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Gastrointestinal 1 > Pathology of Esophagus > Flashcards

Pathology of Esophagus Flashcards

1
Q

What is a tracheoesophageal fistula? (remember fistula= abnormal connection between two tubes)

A

congenital defect resulting in a connection between the esophagus and trachea

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2
Q

What is the most common tracehoesophageal fistula variant?

A
  • proximal esophageal atresia (blind pouch) with the distal esophagus arising from the trachea.
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3
Q

What are the 4 clinical features of a TE fistula?

A

1) vomiting
2) polyhydramnios (excess amniotic fluid)
3) abdominal distension
4) aspiration

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4
Q

What is an esophageal web?

A
  • 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
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5
Q

For what cancer does esophageal web increase your risk?

A

esophageal squamous cell carcinoma

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6
Q

What is the most important syndrome that can manifest from esophageal web?

A

Plummer-Vinson syndrome= severe iron deficiency anemia, esophageal web, and beefy red tongue (due to atrophic glossitis).

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7
Q

What is Zenker Diverticulum?

A

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.

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8
Q

How does Zenker Diverticulum present?

A
  • dysphagia, obstruction, and halitosis (bad breath).
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9
Q

What is Nutcracker esophagus?

A

lack of coordination of the muscular layers leading to short lived obstruction

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10
Q

How do Tracker and Epiphrentic diverticulum differ from Zenker Diverticulum?

A
  • Tracker= midpoint of esophagus

- Epiphrenic= above the lower esophageal sphincter

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11
Q

What is esophageal stenosis?

A

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

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12
Q

What are Esophageal rings (Schatzki rings)?

A

similar to webs, but are circumferential and thicker

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13
Q

What is Mallory-Weiss syndrome?

A
  • longitudinal laceration of mucosa at the gastroesophageal junction.
  • caused by severe vomiting (usually due to alcoholism or bulimia).
  • presents with PAINFUL HEMATEMESIS
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14
Q

For what does Mallory-Weiss syndrome increase your risk?

A

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

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15
Q

What are esophageal varices?

A

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)

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16
Q

What is the most common risk of death in cirrhosis?

A

ruptured esophageal varices

17
Q

What is achalasia? (A=without, chalsia= relaxation)

A
  • disordered esophageal motility with inability to relax the lower esophageal sphincter (LES), due to damaged ganglion cells in the myenteric plexus.
18
Q

Where are the ganglion cells of the myenteric plexus located?

A

between the inner circular and outer longitudinal layers of the muscularis propria.

19
Q

How can damage to the ganglion cells of the myenteric plexus occur?

A
  • idiopathically

- secondary to a known insult (Trypanosoma cruzi infection in Chagas disease).

20
Q

What are the clinical features of Achalasia?

A
  • 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
21
Q

What is Gastroesophageal Reflux Disease (GERD)?

A
  • reflux of acid from the stomach due to reduced LES tone.
22
Q

What are the risk factors for GERD?

A
  • alcohol, tobacco, obesity, fat-rich diet, caffeine, and hiatal hernia.
23
Q

What are the clinical features of GERD?

A
  • heartburn (mimics cardiac chest pain)
  • asthma (adult onset) and cough
  • damage to enamel of teeth
  • ulceration with stricture and Barrett esophagus (late complications).
24
Q

What is the normal lining of the lower esophagus?

A

Non-keratinized stratified squamous epithelium

25
Q

What is Barrett’s esophagus?

A

metaplasia of the lower esophageal mucosa from stratified squamous epithelium to NONCILIATED COLUMNAR epithelium with GOBLET cells. This is the response of the stem cells to acidic stress.
*dysplasia can occur marked by high N-C ratio

26
Q

What are the two types of esophageal carcinoma?

A
  1. adenocarcinoma

2. squamous cell carcinoma

27
Q

** What is adenocarcinoma of the esophagus?

A
  • malignant proliferation of GLANDS (most common in the western world) arising from preexisting Barrett esophagus.
  • remember there are not normally glands in the LOWER 1/3 of esophagus so this is occurring due to metaplasia.
28
Q

What is squamous cell carcinoma of the esophagus?

A
  • malignant proliferation of SQUAMOUS cells (most common esophageal cancer worldwide)
  • usually middle or UPPER 1/3
29
Q

What is the main risk factor for squamous cell carcinoma of the esophagus?

A

IRRITATION (alcohol, tobacco, very hot liquids, achalasia, esophageal web; plummer-vinson syndrome…)

30
Q

What are the symptoms of both types of esophageal carcinoma?

A

progressive dysphagia (solids to liquids), weight loss, pain, and hematemesis

31
Q

** What additional symptoms may squamous cell carcinoma present with?

A
  • hoarse voice (recurrent laryngeal nerve involvement) and cough (trachea)
32
Q

What are the areas of lymph node metastasis for esophageal carcinoma?

A
  • upper 1/3 involvement= cervical nodes
  • middle 1/3 involvement= mediastinal or tracheobronchial nodes.
  • lower 1/3 involvement= celiac and gastric nodes.
33
Q

What is the most common cause of infectious esophagitis?

A

candidiasis

34
Q

What will you see histologically with CMV esophagitis?

A

shallow, linear ulcerations with nuclear and cytoplasmic inclusions in capillary endothelium and stromal cells.

35
Q

What will you see in reflux or eosinophilic esophagitis?

A

eosinophils but much more in eosinophilic than reflux esophagitis
*pts with eosinophilic esophagitis often have atopic dermatitis, allergic rhinitis, asthma or peripheral eosinophilia

36
Q

Is squamous cell carcinoma of the esophagus associated with APC mutations?

A

NO

37
Q

** What is the most common benign tumor of the esophagus?

A

Leiomyoma

Gastrointestinal 1 (21 decks)

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