Pathology- Esophagus

Question 1

Achalasia

Answer 1

LES too tight
Failure of inhibitory neurons
Secondary form caused by Chaga’s disease- lesions of vagal motor nuclei
Dysphagia, Regurgitation
Increased risk of squamous cell carcinoma

Question 2

Zenker’s Diverticulum

Answer 2

Located above UES

Outpouching of mucosa due to motility abnormalities- spasms

Question 3

Traction Diverticulum

Answer 3

Mid esophagus

Associated with mediastinal adhesions or abnormal motility

Question 4

Epiphrenic Diverticulum

Answer 4

Located above LES

Question 5

Clinical Diverticulum

Answer 5

Mass formation
Regurgitation
Aspiration

Question 6

Mallory-Weiss Syndrome

Answer 6

Longitudinal tears at gastroesophageal junction
Excessive vomiting
Alcoholics
Can penetrate stomach wall and cause mediastinitis
Mallory bodies

Question 7

Esophageal Varices

Answer 7

Form at anastomoses between portal and caval systems
Causes: prolonged/severe portal hypertension, cirrhosis
Can rupture and cause serious hemorrhage

Question 8

Hiatal Hernia

Answer 8

Upward protrusion of stomach through diaphragm
Congenital?
Increased age, obesity, smoking
Complications: reflux esophagitis, ulcerations, bleeding, perforations

Question 9

GERD

Answer 9

Causes:
Hiatal Hernia, increased gastric volume, increased abdo pressure, decreased LES tone

Symptoms:
Heartburn, Regurg, Dysphagia, Hematemesis, Melena

Barrett’s Esophagus: metaplasia, Goblet cells, increased risk for adenocarcinoma

Question 10

Esophagitis caused by Herpes simplex

Answer 10

Eosinophilic intranuclear inclusions
Multinucleate
Fine chromatin
Prominent nuclear membrane

Question 11

Esophagitis caused by CMV

Answer 11

Affects fibroblasts and endothelial cells in lamina propria
Very large cells
OWLS EYE inclusions
Large intranuclear inclusions
Small cytoplasmic inclusions

Question 12

Eosinophilic Esophagitis

Answer 12

Numerous eosinophils
Food allergies
Esophageal rings- contractions of muscularis propria from proteins released by eosinophils

Question 13

Adenocarcinoma

Answer 13

40 year old white men
Risk increased by tobacco, obesity, radiation
Risk decreased by diet rich in fruits and veggies
Dysphagia, weight loss, hemorrhage, chest pain, vomiting
Advanced by the time symptoms appear

Question 14

Squamous Cell Carcinoma

Answer 14

45 yo men from Iran, China, Brazil, South Africa
Etiology:
Alcohol, tobacco, loss of p53 and p16, nutritional deficiencies, nitrosamines, carcinogens in fungal contaminated food, esophageal injury/achalasia

Cytokeratin and intercellular bridges
Dysphagia, obstruction, cachexia, debilitation, hoarseness
Hemorrhage, sepsis, aspiration leading to chronic cough, metastasis to regional LNs

Question 15

Pancreatic insufficiency

Answer 15

Malabsorption
Defective intraluminal digestion
Deficiency of pancreatic enzymes
Due to chronic pancreatitis or CF

Question 16

Crohn’s disease

Answer 16

Malabsorption

Defective intraluminal digestion, terminal digestion at brush border, transepithelial transport

Question 17

Celiac disease

Answer 17

Malabsorption
Immune-mediated enteropathy
HLA-DQ2, HLA-DQ8
Defective terminal digestion, transepithelial transport
IgA antibodies against transglutaminase
IgA/IgE antibodies against gliadin
Anti-endomysial antibodies very specific to Celiac's
Complications:
Enteropathy-associated T-cell Lymphoma
Small intestinal adenocarcinoma

Villous atrophy, Crypt hyperplasia

Question 18

Tropical Sprue

Answer 18

Celiac-like malabsorption
Tropics, Caribbean
Follows acute diarrheal infection
More pronounced in distal small intestine
Rapidly responds to broad spectrum antibiotics

Question 19

Whipple’s disease

Answer 19

Rare systemic disease- intestines, heart, joints, CNS
Gram (+) Tropheryma whippelii
Macrophages stuffed with organism and obstruct lymphatics
Malabsorptive diarrhea due to impaired lymphatic transport

Macrophages PAS+
Acid-fast stain will label mycobacteria but not Whipple

Fever, joint pain, lymphadenopathy, cardiac, neuro symptoms
Long course of broad spectrum antibiotics

Question 20

Lactase deficiency

Answer 20

Congenital form: infants exposed to breastmilk

Acquired form: blacks, native americans, chinese

Question 21

Abetalipoproteinemia

Answer 21

Spur cells- Acanthocytes
Inability to secrete triglyceride rich lipoproteins
Mutation of Microsomal Triglyceride Transfer Protein (MTP)
Intestinal cells unable to transport lipoproteins and free fatty acids- triglycerides accumulate
Deficiency of fat-soluble vitamins –> defective lipid membranes –> spur cells