Patho- Esophageal Diseases

Question 1

Oesophagitis is ……..

Answer 1

Inflammation of the oesophagus

Question 2

Causes of Oesophagitis

Answer 2

• GERD
• Corrosives ( acids , alkalis) and chemicals
  • Infections
  • Radiation

Question 3

Oesopahageal varices is ……….

Answer 3

Dilated tortuous veins lying within the submucosa with distal oesophagus

Question 4

Cause of Oesopahageal varices

Answer 4

portal hypertension

Question 5

Complication of Oesopahageal varices

Answer 5

Rupture may occur fatal haematemesis

Question 6

Achalasia is ……..

Answer 6

failure to relax,’’ of the lower esophageal sphincter response to swallowing .

Question 7

Pathogenesis of Achalasia

Answer 7

loss of ganglion cells in the myeteric plexus

Question 8

Types of Achalasia

Answer 8

1. Primary achalasia: uncertain etiology
2. Secondary achalasia: e.g
   Chagas disease (Trypanosoma cruzi)

Question 9

major abonomalities in achalasia:

Answer 9

(1) Aperistalsis
(2) partial or incomplete relaxation of the lower esophageal sphincter
(3) increased resting tone of the lower esophageal sphincter

Question 10

Complication of Achalasia

Answer 10

1. inflammation and ulceration
2. dysphagia
3. Nocturnal regurgitation
   and aspration of undigested food
4. Esophageal squamous cell carcinoma (the most serious

Question 11

Longitudinal tears at the esophagogastric junction is called …………

Answer 11

Lacerations (Mallory-Weiss Syndrome)

Question 12

Causes of Lacerations

Answer 12

chronic alcoholics or sever vomiting

Question 13

Lacerations affect which layer of esophagus?

Answer 13

mucsoa only.

Question 14

[Gastric content reflux in distal oesophagus]

Answer 14

Reflux oesophagitis (GERD)

Question 15

Gross of GERD

Answer 15

• Redding
• Ulceration
• Fibrous narrowing

Question 16

Microscopic picture of GERD

Answer 16

1) Hyperplasia: of basal cells
2) Elongation: of lamina propria
3) Vasodilatation
4) Infiltration: of epithelium by PNLS & esinophils
5) Superficial necrosis & ulceration: severe cases

Question 17

Complications of GERD

Answer 17

(1) PU
(2) Scarring stricture
(3) Barrett’s esophagus

Question 18

Barrett›s oesophagus affect which part of esophagus? And what is that effect ?

Answer 18

metaplastic changes in %10 of lower oesophagus from Squamous >
Columnar «intestinal epithelium»

Question 19

Describe diagnosis of Barrett›s oesophagus

Answer 19

endoscopy with biopsy >3 cm above gastro-esophageal junction

Question 20

Complications of Barrett›s oesophagus

Answer 20

risk for adenocarcinoma.

Question 21

Causes of Barrett›s oesophagus

Answer 21

1) Lumen : F.B

2)Wall :
1- Congenital: stenosis, web, atresia
2- Inflammatory: oesophagitis, PU.
3- Traumatic : due to corrosives ( acids , alkalies)
4- Tumors: carcinoma, leiomyoma.
5- Achalasia of cardia
6- Plummer-Vinson $

3) Pressure from outside :
•Enlarged mediastinal LNs
» Lymphoma
» Sarcoidosis
» T.B
•Bronchogenic carcinoma
•Aortic aneurysm

Question 22

Predesposing factors of Carcinoma of oesophagus

Answer 22

1. Male >50yrs
2. Dietary:
   -Consumption of very hot beverage
   -Fungal contamination of food stuff.
   - nitrites المواد الحافظة
   - def. of vits. («A») and minerals as (Zn)
3. Oesophageal disorders:
   - Achalasia & diverticula
   - Plummer-Vinson > $ post cricoid carcinoma (Female)
   - Chr. Oesophagitis, reflux with Barrett’s
4. Alcohol & smoking
5. HPV infection

Question 23

Gross of Carcinoma of oesophagus

Answer 23

1) Fungating polypoid Mass
2) ulcerating
3) Diffuse infiltrative

Question 24

Microscopic picture of Carcinoma of oesophagus

Answer 24

o SCC %90
o Adenocarcinoma %10

Question 25

Sites of Carcinoma of oesophagus

Answer 25

1st 1/3
2nd 1/3 (ssc)
3rd 1/3 ( adenoma)

Question 26

Spread of Carcinoma of oesophagus

Answer 26

• Local:
oesophagus then trachea, bone, lung,mediastinum aorta fatal
• Lymphatic:
Cervical, mediastinal, abdominal LNs (early)
• Blood:
Liver ,Lung , Brain , Bone , Renal , Supra- renal ( late )

Question 27

Most common benign tumor of esophagus

Answer 27

Leomyoma