esophageal pathology Flashcards

Terms Definitions
how is barrett esophagus diagnosed?
endoscopy/biopsy
does multilayered epithelium (Me) have squamous or columnar differentiation?
both
functional disorder of the lower esophageal sphincter that prevents its relaxation. Associated with T. cruzi infections.
Achalasia
are esophageal varices symptomatic in their early phase?
not usually
what is the major sign associated w/angiodysplasia
hematochezia
what can cause esophagitis?
alcohol, acid/alkali, medications, hot fluids, heavy smoking, radiation, chemo, and infections
what is the most life threatening esophageal pathology associated with alcoholics?
esophageal varices
common to alcoholics; this presents as lacerations in the esophagus from violent retching
Mallory-Weiss Syndrome
what are morphologic changes associated with reflux esophagitis?
hyperemia, infiltration by eosinophils and neutrophils and basal zone hyperplasia w/elongation of the lamina propria papillae
what needs to be established above the gastroesophageal junction to dx barrett esophagus?
metaplastic epithelium
which lymph nodes are often infiltrated by upper esophageal SCC lesions?
the cervical lymph nodes
what are symptoms of achalasia?
dysphagia, vomiting, some chest pain
elevated gastrin levels and peptic ulcer disease suggest what?
Zollinger-Ellison Syndrome (gastrin secreting tumor)
how does barrett esophagus present?
barrett esophagus presents as patches of red velvety mucosa that alternate with smooth pale squamous mucosa and light brown columnar gastric mucosa
what do metaplastic columnar cells contain?
goblet cells, non-goblet mucinous columnar cells, enterocytes, paneth cells and multilayered epithelium (Me)
what are esophageal varices composed of?
porto-systemic shunts w/congestion of collateral blood vessels - some of which are present in the esophageal submucosa.
what is primary achalasia?
primary achalasia is the failure of the distal esophageal inhibitor neurons, possibly due to degenerative changes in neural innervation
what are schatzki rings?
esophageal rings that are similar to webs, but circumferential and thicker
what type of tumor cell is associated w/linitis plastica gastric carcinoma?
Signet Ring Cells
how do esophageal varices appear?
as tortuous dilated veins in the submucosa of the distal esophagus and proximal stomach
what are the most common esophageal tumors?
squamous cell carcinoma and adenocarcinoma
describe the gastrin concentration in the stomach during peptic ulcer disease
gastrin level = normal; suggests weakened barriers = etiology, not more acid in the stomach lumen
what disease is associated with Burr cells?
Abetalipoproteinemia, a deficiency in betalipoprotein causing a deficiency in cholesterol
what specific kind of infection can lead to achalasia?
chagas disease, or infection by trypanosoma cruzi can lead to destruction of the myenteric plexus, which then leads to failure of peristalsis and esophageal dilatation
what is the relationship between barrett esophagus/GERD and esophageal adenocarcinomas?
there is a close association, barrett esophagus can progress to an esophageal adenocarcinoma via a series of genetic changes
what is a common esophageal laceration?
the mallory-weiss tear, which is a *longitudinal (vertical)* tear at the gastroesophageal junction - often due to retching associated w/alcohol intoxication (an alcoholic w/cirrhosis can die of bleeding out this way). this may cross into the GE junction, and can be lethal - though healing is usually the outcome
the metaplasic change in Barrett Esophagus (from what to what)? Color change?
from squamous to columnar, from white to red
are there genetic risk factors for esophageal SCC?
yes, loss of tumor suppressor genes such as p53 and p16/INK4a can play a role
what is a zenker diverticulum? what is usually the cause?
a diverticulum above the upper esophageal sphincter that may grow large and trap food. zenker's diverticuli are usually due to points of weakness in the wall
what is the difference between acute and chronic gastritis
Acute = no BM involvement, whereas Chroinc flattens rugae and can progress to metaplasia / neoplasia
what is a possible marker for esophageal cancer in terms of a pt's diet?
a slow change from solid to semisolid to liquid
what is a tracker diverticulum? what is usually the cause?
a diverticulum near the midpoint of the esophagus. tracker diverticuli are usually due to inflammation and traction
what is the major risk with barrett esophagus?
the metaplasic component can give rise to a dysplastic component and then to well differentiated and finally poorly differentiated adenocarcinoma
what is reflux esophagitis? what are contributing factors?
reflux of acid injuring the mucosa of stratified squamous epithelium (which is sensitive to acid) - giving rise to GERD. contributing factors include decreased LES tone, smoking, alcohol, obesity, pregnancy, and increased gastric volume (things that increase the intraluminal stomach pressure). reflux esophagitis is kind of the opposite of achalasia
is dysplasia detectable under endoscopy?
not generally
Diverticulum associated with upper esophagus, just above cricopharygeus muscle.
