Pathology of Esophagus Flashcards
What are the different types of oesophageal obstruction?
Mechanical and Functional
What are examples of mechanical obstruction?
Artesia
Fistula
What are examples of functional obstruction
Achalasia
What is the esophagus?
A muscular tube that extends from the pharynx to the stomach
What are the 4 layers of the esophagus?
Muscosa
Submucosa
Muscularis externa
Adventitia
What are the sublayers of the mucosa?
Epithelium
Lamina propria
Muscularis interna
What is the definition of mechanical obstruction?
Congenital group of disorders discovered shortly after birth due to regurgitation during feeding
How does Artesia occur?
From the failure of the primitive foregut to recanalize
Where does Artesia usually occur?
At or near the tracheal bifurcation and usually associated with the fistula connecting the lower and upper oesophageal pouches to bronchus or trachea
How does a fistula happen?
Results from incomplete separation of the primitive foregut into two completely separate tubes
What are the clinical features of oesophageal obstruction?
Vomiting
Aspiration
Suffocation
Pneumonia
Severe fluid and electrolyte imbalance
What is achalasia?
Failure pf the LES to relax with swallowing and poor peristalsis in the body of the esophagus
What are the two types of achalasia?
Primary and secondary
What is primary achalasia?
An inflammatory disease that cause loss of inhibitory neurons in the myenteric plexus
What does chronic inflammation of the myenteric plexus lead to?
Neuritis, ganglionitis and ganglion cell loss and fibrosis
What is secondary achalasia?
Trypanosoma cruzi infection causes destruction of myenteric plexus, failure of LES relaxation and dilation
What is secondary achalasia associated with?
Chagas disease
What are the clinical features of achalasia?
Dysphagia gor solids and liquids
Putrid breath
High LES pressure
Bird-beak sign on barium swallow
Increased risk of esophageal squamous cell carcinoma
What causes reflux esophagitis?
Regurgitation of gastric contents (GERD)
What is the most common cause of esophagitis
Reflux esophagitis
When is reflux esophagitis most common?
Individuals over 40
What is the associated clinical condition of reflux esophagitis called?
GERD
What are the agents that decrease the tone of the LES or increase abdominal pressure?
Alcohol, chocolate, fatty foods, cigarette smoking
Certain nervous system depressants
Pregnancy
What are the gross features of reflux esophagitis?
Severe cases have hyperaemic mucosa with focal haemorrhage
What is the morphological features of reflux esophagitis, in mild cases?
Often unremarkable
What is the morphological features of reflux esophagitis, in severe cases?
Recruitment of eosinophils into squamous mucosa, followed by neutrophils
Increase lymphocyte
Basal zone hyperplasia
Elongation of lamina propria ito upper third of esophagus
What are the clinical features of reflux esophagitis?
Heartburn and dysphagia
Noticeable regurgitation of sour-tasting gastric contents
Attacks of severe chest pain (Chronic GERD)
What are the complications of reflux esophagitis?
Esophageal ulceration
Hematemesis
Melena
Stricture development
Barrett esophagus
What is the treatment of reflux esophagitis?
Proton pump inhibitors
Why are PPI’s the treatment for reflux oesophagitis?
Reduce gastric acidity and provide symptomatic relief
What is the ethology of Eosinophilic Esophagitis?
Allergic, majority are atopic
What are the symptoms of Eosinophilic Esophagitis in adults?
Food impaction and dysphagia
What are the symptoms of Eosinophilic Esophagitis in children?
Feeding intolerance or GERD like symptoms