TERMS Flashcards
a segments of the esophagus is only a thin,
non-canalized cord, with blind pouches on either side
Atresia
a connection of one or both of the pouches with trachea or a main stem bronchus
Fistula
non-neoplastic constriction (upper esophagus: webs;
gastroesophageal junction: Schatzki’srings)
Clinical presentation: •progressive dysphagia, especially to solidfoods
Stenosis
impaired relaxation of lower esophageal sphincter with consequent esophageal dilatation; localized area of stenosis with dilation proximally
Clinical presentation: •dysphagia, regurgitation and weightloss
Clinical significance: • 2-7% risk of carcinoma • Candida esophagitis • Diverticulum • Aspiration pneumonia
Achalasia
a saclike dilatation of the stomach with protrusion above the diaphragm, separation of the
diaphragmatic crura and widening of esophageal foramen
Clinical presentation
• Retrosternal chest pain related to regurgitation of gastric juices
Clinical significance
• Ulceration and bleeding
• Strangulation and perforation
Hiatal hernia
out-pouchings of 1 or more layers of esophagealwall
Clinical presentation:
• “lump in the throat” - gurgling, halitosis, regurgitation
Clinical significance:
• Site of food accumulation
• Regurgitation
• Aspiration pneumonia
Diverticulum
(Mallory-Weiss Syndrome) - irregular, longitudinal mucosal tears which rarely penetrate the esophageal wall in the region of gastroesophageal junction
Clinical presentation:
• usually nonfatal bleeding - healing tends to be prompt (scar formation)
Clinical significance: • Potentially massive hematemesis • Inflammation • Residual ulcer • Mediastinitis • Peritonitis
Laceration
tortuous, dilated veins lying primarily within the submucosa of the distal esophagus and proximal stomach causing an irregular protrusion of overlying mucosa into lumen
Clinical presentation:
•clinically silent until rupture resulting in catastrophichematemesis
Clinical significance:
▪catastrophic hematemesis - urgent surgical treatment required
• 40% fatality for each episode of bleeding
• 90% chance of recurrence within a year in survivors
Varices
Most common cause: reflux of gastric contents (reflux esophagitis)*
Esophagitis
injury to esophageal mucosa due to reflux of gastric contents; usually occurs in adults
Clinical presentation: • Dysphagia & heartburn • Regurgitation of a sour brash • Hematemesis • Melena (blood stool)
Clinical significance:
• Superficial necrosis and ulceration
• Stricture formation
• Barrett esophagus
Reflux esophagitis
replacement of a distal esophageal squamous epithelium by a metaplastic columnar epithelium (more resistant to acidic juices); response to prolonged injury
Clinical significance: ▪ulceration and stricture formation
• 30x increased risk for the development of adenocarcinoma*
Barrett esophagus
this is a malignant carcinoma that is 50% of esophageal cancers
Clinical presentation: ▪ Insidious onset, late developing symptoms: • Dysphagia • Esophageal obstruction • Weight loss
Clinical significance:
▪ Metastasize to nearby LNs, lung and liver (usually by time of diagnosis)
• Locally invade adjacent mediastinal structures
Squamous cell carcinoma
assoc with barretts esophagus, 50% of esophageal cancers
Clinical presentation: • Dysphagia • Esophageal obstruction • Weight loss • Gastroesophageal reflux (<50%)
Clinical significance:
• overall 5-year survival <30%
Adenocarcinoma
weakness or defect in diaphragm which does not involve the hiatal orifice; more common on
left than right
Clinical significance:
• Usually develops in utero
• Respiratory impairment
• Pulmonary hypoplasia
Diaphragmatic hernia
narrowing of the pyloric lumen secondary to muscular hypertrophy; most common malformation of
stomach*
Clinical presentation:
• projectile vomiting by 3rd week oflife
• Peristalsis visible
• Palpable firm, ovoid mass just above the belly button★★
Clinical significance:malnourishment
Pyloric stenosis
an acute inflammatory mucosal process; usually transient
Clinical presentation: 3 forms
• Asymptomatic
• Minor abdominal pain
• Acute abdominal pain with hematemesis
Clinical significance:
• overt hemorrhage, massive hematemesis, melena
Acute gastritis
chronic mucosal inflammatory changes eventually leading to mucosal atrophy and
epithelial metaplasia; constitutes background for dysplasia and carcinoma
Clinical presentation:
• Usually few symptoms - N/V, upper abdominal discomfort
• Pernicious anemia (in autoimmune gastritis) - no absorption ofB12
• Lab findings: gastric hypochlorhydria, serumhypergastrinemia
Clinical significance:
• Dysplasia in some long-standing cases
• Long term risk for cancer is 2-4%
Chronic gastritis
chronic, most often solitary, mucosal defect arising from exposure to acid-peptic juices; involves any portion of the alimentary tract (duodenum and stomach 98%)
Clinical presentation:
• Epigastric gnawing, burning or aching pain
• N/V, bloating, belching and weightloss
Clinical significance:
• Hemorrhage, anemia, perforation or obstruction
• Malignant transformation israre
Peptic ulcer
focal, acutely developing gastric mucosal defect which appears during severe stress (“stress ulcer”)
Clinical presentation: upper GI hemorrhage
Clinical significance: the single most important determinant of outcome is ability to correct
underlying disease condition
Acute gastric ulceration
giant cerebriform enlargement of gastric rugalfolds*
Clinical presentation:
• Hypoalbuminemia
• Protein-losing gastroenteropathy
Clinical significance:
• Mimic diffuse gastric cancer orlymphoma
• Increased risk for peptic ulceration and adenocarcinoma
three forms:
menetriers disease, hypertrophic-hypersecretory gastropathy, zollinger-ellison syndrome
Hypertrophic gastropathy
a mass lesion arising from the mucosa projecting above the level of the surrounding mucosa
Clinical significance: often arise in the setting of chronic gastritis
• No malignant potential
Hyperplastic / inflammatory polyps (90%)
a mass lesion arising from the mucosa WITH malignant potential
Clinical significance:
• Incidence increases with age
• Up to 40% harbor carcinoma at the time of diagnosis
• Often arise in the setting of chronic gastritis or genetic polyposis syndromes
Gastric adenoma (10%)
this is a malignant neoplasm
90-95% of all gastric malignancies
2.5% of all cancer deaths in the US
Clinical presentation: ▪ Initially asymptomatic developing: • Abdominal pain • N/V and weight loss • Anemia
Clinical significance:
• Prognosis dismal and depends only on depth of invasion
Gastric carcinoma