Zenker Diverticulum
what characterizes esophagitis?
infiltration of neutrophils, wall necrosis, ulceration, granulation tissue, and possible fibrosis
can esophageal varices be detected?
yes, via venogram
what is key but difficult to preventing death due to esophageal SCC?
early detection
how is dysplasia defined?
increased levels of epithelial proliferation, either low/high grade
what is *plummer-vinson syndrome*?
plummer-vinson syndrome includes upper esophageal webs, iron deficiency anemia, glossitis, and cheilosis
protrusion of the stomach through the diaphragmatic hiatus. Either sliding-type or paraesophageal-type. Asymptomatic or common signs of other esophageal disorders
Hiatal Hernias
what is a sensitive and specific marker for GERD?
Me (multilayered epithelium)
what is dysphasia? odynophasia?
dysphasia is difficulty swallowing, odynophasia is painful swallowing
what are complications of esophageal SCC?
malnutrition, hemorrhage/sepsis, or aspiration via a tracheoesophageal fistula
what is achalasia?
achalasia is increased tone of the lower esophageal sphincter (LES), which leads to decreased relaxation of the LES and aperistalsis of the esophagus
what is boerhaave syndrome?
a distal esophageal rupture, usually the lower 1/3 in the L posterolateral region, accounting for 15% of esophageal ruptures
Esophageal webs associated with Iron Deficiency Anemia. Common to Scandinavian patients.
Plummer - Vinson Syndrome
what demographic are esophageal adenocarcinomas usually seen in?
white males in developed countries (*incidence is increasing)
how differentiated are most cases of esophageal SCC?
moderately to well differentiated
what are common complications of GERD?
ulceration, barrett esophagus and stricture development
what is boerhaave syndrome associated with? what causes it?
boerhaave syndrome is associated with mediastinitis (due to esophageal contents leaking out) and a high mortality rate. usually boerhaave syndrome occurs from a sudden increase in intraluminal pressure - often from violent vomiting following heavy food or alcohol intake
what local structures are often the first points of spread if esophageal SCC metastasizes? what potentiates this spread?
the respiratory tree, aorta, mediastinum and pericardium. b/c of insidious onset, most cases present w/advanced lesions which have invaded the esophageal wall. the esophagus itself has a rich lymphatic network which promotes the spread both longitudinally and circumferentially w/satellite lesions
what about esophageal varices makes them so life-threatening? how?
the potential for hemorrhage. vomiting can lead to erosion of the mucosa and with pressure from increasingly dilated veins, bleeding can be massive.
what is the difference between early-stage and late-stage gastric carcinoma?
Early = no penetration beyond submucosa; Late = penetration + you're fucked (<20% 5 yr survival)
what are the S/S of pyloric stenosis
Projectile vomiting, palpable mass over abdomen - found in children (congenital defect of hypertrophy)
what are the most common symptoms of GERD?
dysphagia and heartburn, sometimes severe chest pain (mimics an MI)
what is a epiphrenic diverticulum? what is usually the cause?
a diverticulum above the lower esophageal sphincter. epiphrenic diveriticuli are usually due to complications including pneumonia, perforation, mediastinitis and carcinoma
what is eosinophilic esophagitis? are there other common co-presentations?
a marked increase in intraepithelial eosinophils in larger numbers than would be seen in reflux esophagitis. other common co-presentations are atopic dermatitis, allergic rhinitis, asthma, or peripheral eosinophilia (overall allergic asthmatic kinds of people). pts w/this may have significant dietary restrictions
Which inflammatory bowel dz presents with granulomas?
Crohn Dz (NOT ulcerative colitis, the other dz)
what is *barrett esophagus*? who does it most commonly affect?
a complication of GERD, where intestinal metaplasia occurs in the esophageal squamous epithelium (becomes adenomatous and columnar w/goblet cells). barrett esophagus most commonly affects white males between 40-60 and is associated with an approx 30x greater risk of developing adenocarcinoma. incidence is rising.
what are the genetic risk factors for an esophageal adenocarcinoma?
mutations of p53, amplification of c-ERB-B2, cyclin D1, cyclin E, mutation of retinoblastoma tumor suppressor gene, allelic loss of cyclin dependent kinase inhibitor p16/INK4a, and since TNF and NF kappa B dependent geners are overexpressed - inflammation likely plays a role
where are esophageal webs most common? how do they appear? what are they composed of? what can they cause?
esophageal webs are most common in the upper esophagus and are semicircular lesions protruding
what can a diffuse esophageal spasm lead to?
a diffuse esophageal spasm can lead to functional obstruction and pseudodiverticula
what is the *most common cause* of infectious esophagitis?
candidiasis, due to its adherent soft white pseudomembranes
what is the difference in ability to detect esophageal SCC vs an esophageal adenocarcinoma?
there are not usually many good markers for impending esophageal SCC but with esophageal adenocarcinomas, if a pt has barrett esophagus - then the dr should know to keep and eye out for adeno CAs in that area
what are the 2 types of schatzki rings?
A rings: in distal esophagus, above the GE junction and covered by squamous mucosa and B rings: may have gastric cardia-type mucosa on their undersurface
where in the esophagus is SCC more common?
SCC is seen more commonly in the *upper/middle esophagus
what will be elevated in the serum if a duodenal ulcer perforated?
Amylase, b/c head of pancreas found near duodenum
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