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Gastrointestinal System > Pathology of Esophagus > Flashcards

Pathology of Esophagus Flashcards

1
Q

What are the different types of oesophageal obstruction?

A

Mechanical and Functional

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2
Q

What are examples of mechanical obstruction?

A

Artesia
Fistula

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3
Q

What are examples of functional obstruction

A

Achalasia

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4
Q

What is the esophagus?

A

A muscular tube that extends from the pharynx to the stomach

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5
Q

What are the 4 layers of the esophagus?

A

Muscosa
Submucosa
Muscularis externa
Adventitia

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6
Q

What are the sublayers of the mucosa?

A

Epithelium
Lamina propria
Muscularis interna

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7
Q

What is the definition of mechanical obstruction?

A

Congenital group of disorders discovered shortly after birth due to regurgitation during feeding

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8
Q

How does Artesia occur?

A

From the failure of the primitive foregut to recanalize

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9
Q

Where does Artesia usually occur?

A

At or near the tracheal bifurcation and usually associated with the fistula connecting the lower and upper oesophageal pouches to bronchus or trachea

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10
Q

How does a fistula happen?

A

Results from incomplete separation of the primitive foregut into two completely separate tubes

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11
Q

What are the clinical features of oesophageal obstruction?

A

Vomiting
Aspiration
Suffocation
Pneumonia
Severe fluid and electrolyte imbalance

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12
Q

What is achalasia?

A

Failure pf the LES to relax with swallowing and poor peristalsis in the body of the esophagus

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13
Q

What are the two types of achalasia?

A

Primary and secondary

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14
Q

What is primary achalasia?

A

An inflammatory disease that cause loss of inhibitory neurons in the myenteric plexus

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15
Q

What does chronic inflammation of the myenteric plexus lead to?

A

Neuritis, ganglionitis and ganglion cell loss and fibrosis

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16
Q

What is secondary achalasia?

A

Trypanosoma cruzi infection causes destruction of myenteric plexus, failure of LES relaxation and dilation

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17
Q

What is secondary achalasia associated with?

A

Chagas disease

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18
Q

What are the clinical features of achalasia?

A

Dysphagia gor solids and liquids
Putrid breath
High LES pressure
Bird-beak sign on barium swallow
Increased risk of esophageal squamous cell carcinoma

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19
Q

What causes reflux esophagitis?

A

Regurgitation of gastric contents (GERD)

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20
Q

What is the most common cause of esophagitis

A

Reflux esophagitis

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21
Q

When is reflux esophagitis most common?

A

Individuals over 40

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22
Q

What is the associated clinical condition of reflux esophagitis called?

A

GERD

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23
Q

What are the agents that decrease the tone of the LES or increase abdominal pressure?

A

Alcohol, chocolate, fatty foods, cigarette smoking

Certain nervous system depressants

Pregnancy

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24
Q

What are the gross features of reflux esophagitis?

A

Severe cases have hyperaemic mucosa with focal haemorrhage

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25
Q

What is the morphological features of reflux esophagitis, in mild cases?

A

Often unremarkable

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26
Q

What is the morphological features of reflux esophagitis, in severe cases?

A

Recruitment of eosinophils into squamous mucosa, followed by neutrophils

Increase lymphocyte

Basal zone hyperplasia

Elongation of lamina propria ito upper third of esophagus

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27
Q

What are the clinical features of reflux esophagitis?

A

Heartburn and dysphagia

Noticeable regurgitation of sour-tasting gastric contents

Attacks of severe chest pain (Chronic GERD)

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28
Q

What are the complications of reflux esophagitis?

A

Esophageal ulceration
Hematemesis
Melena
Stricture development
Barrett esophagus

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29
Q

What is the treatment of reflux esophagitis?

A

Proton pump inhibitors

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30
Q

Why are PPI’s the treatment for reflux oesophagitis?

