Pathology of the Esophagus

Question 1

what are causes of esophagitis

Answer 1

1)Chemical injury
Reflux of gastric contents
Acids, alkalis (e.g. lye), alcohol, tobacco
Medications (e.g. “pill” esophagitis and
chemotherapeutics)

2)Infection
Fungal (e.g. Candida) Viral (e.g. Herpes simplex virus)

3)Immune related diseases
Eosinophilic esophagitis
Dermatologic diseases (e.g. lichen planus)

4) Radiation
5) Trauma

Question 2

what is reflux esophagitis …

Answer 2

…it is injury and inflammation that results from reflux of gastric contents into the esophagus

…results in gastroesophageal reflux disease:

Question 3

In herpetic esophagitis what is seen on endoscopy and histology

Answer 3

endoscopy: punched out ulcers
Histology: viral inclusions

Question 4

In Candida esophagitis, what is observed in endoscopy and histology

Answer 4

endoscopy: white plaques
Histology: fungus

Question 5

what is seen on endoscopy and histology for Eosinophilic Esophagitis

Answer 5

Endoscopcy: ringed esophagus with linear furrows
Histology: lots of Eosinophils

Question 6

what is Zenkers diverticula

Answer 6

occurs in Uppermost portion of the esophagus
Sx’s include Regurgitation, halitosis (bad breath), and aspiration (clinical: gurgling)
Associated with reduced UES compliance

Question 7

what is the definition of diverticulum

Answer 7

an abnormal sac or pouch formed at a weak point in the wall of the alimentary tract.

Question 8

Descibe Mid Esophagus diverticula clinical presentaion

Answer 8

Usually asymptomatic, associated with mediastinal inflammation (ie TB)

Question 9

describe Epiphrenic diverticula

Answer 9

Symptomatic, secondary to coexistence with hiatal hernia

Question 10

What are Esophageal webs and rings

Answer 10

Acquired,
Clinically account for 5-15% of dysphagia or choking sensation,
More common in females > 40 years of age

Question 11

describe the Sx’s of esophageal webs and rings

Answer 11

Mostly asymptomatic,

Dysphagia and odynophagia (Pain on swallowing food and fluids) are common symptoms.

Question 12

what is ESOPHAGEAL ATRESIA AND TRACHEOESOPHAGEAL FISTULA

Answer 12

Congenital anomalies resulting from failure of the foregut to divide into trachea and esophagus during the fourth week of embryonic development

Question 13

what is Congenital esophageal stenosis

Answer 13

Anomaly demonstrates a significant narrowing of the mid-esophagus by way of:
Esophageal web/ rings
Muscular hypertrophy
Inflammation

Question 14

what is Nutcracker esophagus

Answer 14

Motility disorder caused by extensive hypertrophy of the inner muscle layer

Question 15

what causes Corkscrew esophagus

Answer 15

Diffuse esophageal spasms

Question 16

what are Mallory-Weiss tears

Answer 16

tears in esophagus from severe retching or vomiting, often associated with alcohol intoxication

Question 17

what is Boerhaave syndrome

Answer 17

rupture of the esophagus from severe retching or vomiting, often associated with alcohol intoxication

Question 18

______ % of low grade dyplsasia in barretts esophagus will become adenocarcinoma

Answer 18

~ 2- 12

Question 19

______% of high grade dysplasia in barretts esophagus will become adenocarcinoma

Answer 19

~ 16- 60%

Question 20

adenocarcinoma is asscociated with ______

Answer 20

GERD,
tobacco use,
radiation exposure

Question 21

adenocarcinoma occurs more commonly in _____

Answer 21

men (7 M : 1 F)

Question 22

Sqaumous cell carcinoma is more common ________, and is associated with _______

Answer 22

world-wide (Asia and Africa) and in men (4 M : 1 F) and in African Americans (8 AA : 1 US Caucasian)

alcohol, tobacco, and dietary factors

Question 23

overall 5-year survival of squamous cell carcinoma of the esophagus is _______

Answer 23

~ 5-10%

Question 24

overall 5-year survival of adenocarcinoma of the esophagus is _______

Answer 24

~25%

Question 25

what is the Tx of Eosinophilic Esophagitis

Answer 25

Elimination of food allergens and the swallowing of topical corticosteroids are the treatments of choice.