Pathology of the esophagus Flashcards
definition: odynophasia
painful swallowing
definition: achalasia
failure of relaxation of LES - functional obstruction
what are the symptoms of achalasia?
progressive dysphagia
nocturnal regurgitation
what is the primary cause of achalasia? secondary?
idiopathic
failure of distal inhibitory neurons containing NO and VIP
what is the morphology associated with achalasia?
dilation above LES
what is the danger associated with achalasia?
squamous cell carcinoma
what are the causes of secondary achalasia?
chagas
vagal dorsal motor nuclei
diabetic autonomic neuropathy
infiltrative disorders - malignancy, amyloidosis, sarcoidosis
what is the main subtype of hiatal hernia?
sliding hernia (95%)
definition: true diverticula
outpouching of GI tract containing all visceral layers
definition: false diverticula
outpouching of GI tract containing mucosa and submucosa
where does a zenker diverticulum present? is it false or true?
immediately above UES
false
where does a traction diverticulum present? is it false or true?
mid esophagus
true
where does an epiphrenic diverticulum present? is it false or true?
immediately above LES
true
what is a mallory weiss tear?
longitudinal tear at GE junction
what is a mallory weiss tear associated with?
alcoholism
severe retching
pregnancy
what is the pathogenesis of mallory weiss tear?
failure of reflex relaxation of LES
what is the main cause of esophageal varices?
portal hypertension secondary to alcoholic cirrhosis
what is the general cause of reflux esophagitis? specific agents?
decreased efficacy of antireflux mechanisms (LES tone)
CNS depressants pregnancy, obesity irrtants - EtOH, smoking scleroderma hypothyroidism delayed gastric emptying
what is an early marker of reflux esophagitis?
eosinophils
what indicates increased severity of reflux esophagitis?
neutrophils
what is the main sequelae of prolonged reflux esophagitis?
Barrett esophagus
definition: barrett esophagus
replacement of normal distal squamous mucosa by metaplastic columnar epithelium, goblet cells (response to prolonged injury)
patients with barrett esophagus are 30x-40x more likely to develop what major condition?
carcinoma
once dysplastic cells break through the basement membrane of the esophagus what condition results?
adenocarcinoma
how does scleroderma lead to stenosis?
vascular obliteration and fibrosis in smooth muscle leads to
weak LES
poor esophageal contractility
delayed gastric emptying
what is the most common benign tumor of the esophagus?
leiomyoma
malignant tumors of the esophagus are usually of what origin?
epithelial
what is the most common esophagus cancer worldwide?
squamous cell carcinoma
what are the primary factors influencing development of squamous cell carcinoma?
dietary and environmental
what is the pathogenesis of dietary factors on development of squamous cell carcinoma?
methylating nitroso compounds in diet may lead to p53 point mutations
progressive gradual dysphagia is not normally noticed until the lumen is closed to what degree?
30-50%
what are the three morphologies of squamous cell carcinoma?
protruded
flat
excavated
what is the most common squamous cell carcinoma morphology?
protruded
what is the typical site of origin for adenocarcinoma of esophagus?
GE junction
