Path - Esophagus Flashcards
insidious (gradual) onset of dysphagia, odynophagia, or obstruction
esophageal squamous cell carcinoma
most common cause of esophagitis
GERD
where do most esophageal adenocarcinomas occur
distal 1/3 esophagus
loss of coordination of smooth muscle of inner circular layer and outer longitudinal layer
nutcracker esophagus
common causes of infectious esophagitis
- Herpes simplex
- Cytomegalovirus
- candida/aspergillosis
- mucormycosis (immunocompromised)
systemic diseases that cause secondary achalasia
- chaga’s dz
- diabetic autonomic neuropathy
- lesions of dorsal motor nuclei
- down’s
- allgrove syndrome
- HSV1
- Sjogren’s
pt presents with dysphagia, pain with swallowing, progressive weight loss, hematemesis, chest pain, and vomiting
esophageal adenocarcinoma
histo: patches of red, velvety mucosa extending cephalad from the GE junction
barrett esophagus
early mutations in TP53, CDKN2A (p16/INK4a)
esophageal adenocarcinoma
SOX2 amplification
esophageal squamous cell carcinoma
repetitive, simultaneous contractions of distal esophageal smooth m. causing chest pain when swallowing cold food
diffuse esophageal spasm
what can decrease your risk fo esophageal adenocarcinoma
- diet rich in fruits and vegetables
- some serotypes of H. pylori (they cause gastric atrophy leading to reduced acid secretion and reflux)
demographic for esophageal adenocarcinoma
caucasian, males (7x more than females)
achalasia due to destruction of esophagus myenteric plexus due to systemic dz
secondary achalasia
sx of barrett esophagus
heartburn, regurg, dysphagia
compare spread in the lymphatic network between cancers in upper esophagus, middle esophagus, and lower esophagus
upper 1/3: cervical LNs
middle 1/3: mediastinal, paratracheal, and tracheobrochial LNs
lower 2/3: gastric and celiac LNs
histo: punched out ulcers w/ viral inclusinos and rim of epithelial cells
HSV
salmon colored mucosa
barrett esophagus
high amplitude contractions of distal esophagus
nutcracker esophagus
greatest concern for barrett esophagus
increased risk of esophageal adenocarcinoma
histo: large numbers of intraepithlial eosinophils superficially
eosinophilic esophagitis
intestinal metaplasia within the esophageal squamous mucosa
barrett esophagus
decreased LES tone and increased abd pressure can cause _____
GERD
narrowing of esophageal lumen from fibrous thickening of the submucosa
benign esophageal stenosis
compare A and B esophageal rings
A: present in distal esophagus above GE junction, covered w/ squamous mucosa
B: located at the squamocolumnar junction of lower esophagus, covered w/ gastric cardia mucosa
will PPIs help with eosinophilic esophagitis?
nope - acid reflux is not a prominent sx
demographic for esophageal squamous cell carcinoma
pts older than 45, males 4:1, 8x increase in african americans
- increased incidence in iran, central china, hong kong, brazil, south africa
transmural tearing and rupture of distal esophagus leading to mediastinitis, tachypnea, and shock
boerhaave syndrome
sphincter abnormality in the absence of altered contraction patterns
hypertensive lower esophageal sphincter
histo: basal epithelial apoptosis with mucosal atrophy and submucosal fibrosis
graft vs host disease
pts where diet is subconsciously altered to soft food and liquid which attributes to nutritional deficiency and weight loss
esophageal squamous cell carcinoma
describe venous blood flow from the GI tract
venous blood from GI tract –> portal vein in liver –> returns to the heart
in situ gray-white plaque in esophagus
esophageal squamous cell carcinoma
esophagitis associated w/ atopic dermatitis, allergic rhinitis, asthma
eosinophilic esophagitis
idiopathic ledge-like protrusions of mucosa that may cause obstruction
esophageal mucosal webs
pathogenesis of esophageal varices
portal hypertension –> development of collateral channels at sites where portal and caval systems communicate –> develops congested subepithelial and submucosal venous plexi in distal esophagus and proximal stomach (varices)
prognosis of esophageal varices
- 30% w/ variceal hemorrhage due
- >50% who survive first variceal bleed have recurrent hemorrhage within 1 year –> 30% mortality
sx of achalasia
- dysphagia
- difficulty belching
- chest pain
incomplete lower esophageal sphincter relaxation, increased lower esophageal sphincter tone, aperistalsis of esophagus
achalasia
achalasia due to distal esophageal ganglion cell degeneration
primary achalasia
normal esophageal stratified squamous epithelium that becomes columnar epithelium
barrett esophagus
clinical presentation of esophageal varices
clinically silent until rupture w/ catastrophic hematemesis
risk factors for esophageal squamous cell carcinoma
- alcohol and tobacco synergy
- esophageal injury
- achalasia
- plummer-vinson syndrome
- scalding hot beverages
- tylosis
stratified squamous epithelium damage leading to dysphagia and pain +/- hemorrhage leading to odynophagia
chemical and infectious esophagitis
diverticulum immediately above upper esophageal sphincter that develops after age 50
Zenker diverticulum
mucosal injury due to reflux of gastric juices
GERD
where do most esophageal squamous cell carcinomas occur
middle 3rd of esophagus
histo: shallow ulceration with nuclear and cytoplasmic inclusions
CMV
TP53, E-cadherin, NOTCH1 loss of function
esophageal squamous cell carcinoma
histo: grey-white psudomembranes of hyphae and inflammatory cells
candidiasis
metaplastic mucosa alternating b/w smooth, pale, squamous mucosa and light-brown columnar mucosa
barrett esophagus
risk factors for esophageal adenocarcinoma
- tobacco use
- radiation
crunching sound upon auscultation of heart
boerhaave syndrome
most esophageal adenocarcinomas arise from _____
barrett esophagus or obesity related GERD
late mutatinos in EGFR, ERBB2, MET, cyclin D1, cyclin E
esophageal adenocarcinoma
distention of venous vessels in the esophagus
esophageal varices
circumferential, thick protrusions of mucosa and submucosa in the esophagus
esophageal rings (Schatzki rings)
budding, irregular shapes, and cellular crowding gland architecture
barrett esophagus
longitudinal laceration of mucosa near GE junction associated with severe vomiting secondary to alcohol intoxication
mallory-weiss tears
