Pathology of the GI Tract- SI and Colon (2)

Question 1

the esophagus develops from what and is recognizable at what point?

Answer 1

develops from the cranial portion of the foregut and is recognizable by the third week of gestation

Question 2

what is the blood supply of the esophagus?

Answer 2

upper 1/3: inferior thyroid artery middle 1/3: branches of thoracic aorta; lower 1/3: left gastric artery

Question 3

what is the nerve supply to the esophagus?

Answer 3

sympathetic trunks; parasympathetic nerve: vagus

Question 4

what is the epithelium of the esophagus?

Answer 4

it is a continuation of the squamous epithelium from the oral cavity

Question 5

what are 3 functional causes of obstruction in the esophagus?

Answer 5

nutcracker esophagus, diffuse esophageal spasm, and systemic sclerosis- CREST syndrome

Question 6

what does it mean to have a function cause of obstruction in the esophagus?

Answer 6

there is a disruption in coordinated peristalsis

Question 7

what is an example of a complication due to increased intraesophageal pressure?

Answer 7

Zenker diverticulum

Question 8

what is Zenker diverticulum associated with?

Answer 8

the upper pharyngo constrictor muscle

Question 9

what are four non-cancer causes of strictures/stenosis in the esophagus?

Answer 9

esophageal web, esophageal ring, achalasia, and inflammation and scarring (esophagitis)

Question 10

what is an esophageal web?

Answer 10

a partial shelf like occlusion

Question 11

what is an esophageal ring?

Answer 11

circumferential abnormality

Question 12

what is achalasia characterized by?

Answer 12

the triad of incomplete LES relaxation, increased LES tone, and peristalsis of the esophagus

Question 13

what is the etiology of primary achalasia?

Answer 13

ganglion cell degeneration (rare)

Question 14

what are the etiologies of secondary achalasia?

Answer 14

Chagas, achalasia-like disease, infiltrative disorders, lesions of DMN

Question 15

which is more common, UGIB or LGIB?

Answer 15

UGIB is 4 times more common than LGIB

Question 16

how is an UGIB defined?

Answer 16

pharynx to ligament of Treitz

Question 17

what are the signs/symptoms associated with an UGIB?

Answer 17

hematemesis and melena (tarry stools)

Question 18

what are the signs/symptoms associated with a LGIB?

Answer 18

hematochezia (bright red blood)

Question 19

What are three examples of esophageal causes of hematemesis?

Answer 19

mallory-weiss syndrome, boerhaave’s syndrome, and esophageal varices

Question 20

what is Mallory-weiss syndrome?

Answer 20

a tear on the gastric side of the gastroesophageal junction; it is superficial as it only affects the mucosa and submucosa; it is associated with binge drinking; resolves on its own

Question 21

what is Boerhaave’s syndrome?

Answer 21

a catastrophic event; complete rupture at the lower thoracic esophagus; bleeding associated with arterial blood supply

Question 22

what are some signs/symptoms associated with boerhaave’s syndrome?

Answer 22

Hamman’s sign, chest pain, shock, subcutaneous emphysema

Question 23

what is hamman’s sign?

Answer 23

crunching sound upon auscultation of the heart due to pneumomediastinum

Question 24

how can esophageal varices be treated?

Answer 24

medically by inducing splanchnic vasoconstriction or endoscopically by sclerotherapy (injection of thrombotic agents), balloon tamponade, or variceal ligation

Question 25

who is at risk for developing esophageal varices?

Answer 25

cirrhotics

Question 26

what is the outcome of variceal hemorrhage?

Answer 26

variceal hemorrhage is a medical emergency; 30% die initially, 50% recur within a year

Question 27

what is the most common cause of varices?

Answer 27

hepatic schistosomiasis

Question 28

what type of obstruction does esophagitis cause?

Answer 28

structural/mechanical

Question 29

what are the symptoms associated with esophagitis?