A

Reduce gastric acidity and provide symptomatic relief

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31
Q

What is the ethology of Eosinophilic Esophagitis?

A

Allergic, majority are atopic

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32
Q

What are the symptoms of Eosinophilic Esophagitis in adults?

A

Food impaction and dysphagia

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33
Q

What are the symptoms of Eosinophilic Esophagitis in children?

A

Feeding intolerance or GERD like symptoms

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34
Q

What is a differential characteristic of Eosinophilic Esophagitis?

A

Failure of high dose PPI treatment and the absence of acid reflux

35
Q

What are the microscopic features of eosinophilic esophagitis?

A

Epithelial infiltration by eosinophils

36
Q

What is the treatment of eosinophilic esophagitis?

A

Dietary restrictions
Topical or systemic corticosteroids

37
Q

What is Barrett’s Esophagus?

A

Result of chronic GERD

Characterised by intestinal metaplasia within the lower oesophageal squamous mucosa

38
Q

What is the epidemiology of Barrett’s Esophagus?

A

10% of people with symptomatic GERD
More common in white males
Present between 40 and 60
Increased risk of oesophageal adenocarcinoma
Smokers have greater chance

39
Q

What are the gross features of Barrett’s Esophagus?

A

Tongues or patches of red, velvety mucosa extending upwards from gastroesophageal junction

40
Q

What are the microscopic features of Barrett’s Esophagus?

A

Gastric or intestinal metaplasia
Well-formed goblet cells interspersed with gastric foveolar cells
Dysplasia
Intermucosal carcinoma

41
Q

What are the clinical features of Barrett’s Esophagus?

A

Diagnosis is established by endoscopy with biopsy
Patients followed up closely to diagnose any complication

42
Q

What happens to low grade dysplasia after giving Barrett’s Esophagus treatment?

A

Regression

43
Q

What are chemical and infectious esophagitis?

A

Damage to stratified squamous mucosa of the esophagus by a variety of irritants

44
Q

What are the irritants that cause chemical and infectious esophagitis?

A

Alcohol
Corrosive acids or bases
Excessively hot fluids
Heavy smoking
Pill-induced esophagitis

45
Q

What are the clinical features of chemical and infectious esophagitis?

A

Pain, odynophagia (pain when swallowing)
Hemorrhage (severe cases)
Stricture (severe cases)
Perforation (severe cases)

46
Q

Which kind of patients is infectious esophagitis associated with?

A

Immunocompromised patients

47
Q

What are the most common organisms causing infectious esohpgaitis?

A

Fungal organisms: Candida
Herpes Simplex Virus
Cytomegalovirus (CMV)

48
Q

What will be seen in the endoscopy of infectious esophagitis caused by candida?

A

Adherent, grey-white pseudomembranes

49
Q

What will be seen in the endoscopy of infectious esophagitis caused by HSV?

A

Endoscopy: punched-out ulcers

50
Q

What will be seen histologically of infectious esophagitis caused by HSV?

A

Multicluated viral inclusion within rim of degenerated epithelial and Cowdry A inclusion of virus

51
Q

What will be seen in the endoscopy of infectious esophagitis caused by CMV?

A

Shallower ulcerations

52
Q

What will be seen histologically of infectious esophagitis caused by CMV?

A

Nuclear and cytoplasmic inclusions within capillary endothelium and stromal cells

53
Q

What is the most common laceration of the esophagus?

A

Mallory-Weiss Tears

54
Q

What are Mallory-Weiss Tears associated with?

A

Severe retching or vomiting
May occur with acute alcohol intoxication

55
Q

What is the pathogenesis of the Mallory-Weiss Tears?

A

Reflex relaxation of the gastroesophageal musculature precedes the anti peristaltic contractile wave associated with vomiting

This relaxation is taught to fail during prolonged vomiting –> refluxing gastric contents –> cause the oesophageal wall to stretch and tear

56
Q

What are the clinical features of the Mallory-Weiss Tears?

