SFP: esophagus topics Flashcards
What is a hiatal hernia?
A portion of the stomach goes above the diaphragm.
What is a rolling hernia?
Part of the stomach pokes through the side of the diaphragm.
What is a paraoesophageal hiatal hernia?
A portion of the stomach enters the thorax next to the esophagus; it is rare.
What is a sliding hiatal hernia?
The super common type of hiatal hernia. There is a L-shaped protrusion of the stomach above the diaphragm.
What is an issue with sliding hiatal hernia?
There is a potential for stomach acid to reach the lower esophagus, causing epithelial change.
What is achalasia?
Incomplete relaxation of LES causes esophageal dysfunction.
What are the types of achalasia?
Primary that often occurs in childhood, or secondary that results from other issues.
What is mallor-weiss syndrome?
Superficial laceration of the stomach or lower esophagus.
What is the major symptom of mallor-weiss syndrome?
Coffee ground emesis.
What is Boerhaave’s syndrome?
A complete laceration of the esophageal wall. It is a medical emergency.
What are clinical manifestations of Boerhaave’s syndrome?
Sudden chest pain, pleural effusion, empyema.
In what population are esophageal varices common?
Those with cirrhotic livers due to portal HTN.
What is an outcome of esophageal varices?
Massive hemorrhage of bright red blood. 40% die the first time, 50% the second.
What is esophagitis?
Injury to esophageal mucosa which causes inflammation.
What is reflux esophagitis?
Injury and inflammation due to reflux of gastric contents.
What are histologic features of reflux esophagitis?
High fibrovascular papilla, expanded parabasal cells due to rapid repair effort, vascular lakes.
In a biopsy of reflux esophagitis, what are the infiltrating cell types seen?
Neutrophils and eosinophils.
What are vascular lakes?
Dilated papillae in the epithelium of an esophagus impacted by GERD/reflux esophagitis.
What are possible outcomes of reflux esophagitis?
Ulceration, carcinoma risk.
What is eosinophilic esophagitis?
Can be associated with allergies; characterized by eosinophilic infiltrate.
What is Barrett’s esophagus?
A complication of long-standing reflux esophagitis that involves replacement of squamous epithelium in the esophagus with abnormal metaplastic columnar epithelium with goblet cells aka intestinal epithelium.
Describe histology of Barrett’s esophagus.
Abnormal glandular epithelium with goblet cells present; limited squamous epithelium left.
If Barrett’s esophagus continues to dysplasia, which part of the esophageal tissue becomes dysplastic?
The glandular tissue; adenocarcinoma development risk.
Describe high grade dysplasia after Barrett’s esophagus.
The mucosa has pseudostratification and mitotic figures, resembling intestinal mucosa. There is a risk for invasive adenocarcinoma.
What is the dominant malignancy in the esophagus?
Adenocarcinoma.
What is a predisposing condition to adenocarcinoma?
Barrett’s esophagus.
Describe squamous dysplasia.
Often associated with alcohol consumption; can progress to SCC.