Answer 29

symptoms range from self-limited pain, particularly on swallowing, to hemorrhage, stricture, or perforation in severe cases

Question 30

what are 5 potential causes of esophagitis?

Answer 30

radiation, chemical, infectious, eosinophilic, and reflux esophagitis

Question 31

what is associated with esophagitis?

Answer 31

most patients have food or seasonal allergies--> asthma, allergic rhinitis, atopic dermatitis

Question 32

what are the morphological changes that occur in esophagitis?

Answer 32

there is trachialization of the esophagus- it has these multiple ridges or furrows that are circumferentially extending the length of the esophagus

Question 33

what would a biopsy look like in a patient with esophagitis?

Answer 33

squamous epithelium infiltrated by numerous eosinophils

Question 34

what is atopy?

Answer 34

it refers to the genetic tendency to develop allergic diseases such as allergic rhinitis, asthma, and atopic dermatitis

Question 35

what is the most frequent cause of esophagitis?

Answer 35

reflux of gastric contents into the lower esophagus

Question 36

what are some causes of LES relaxation associated with GERD?

Answer 36

vagal mediated pathways, increased intra-abdominal pressure, alcohol and tobacco, obesity, hiatal hernia, gastroparesis

Question 37

when is GERD most common?

Answer 37

in individuals older than age 40, but it does occur in infants and children occasionally

Question 38

what are some complications associated with GERD>

Answer 38

ulceration, hematemesis, melena, stricture development, and metaplasia

Question 39

why is tissue biopsy of barrett mucosa important?

Answer 39

metaplasia can be associated with malignancy--> adenocarcinoma

Question 40

benign neoplasms of the esophagus usually arise from what layer?

Answer 40

the submucosal layer

Question 41

what are the most common type of benign neoplasms of the esophagus?

Answer 41

most are mesenchymal, with smooth muscle tumors being the most common

Question 42

what geographical area has the highest risk for squamous cell carcinoma of the esophagus?

Answer 42

iran, central china, hong kong

Question 43

which population has the highest group from squamous cell carcinoma of the esophagus?

Answer 43

>45 years, Males 4:1; african americans 8x more common

Question 44

what are some risk factors associated with squamous cell carcinoma of the esophagus?

Answer 44

alcohol and tobaccos use, poverty, caustic esophageal injury, achalasia, tylosis, radiation, plummer-vinson syndrome, frequent consumption of very hot beverages, mursik (Kenya)

Question 45

where do most squamous cell carcinoma of the esophagus occur?

Answer 45

50% occur in the middle third of the esophagus

Question 46

what are the histologic features of a squamous cell carcinoma of the esophagus?

Answer 46

formation of keratin pearls and intercellular bridges

Question 47

what are three additional risks for esophageal SCC?

Answer 47

tylosis, HPV (maybe), and HIV

Question 48

what is tylosis and what is it caused by?

Answer 48

hyperkeratosis of palms and soles; caused by a RHBDF2 mutation)

Question 49

occasionally, what are the first symptoms of esophageal squamous cell carcinoma caused by?

Answer 49

aspiration of food via a tracheoesophageal fistula

Question 50

could a T-E fistula be acquired later in life?

Answer 50

yes- in the setting of esophageal squamous cell carcinoma

Question 51

which geographic area is at risk for adenocarcinoma of the esophagus?

Answer 51

US, UK, Canada, and Australia

Question 52

what is the highest risk groups for adenocarcinoma of the esophagus?

Answer 52

caucasians, 7x more common in men

Question 53

what are the risk factors for adenocarcinoma of the esophagus?

Answer 53

barrett esophagus, tobacco, radiation, and H. pylori

Question 54

what is the most likely location in the esophagus for adenocarcinoma of the esophagus?

Answer 54

the distal esophagus

Question 55

how might an adenocarcinoma of the esophagus present?

Answer 55

with pain or difficulty in swallowing, progressive weight loss, hematemesis, chest pain, or vomiting