Path III Quiz 3 Esophagus Flashcards
What is most common type of esophageal atresia?
distal fistula
- Where are congenital esophageal webs located?
- Where are acquired esophageal webs?
congenital: distal (middle and inferior 1/3)
aquired: proximal 2/3 (top/cervical area)
What does achalasia look like on an x-ray?
bird beak
What is achalasia?
- Increased pressure and tone at lower esophageal sphincter
- Diminished or absent peristalsis
- Lack of coordinated LES in response to swallowing (can’t relax)
Histology of achalasia?
- lymph infiltrate of auerbachs plexus
- fibrosis
- loss of auerbachs plexus = no peristalsis in lower esophagus
What is etiology of iopathic achalasia according to study findings?
autoimmune and highly related to emotional problems
Where is auerbachs plexus located?
between longitudinal and circular layers of muscularis externs in GI tract
- parasympathetic and sympathetic fibers
Diffues Esophageal Spasm (DES)
- corkscrew esophagus
- contractions are uncoordinated
- several segments contract at same time
- dysphagia
Nutcracker esophagus
- contractions are coordinated
- amplitude is excessive
Mallory Weiss Syndrome
Bleeding from tears in mucosa at gastro esophageal junction
- involves mucosa and submucosa, but not muscular layer
- caused by coughing, vomitting
- associated with alcoholism and NSAID abuse
Boerhaave’s Syndrome
- full thickness tear or rupture in esophageal wall
- from severe vomitting or coughing, perforation of ulcer, lye poisoning
Most common cause of esophagitis
GERD
Most common infection to cause esophagitis
candida in immunocompromised
Histology of candida infection
budding hyphae
Sliding hiatal hernia
gastroesophageal junction moves above diaphragm with some of the stomach
What is esophagtits called if it is caused by GERD?
reflux esophagitis
GERD
mucosal damage to esophageal lining due to stomach acid reaching the esophagus
- caused by changes in barrier between stomach and esophagus:
- abnormal relaxation of LES
- hiatal hernia
Paraesophageal hernia
part of stomach herniates through diaphragm and lies next to esophagus without movement of GE junction
Shatski Ring
form of web near gastro-esophageal junction that marks proximal margin of hiatal hernia
- A ring above esophagus/stomach junction
- B ring lower esophagus at squamocolumnar junction.
- B is more common
Barrett’s Esophagus
transformation of cells at lower esophagus from squamous to columnar epithelium
What type of cancer is Barrett’s esophagus more likely to acquire?
Adenocarcinoma due to metaplastic changes
In Barretts’ esophagus, what type of metaplasia is associated with increased risk of malignancy in genetically susceptible individuals?
Colonic type
What type of cancer are pt with Barrett’s esophagus at higher risk for?
Adenocarcinoma
What are the cellular changes associated with malignancy?
1) increased nucleus to cytoplasm ratio due to cells undergoing division
2) abnormal nucleus: dark stain, increased mitotic figures
3) Abnormal cell shape
Esophageal Varices
dilated veins in lower 1/3 of esophagus
What is #1 etiology of esophageal varices?
Cirrhosis due to portal HTN backing up
What is #1 cause of cirrhosis in US?
alcoholism
What is risk of esophageal varicose?
hemorrhage
What is most common cause of cirrhosis worldwide?
hep B or C
What pressure is considered portal HTN?
> 5mmHg
Granular Tumor
benign
from schwann cells
can be anywhere in body
smooth, pink, normal
Henangioma
benign
from blood vessels
Leiomyoma
from smooth muscle
benign
smooth
What is most common benign esophageal tumor?
leiomyoma = 2/3 of all benign esophageal tumors
leiomyosarcoma
malignant
Where is adenocarinoma found?
lower 1/3 esophagus
associated with Barrett’s and GERD
Where is SCC found?
upper 2/3
What is most common esophageal cancer worldwide?
SCC
What is most common esophageal cancer in US?
adenocarcinoma
Hist of adenocarcinoma?
- normal squamous epithelium becomes glandular
- crypt cells
- columnar
- goblet cells
- darker staining nuclei
Hist of SCC
- in situ: basement membrane is intact
- full thickness replacement with dysplastic cells
