Pathology of the esophagus

Question 1

definition: odynophasia

Answer 1

painful swallowing

Question 2

definition: achalasia

Answer 2

failure of relaxation of LES - functional obstruction

Question 3

what are the symptoms of achalasia?

Answer 3

progressive dysphagia

nocturnal regurgitation

Question 4

what is the primary cause of achalasia? secondary?

Answer 4

idiopathic

failure of distal inhibitory neurons containing NO and VIP

Question 5

what is the morphology associated with achalasia?

Answer 5

dilation above LES

Question 6

what is the danger associated with achalasia?

Answer 6

squamous cell carcinoma

Question 7

what are the causes of secondary achalasia?

Answer 7

chagas
vagal dorsal motor nuclei
diabetic autonomic neuropathy
infiltrative disorders - malignancy, amyloidosis, sarcoidosis

Question 8

what is the main subtype of hiatal hernia?

Answer 8

sliding hernia (95%)

Question 9

definition: true diverticula

Answer 9

outpouching of GI tract containing all visceral layers

Question 10

definition: false diverticula

Answer 10

outpouching of GI tract containing mucosa and submucosa

Question 11

where does a zenker diverticulum present? is it false or true?

Answer 11

immediately above UES

false

Question 12

where does a traction diverticulum present? is it false or true?

Answer 12

mid esophagus

true

Question 13

where does an epiphrenic diverticulum present? is it false or true?

Answer 13

immediately above LES

true

Question 14

what is a mallory weiss tear?

Answer 14

longitudinal tear at GE junction

Question 15

what is a mallory weiss tear associated with?

Answer 15

alcoholism
severe retching
pregnancy

Question 16

what is the pathogenesis of mallory weiss tear?

Answer 16

failure of reflex relaxation of LES

Question 17

what is the main cause of esophageal varices?

Answer 17

portal hypertension secondary to alcoholic cirrhosis

Question 18

what is the general cause of reflux esophagitis? specific agents?

Answer 18

decreased efficacy of antireflux mechanisms (LES tone)

CNS depressants 
pregnancy, obesity 
irrtants - EtOH, smoking 
scleroderma 
hypothyroidism 
delayed gastric emptying

Question 19

what is an early marker of reflux esophagitis?

Answer 19

eosinophils

Question 20

what indicates increased severity of reflux esophagitis?

Answer 20

neutrophils

Question 21

what is the main sequelae of prolonged reflux esophagitis?

Answer 21

Barrett esophagus

Question 22

definition: barrett esophagus

Answer 22

replacement of normal distal squamous mucosa by metaplastic columnar epithelium, goblet cells (response to prolonged injury)

Question 23

patients with barrett esophagus are 30x-40x more likely to develop what major condition?

Answer 23

carcinoma

Question 24

once dysplastic cells break through the basement membrane of the esophagus what condition results?

Answer 24

adenocarcinoma

Question 25

how does scleroderma lead to stenosis?

Answer 25

vascular obliteration and fibrosis in smooth muscle leads to weak LES poor esophageal contractility delayed gastric emptying

Question 26

what is the most common benign tumor of the esophagus?

Answer 26

leiomyoma

Question 27

malignant tumors of the esophagus are usually of what origin?

Answer 27

epithelial

Question 28

what is the most common esophagus cancer worldwide?

Answer 28

squamous cell carcinoma

Question 29

what are the primary factors influencing development of squamous cell carcinoma?

Answer 29

dietary and environmental

Question 30

what is the pathogenesis of dietary factors on development of squamous cell carcinoma?

Answer 30

methylating nitroso compounds in diet may lead to p53 point mutations

Question 31

progressive gradual dysphagia is not normally noticed until the lumen is closed to what degree?

Answer 31

30-50%

Question 32

what are the three morphologies of squamous cell carcinoma?

Answer 32

protruded flat excavated

Question 33

what is the most common squamous cell carcinoma morphology?

Answer 33

protruded

Question 34

what is the typical site of origin for adenocarcinoma of esophagus?

Answer 34

GE junction