Pathology esophagus Flashcards
Be able to discuss the general features of esophagitis and the various causes of esophagitis.
Normal endoscopy is smooth tan/pink with delicate vasculature.
Esophagitis indicated on endoscopy by salmon pink mucosa. On histology, see basal layer hyperplasia, some eosinophils and neutrophils due to reactive epithelial changes.
Esophagitis is any inflammation and injury of the esophageal mucosa of various etiologies, including GERD, infection (herpes or candida), EOE, radiation, etc.
In the esophagus, many vessels lie in the lamina propria (so progressive tumors can easily spread) and risk of bleeding.
Understand the features of most prevalent form of esophagitis, reflux esophagitis, in greater detail, and be able to explain its relation to Barrett esophagus.
Reflux
Reflux can be due to transient LES relaxation, hiatal hernia, decreased LES tone, increased intra-abdominal pressure (secondary to obesity or weight-lifting), and delayed gastric emptying.
Heartburn and regurgitation are typical symptoms. Hoarseness and hiccups can occur as well.
Early detection prevents complications. Treat with PPIs.
Other
Herpetic esophagitis evidenced by punched out ulcers. Candida by white plaques.
Eosinophilic esophagitis caused by allergens. Tease this out from GERD by medical history. On histology, you will see many eosinophils throughout the esophagus. On endoscopy, see ringed esophagus and linear furrows.
Understand the GERD-Barrett esophagus-dysplasia-esophageal adenocarcinoma sequence.
Very few patients of Barrett’s progress to adenocarcinoma.
Compare and contrast the features of esophageal squamous cell carcinoma and adenocarcinoma.
GERD to Barrett’s (intestinal glandular metaplasia) to dysplasia to adenocarcinoma.
Rising incidence in the US.
Only 1-5% with Barrett’s esophagus will develop cancer.
Occurs mostly in men (7:1).
Squamous cell carcinoma is not associated with Barrett’s. Associated with alcohol, tobacco, and dietary factors, low SES, more common in Asia and Africa than US. Males and African American.
On histology, see infiltrative nests of squamous cells.
Describe the various causes of esophageal obstruction.
Can be functional (spasm, achalasia)
structural (diverticula, webs/rings, congenital abnormalities, stenosis, tumors).
Diverticula (Zenker’s, Mid Esophagus, and Epiphrenic)
Symptoms include halitosis, regurgitation, aspiration, gurgling.
Webs (2 cell layers thick) and rings (3 cell layers thick)
Congenital abnormalities including esophageal atresia and tracheoesophageal fistula, and esophageal stenosis.
Symptoms include regurgitation, drooling, and aspiration.
Functional obstruction (motility disorders).
Lacerations or tears.
Can be due to severe retching or vomiting often associated with alcoholism.
Should resolve on their own.
Understand the etiology and significance of esophageal varices.
Due to liver cirrhosis and backup from hepatic portal system into esophageal vasculature.
Vessels pooch out into the esophagus. Tears will cause a medical emergency (especially since patients are low on clotting factors).
Be acquainted with the common congenital abnormalities of the esophagus.
Type C is most common.
A, C, D presents quite readily because these kids won’t feed well, and they’ll drool.
Type B and Type E are the problem. Type B leads to aspirations and failure to thrive.
Type C presents in adolescence with recurrent pneumonia due to aspiration. Not diagnosed until later because these kids grow normally.
Adeno is more common in ____and on the rise than in the rest of the world (versus ____ which is more common in Asia and Africa).
US
Squamous