A

Hematemesis
ABdominal pain

57
Q

What is the prognosis of Mallory-Weiss Tears?

A

Risk of Boerhaave syndrome: rupture of esophagus leading to air in the mediastinum and subcutaneous emphysema

58
Q

What are oesophageal varices?

A

Dilated submucosal veins in the lower esophagus

59
Q

How does oesophageal varice arise?

A

Secondary to portal hypertension or cirrhosis

60
Q

What is the morphology of oesophageal varices through angiography?

A

Tortuous dilated veins lying primarily within the submucosa of distal oesophagus and proximal stomach

61
Q

What are the histologic features of oesophageal varices?

A

Overlying mucosa can be intact but is ulcerated and necrotic if rupture has occurred

62
Q

What are the gross features of oesophageal varices?

A

May not be obvious, collapse in the absence of blood flow

63
Q

What are the clinical features of esophageal varices?

A

Asymptomatic but risk of rupture exists:

a. Presents with painless hematemesis
b. Most common cause of death in cirrhosis

64
Q

What is the effect of inflammation on the mucosa?

A

Can destroy the mucosa/submucosa, wearing the tissue and leading to rupture with haemorrhage

65
Q

What are the types of oesophageal tumors?

A

Adenocarcinoma and Squamous Cell Carcinoma

66
Q

What is adenocarcinoma?

A

Typically arises in a background of Barrett esophagus and long standing GERD

67
Q

Which part of the esophagus does adenocarcinoma affect?

A

Lower one third

68
Q

What are the risk factors for adenocarcinoma?

A

Patients with documented dysplasia
Tobacco use, obesity, previous radiation therapy

69
Q

What is the epidemiology of adenocarcinoma?

A

Occurs mainly in whites
7x more common in men than women

70
Q

What is the pathogenesis of adenocarcinoma?

A
  1. Inactivation of the INK4A/CDKN tumor suppressor gene p16
  2. p53 loss and inactivation of RB
  3. Mutations are often present in early stages of oesophageal adenocarcinoma
71
Q

What is the location of adenocarcinoma?

A

Occurs usually in the distal one third of esophagus, may invade gastric cardia

72
Q

What are the gross features of adenocarcinoma?

A

Large exophytic mass
Infiltrate diffusely, ulcerate and invade deeply

73
Q

What are the microscopic features of adenocarcinoma?

A

Barret’s esophagus usually present adjacent to tumor
Tumor produces mucins and forms glands

74
Q

What are the clinical features of adenocarcinoma?

A

Progressive dysphagia
Weight loss
Pain
Hematemesis

75
Q

What are the clinical features of squamous cell carcinoma?

A

Hoarse voice
Cough

76
Q

What causes squamous cell carcinoma?

A

Malignant proliferation of squamous cells

77
Q

Where does squamous cell carcinoma usually present?

A

In the upper or middle third of esophagus

78
Q

What is the epidemiology of squamous cell carcinoma?

A

Occurs in adults > 45
4x more communion males than females

79
Q

What are the risk factors of squamous cell carcinoma?

A

Alcohol and tobacco use
Poverty
Caustic esophageal injury
Achalasia
Plummer-Vinson syndrome
Consumption of very to beverages
Previous radiation therapy

80
Q

What is the pathogenesis of squamous cell carcinoma?

A

Incompletely defined

81
Q

What are the gross features of squamous cell carcinoma?

A

Three types of tumors:
a. Ulcerating
b. Polypoid, projects into lumen
c. Infiltrating, principal plane of growth is in the wall

82
Q

What does the infiltrating squamous cell carcinoma invade?

A

Respiratory tree –> pneumonia
Aorta –> catastrophic exsanguination
Mediastinum and pericardium

83
Q

What are the microscopic features of the squamous cell carcinoma?

A

Neoplastic squamous cells range from well defined with epithelial pearls to poorly differentiated

84
Q
A

Gastrointestinal System (28 decks)

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