Path: Esophagus & Stomach Flashcards
What portions of the GI tract feature minor salivary glands?
The esophagus only.
What is a key difference between the fetal and mature esophagus?
The fetal esophagus is lined by ciliated columnar epithelium, whereas the mature esophagus is line by non-keratinized stratified squamous epithelium.
J: This is a developmental abnormality in the cervical esophagus in which a portion of the surface is comprised of various types of glandular mucosa.
What is an inlet patch?
What are some notable developmental structural abnormalities to the esophagus?
(1) atresia
(2) tracheoesophageal fistula
(3) duplication cyst
What is in the ddx of esophagitis?
(1) reflux
(2) allergy
(3) Crohn’s disease
(4) viral (CMV, herpes)
(5) trauma
(6) radiation
(7) pemphigus
(8) pemphigoid
(9) vasculitis
(10) fungal
(11) graft vs. host disease
How does reflux esophagitis appear on endoscopy?
Linear erythema with variable linear ulcers.
How does herpes esophagitis appear microscopically?
Punched-out ulcers with multinucleated squamous cells and intranuclear inclusions.
How does candida esophagitis appear on endoscopy?
White, cheesy plaques.
How does eosinophilic esophagitis appear on endoscopy?
(1) tiny, white papules
2) ringed esophagus (called felinization or trachealization
What are some skin disorders that present as esophagitis?
(1) pemphigus
(2) pemphigoid
(3) lichenoid reactions
What is a Schatzki ring?
A muscular ring covered by squamous epithelium. It is present in 10% of people and is a common cause of dysphagia.
What effect can scleroderma have on the esophagus?
Selective atrophy of the inner circular layer of smooth muscle, resulting in decreased motility and reflux.
What is an extreme consequence for the esophagus that could follow repeated wrenching vomiting?
A Mallory-Weiss tear, a tear of the distal esophagus resulting in massive hemorrhage.
What GI organ carries the greatest tumor burden?
The colon/rectum.
What is the most common malignant cancer of the esophagus?
World: squamous carcinoma
US: adenocarcinoma
What profile is most at risk for esophageal adenocarcinoma?
An obese male with a high-fat diet, acid reflux and a characteristic microbiome.
In a patient with Barrett’s esophagus, what could be measured to help determine the risk of cancer?
The length of the segment of the esophagus that has undergone metaplasia. (Note: this length is typically static.)
What is TNM?
A three-pronged system for staging a cancer. T=tumor, N=lymph node, M=metastasis.
What is a pertinent distinction between esophageal squamous carcinoma and cervical and anal squamous carcinoma?
HPV infection is not a prominent risk factor.
What profile is most at risk for esophageal squamous carcinoma?
An alcoholic smoker that has achalasia and has ingested moldy foods and lye.
What are the 2 noted benign lesions of the esophagus?
(1) squamous papilloma
(2) glycogenic acanthosis
In what part of the stomach are enterochromaffin-like cells most prevalent?
The fundus.
What is in the ddx for acute gastritis?
(1) alcohol
(2) severe stress
(3) shock
(4) radiation
(5) caustic agents (iron pill)
(6) NSAIDs
What tests are available for H. pylori infection?
(1) biopsy with thiazine stain
(2) biopsy with CLOtest
(3) blood test for antibody
(4) breath test which is no longer used
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What is the hallmark of chronic gastritis?
Atrophy of the stomach through the loss of parietal and chief cells in the oxyntic mucosa.
What is the typical target in autoimmune gastritis?
The H+/K+ ATPase pump on the lumenal surface of parietal cells.
Describe how autoimmune gastritis can lead to carcinoids.
(1) pH increases.
(2) gastrin secretion increases.
(3) enterochromaffin-like cells proliferate into masses, carcinoids, that can be seen microscopically or on endoscopy.
Why can autoimmune gastritis lead to bacterial overgrowth?
With decreased acid secretion, bacteria are better able to survive in the gastric lumen. Cancer may follow.
What is a hematological consequence of autoimmune gastritis?
Pernicious anemia.
What are the 2 primary causes of chronic gastritis?
(1) H. pylori
(2) autoimmune reaction
What are the 2 main varieties of gastric polyps?
(1) fundic gland polyp
(2) hyperplastic polyp
How do fundic gland polyps form?
Dilation of the glands formed by parietal and chief cells. No cell proliferation occurs.
How do hyperplastic gastric polyps form?
As single or multiple growths of varying size, typically in the antrum, arising from an underlying gastritis.
What are the 2 varieties of hypertrophic gastropathies?
(1) foveolar
(2) parietal
What insult often precedes a gastric maltoma?
An H. pylori infection.
What is a major worry with maltoma?
It could develop into large cell lymphoma.
Describe the pathogenesis of intestinal type gastric cancer.
(1) repeated injury or chronic gastritis
(2) intestinal metaplasia
(3) dysplasia
(4) adenocarcinoma
What is the etiology of signet cell gastric cancer?
Two mutations to E-cadherin. Does not arise from chronic gastritis.
What profile has a higher risk of intestinal type gastric cancer?
An aging male with a diet high in nitroso compounds (processed meats) and low in vegetables and vitamin C.
What is a common presentation of gastric cancer?
A non-healing ulcer.
What other cancer is associated with signet cell gastric cancer?
Lobular carcinoma of the breast.
From what cells are signet cells derived?
Mucin-secreting cells.
