Pathology Of The Esophagus Flashcards
What is the type of esophageal mucosa epithelium?
Nonkeratinized stratified squamous epithelium
What occurs in the esophagus physically during esophageal stenosis?
Fibrous thickening of the Submucosa with atrophy of the muscularis propria
What are common acquired causes for esophageal stenosis
chronic GERD
Irradiation
Ingestion of caustic agents
Severe trauma to the esophagus
What are esophageal mucosal webs?
Idiopathic ledge like protrusions of mucosa that may cause obstruction
- these are uncommon lesions that typically only occur in women >40 yrs or patients with chronic GERD
- produces non progressive dysphagia
Can also be seen in
- iron-deficiency
- glossitis
- cheilosis from Paterson-brown-Kelly or Plummer-Vinson Syndrome
What are Schatzki rings?
Are circumferential and thicker transmutation rings that include the mucosa/Submucosa and sometimes hypertrophic muscularis
- cause non-progressive dysphagia
most commonly seen at the gastroesophageal junction and is really only seen from chronic GERD
What is achalasia?
A triad of:
- incomplete LES relaxation
- increased LES tone
- esophageal aperistalsis
Can be primary or secondary:
- primary = failure of inhibitory neurons and is idiopathic
- secondary = degenerative changes in the esophagus or the vagus nerve
Symptoms:
- cant eat even though they are hungry
- abdominal mass
- “bird-beak” apperance on imaging
What is the relation between Chagas’ disease and achalasia
Chagas is a common secondary cause of achalasia since chronic exposure induces destruction of the myenteric plexus
Esophageal varices
Dilation of the portal veins due to impediment of portal blood in some way or fashion
- induces portal HTN
- is life threatening and will induce massive bleeding if ruptured
- # 1 common cause is liver cirrhosis*
2nd most common is hepatic schistosomiasis
Clinical features of esophageal varices
Most are asymptomatic
Symptoms
- massive hematemesis (if ruptured)
- dysphagia (if large enough)
is a medical emergency if they rupture
Mallory-Weiss tears
Most common esophageal lacerations
Partial thickness and longitudinal lacerations of the Gastroesophageal junction.
- only in the mucosa and Submucosa layers
- patient usually presents with hematemesis
Are caused by severe vomiting where relaxation of the gastroesophageal musculature is impeded
most commonly seen in alcoholics and bulimics
Boerhaave Syndrome
Are severe transmural esophageal tears
- are worse Mallory-Weiss tears and always require surgical intervention
What does the term odynophagia mean?
Pain with swallowing
What are the most common infectious agents of esophagitis?
HSV, CMV, fungal organisms (especially candida and aspergillus)
HSV = “punched-out” ulcers with nuclear viral inclusion bodies on histopathy
CMV = shallow ulcerations with nuclear and cytoplasmic inclusions within stroma cells
What is the most common GI ailment for outpatient settings?
GERD
What are possible causes of GERD?
Obesity
Pregnancy
Being female
Alcohol/tobacco use
CNS depressant use
Hiatal hernia
Delayed gastric emptying
What histological changes occur in GERD
Can show metaplasia (Buretts esophagus)
Eosinophils and neutrophils infiltrate the tissues
Clinical features, complications and treatment of GERD
most common in females over 40yrs
Features:
- heartburn
- dysphagia
- sour-tasting gastric contents
- (rare) severe rapid bouts of chest pain (mimics heart attack)
Complications:
- esophageal ulcerations
- hematemesis
- stricture development
- Barrett esophagus
- Elena
Treatment:
- proton pump inhibitors
Eosinophilic esophagitis
A chronically immunologically mediated disorder
- large number of eosinophils in primarily superficial proximal esophagus areas
Symptoms:
- dysphagia
- GERD-like symptoms (is good at mimicking GERD)
- allergy-like symptoms
How to differentiate eosinophilic esophagitis from GERD?
1) EE effects the proximal esophagus, GERD effects the distal portions closest to the stomach
2) EE shows prominent rings in the upper and mid portions of the esophagus. GERD does not show this
Treatment of EE
Dietary restrictions and typical/systemic corticosteroids
Barrett esophagus
A complication of chronic GERD which shows intestinal metaplasia within esophageal squamous mucosa
Most common patients are white males between 40-60yrs old
- very heavily linked with GERD
increased risk for esophageal adenocarcinoma (1% chance each year)
What is the defining histological characteristic of Barrett esophagus?
Goblet cells in the esophageal tissues
- stains pale blue/ white
Esophageal adenocarinoma
Aggressive esophageal cancer
- most commonly associated with GERD
Risk factors:
- previous radiation
- smokers
- document chronic dysplasia
- obesity
- white people
- males
- living in a western country
Survivability = <25% 5-yr
What chromosome abnormalities are present in adenocarcinoma of the esophagus?
TP53 mutations
