Pathology of Esophagus Flashcards
What is a tracheoesophageal fistula? (remember fistula= abnormal connection between two tubes)
congenital defect resulting in a connection between the esophagus and trachea
What is the most common tracehoesophageal fistula variant?
- proximal esophageal atresia (blind pouch) with the distal esophagus arising from the trachea.
What are the 4 clinical features of a TE fistula?
1) vomiting
2) polyhydramnios (excess amniotic fluid)
3) abdominal distension
4) aspiration
What is an esophageal web?
- thin protrusion of esophageal MUCOSA, most often in the upper esophagus that presents with dysphagia for poorly chewed food.
- rare, but more in women over 40
For what cancer does esophageal web increase your risk?
esophageal squamous cell carcinoma
What is the most important syndrome that can manifest from esophageal web?
Plummer-Vinson syndrome= severe iron deficiency anemia, esophageal web, and beefy red tongue (due to atrophic glossitis).
What is Zenker Diverticulum?
out-pouching of pharyngeal mucosa through acquired defect in muscular wall (actually a false diverticulum because it doesn’t go through the entire wall).
*arises above the upper esophageal sphincter at the junction of the esophagus and pharynx.
How does Zenker Diverticulum present?
- dysphagia, obstruction, and halitosis (bad breath).
What is Nutcracker esophagus?
lack of coordination of the muscular layers leading to short lived obstruction
How do Tracker and Epiphrentic diverticulum differ from Zenker Diverticulum?
- Tracker= midpoint of esophagus
- Epiphrenic= above the lower esophageal sphincter
What is esophageal stenosis?
fibrous thickening of the submucosa and atrophy of the muscularis propria and epithelial damage leading to narrowing of the lumen.
*will ingest more liquids than solids
What are Esophageal rings (Schatzki rings)?
similar to webs, but are circumferential and thicker
What is Mallory-Weiss syndrome?
- longitudinal laceration of mucosa at the gastroesophageal junction.
- caused by severe vomiting (usually due to alcoholism or bulimia).
- presents with PAINFUL HEMATEMESIS
For what does Mallory-Weiss syndrome increase your risk?
Boerhaave syndrome= rupture of esophagus leading to air in the mediastinum and subcutaneous emphysema
What are esophageal varices?
dilated submucosal veins in the lower esophagus that arise secondary to portal hypertension (distal esophageal vein normally drains into the portal vein via the left gastric vein).
*asymptomatic, but risk of rupture exists (presents with painless hematemesis)
What is the most common risk of death in cirrhosis?
ruptured esophageal varices
What is achalasia? (A=without, chalsia= relaxation)
- disordered esophageal motility with inability to relax the lower esophageal sphincter (LES), due to damaged ganglion cells in the myenteric plexus.
Where are the ganglion cells of the myenteric plexus located?
between the inner circular and outer longitudinal layers of the muscularis propria.
How can damage to the ganglion cells of the myenteric plexus occur?
- idiopathically
- secondary to a known insult (Trypanosoma cruzi infection in Chagas disease).
What are the clinical features of Achalasia?
- dysphagia for solids and liquids
- putrid breath
- high LES pressure on esophageal manometry
- BIRD-BEAK sign on barium swallow
- increased risk for esophageal squamous cell carcinoma
What is Gastroesophageal Reflux Disease (GERD)?
- reflux of acid from the stomach due to reduced LES tone.
What are the risk factors for GERD?
- alcohol, tobacco, obesity, fat-rich diet, caffeine, and hiatal hernia.
What are the clinical features of GERD?
- heartburn (mimics cardiac chest pain)
- asthma (adult onset) and cough
- damage to enamel of teeth
- ulceration with stricture and Barrett esophagus (late complications).
What is the normal lining of the lower esophagus?
Non-keratinized stratified squamous epithelium
