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Gastrointestinal > Pathology of the esophagus > Flashcards

Pathology of the esophagus Flashcards

1
Q

What is dysphagia?

A

DIfficulty swallowing due to mechanical and functional disorders

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2
Q

What is odynophagia?

A

Painful swallowing

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3
Q

Problems swallowing solids and liquids problems are suggestive or what type of etiology, as opposed to solids alone?

A

Nerve problems

Solids alone is more likely obstructional

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4
Q

What are the ssx of achlasia?

A

Progressive dysphagia, nocturnal regurgitation, or functional obstruction

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5
Q

What are the three abnormalities associated with achalasia?

A

Aperistalsis
Incomplete relaxation of LES

Increased resting tone of LES

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6
Q

What are the causes of achalasia?

A

primary = unknown

Secondary = changes in innervation (NO VIP release)

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7
Q

What is the morphology of achalasia?

A

Dilated lower esophagus

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8
Q

What is the danger associated with achalasia?

A

SCC
ASpiration
Obstruction

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9
Q

Damage to what nerve plexus can lead to achalasia?

A

Myenteric

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10
Q

What are the pathological changes above the esophagus in achalasia? (3)

A

Muscular hypertrophy/thinning

Diminished myenteric ganglia

Mucosal damage

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11
Q

What is the infectious organism that can lead to secondary achalasia?

A

Chagas disease (trypanosoma cruzi destroys ganglion cells)

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12
Q

Disorder of what motor nuclei can lead to achalasia?

A

Vagal dorsal motor nuclei

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13
Q

How can DM cause achalasia?

A

Neuropathy

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14
Q

What are the infiltrative disorders that can cause secondary achalasia?

A

Malignancy
Amyloidosis
Sarcoidosis

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15
Q

What are the two different hiatal hernias?

A

Sliding (whole cardiac portion)

Paraesophageal (just a finger projection)

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16
Q

What is the complication that can occur with a paraesophageal hiatal hernia?

A

Strangulation of the esophagus

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17
Q

What is a true diverticulum?

A

Has all four components of the GI tract wall outpouched

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18
Q

What is a false diverticulum?

A

Just mucosa and submucosa are outpouched

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19
Q

What is a Zenker diverticulum? Is this true or false?

A

Immediately above the UES

False

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20
Q

What is a traction diverticulum? Is this true or false?

A

Midportion of the esophagus

True

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21
Q

What is an epiphrenic diverticula? Is this true or false?

A

Immediately above the LES

True

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22
Q

What is the cause of Traction diverticula?

A

Congenital or scarring

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23
Q

What is the cause of epiphrenic diverticula?

A

Peristaltic discoordination

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24
Q

What are Mallory-Weiss tears?

A

Longitudinal tears at GE junction, caused by failure of the relaxation of the LES and peptic ulcers

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25
Q

What is the complication with esophageal varices?

A

Can rupture and bleed–very hard to stop

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26
Q

What is the infectious agent that can lead to cirrhosis of the liver, and esophageal varices?

A

Schistosomiasis

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27
Q

What are the symptoms of esophagitis?

A 
Dysphagia
Dyspepsia
Regurgitation
Hematemesis
Melena
28
Q

What is the cause of esophagitis?

A 
Reflux esophagitis (GERD)
Infections and chemical causes
29
Q

What is the cause of reflux esophagitis?

A

Decreased efficacy of antireflux mechanisms (CNS depressants, prego, irritants), leading to increased acid in the esophagus

30
Q

What are the substances that may cause reflux esophagitis?

A

EtOH
Caffeine
Smoking
Chocolate/fired foods

31
Q

What are the gross characteristics of reflux esophagitis?

A

Reddening and streaking of the esophagus

32
Q

What WBCs increase in esophagitis?

A

Eosinophils and, later, neutrophils

33
Q

What happens histologically with reflux esophagitis?

A

Basal zone hyperplasia, and elongation of the lamina propria papillae

34
Q

Where does Barrett’s esophagus occur?

A

above the LES

35
Q

What percent of esophagitis pts will develop barrett’s esophagus?

A

10%

36
Q

What is the risk of Barrett’s esophagus?

A

adenocarcinoma (30-40x)

37
Q

What are the gross characteristics of Barrett’s esophagus?

A

Salmon colored esophagus

38
Q

What is the adenomatous change in Barrett’s’ esophagus?

A

Dysplasia in the glands of the esophagus (piling up of gland cells)

39
Q

What are the signs of high grade dysplasia in esophagitis?

A

Prominent nucleoli

40
Q

When does dysplasia become cancer?

A

When the dysplasia reaches below the basement membrane

41
Q

What are the causes of Barrett’s esophagus?

A

Irritants (EtOH, very hot fluids, dry swallow of pills)

42
Q

What are the histological findings of radiation esophagitis?

A

Fibrosing of the mucosa

43
Q

What is a common-ish complication of radiation esophagitis?

A

Fibrosis and sticking to other nearby structures

44
Q

Whitish plaques on the epithelium of the esophagus = ?

A

Candida

45
Q

What are the histological characteristics of candida?

A

Non-hyphae branching at 45 degrees

46
Q

What is the viral cause of esophagitis in AIDS or immunocompromised pts? (hint: it’s not HIV)

A

Herpes

47
Q

What is the cause of strictures of the esophagus?

A

Fibrosis that occurs with frequent exposure to stuff

48
Q

What is scleroderma?

A

Autoimmune disease causing sclerosing of the skin and CT

49
Q

What are the tests for scleroderma?

A

Antinuclear antibodies
Scler-70
Anti topoisomerase

50
Q

What is the cause of stenosis by scleroderma?

A

Vascular obliteration

Fibrosis in smooth muscles (weaken muscles)

51
Q

Where do benign tumors arise from in the esophagus?

A

mesenchymal tissue

52
Q

What is the most common benign tumor of the esophagus?

A

Leiomyomas

53
Q

What are the two malignant tumors of the esophagus?

A

SCC

Adenocarcinoma

54
Q

What is the origin of scc and adenocarcinoma of the esophagus?

A

Epithelial origin

55
Q

Who usually gets SC of the esophagus?

A

Black males who are overweight

56
Q

What are the malignant HPV viruses? What are the proteins that these affect?

A

16 18 31 33 35

E6 E7

57
Q

What is the viral cause of esophagitis?

A

HPV

58
Q

How can diet cause esophageal CA?

A

act as promoters, potentiations

59
Q

How does nitrosamines from cigarette smoke lead to CA?

A

p53 mutations

60
Q

What are the three types of SCC in the esophagus?

A

Protruded
Flat
Excavated

61
Q

Where in the esophagus dose adenocarcinoma usually occur?

A

Distal 1/3

62
Q

Who usually gets adenocarcinoma of the esophagus?

A

White males

63
Q

What are the histological findings of very aggressive adenocarcinoma?

A

Signet ring

64
Q

What layer of the GI tract houses the lymphatics?

A

Submucosa

65
Q

What are the Keratin pearls?

A

histological characteristics of SCC

Gastrointestinal (42 decks)

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