eosinophils in epithelium (can see on histo)
the gross pathology of eosinophilic esophagitis?
varies (normal, microabscesses, strictures)
pathogenesis of GERD
reflux of gastric contents (acid, pepsin, +/- bile) into esophagus -> chemical injury to mucosa
gross pathology of GERD
distal esophagus shows erythema +/- erosions/ulcers; ulcers can cause strictures
histopath of GERD
intraepithelial inflammation with neutrophils and eosinophils
long-term acid exposure from GERD causes the normal _____ epithelium of the esophagus to turn into _____ epithelium like that seen in the _____
stratified squamous; simple columnar epithelium with crypts and villi; stomach/intestine
eventually, Barrett’s esophagus could cause?
adenocarcinoma of the esophagus
