Pathology of Esophagus

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pg 767-774

nutcracker esophagus

Outer longitudinal layer of smooth m. contracts before the inner circular layer that can cause periodic short-lived esophageal obstruction

diffuse esophageal spasm

motor disorder of the esophagus (uncoordinated contraction) that causes diverticulae (small mucosal outpouchings) to form

Zenker diverticulum

palpable mass located above the upper esophageal sphincter, may cause regurgitation due to accumulation of food

esophageal stenosis is caused by thickening of the ___ or atrophy of the ___

fibrous thickening of the SUBMUCOSA,
atrophy of the MUSCULARIS PROPRIA

*stenosis is most often due to ?

inflammation and scarring caused by reflux

esophageal mucosal webs

protrusions of the mucosa that lead to obstruction, women >40

Webs are associated with ? (3)

reflux, graft vs host disease and blistering skin disease

upper esophageal webs associated with

iron deficiency anemia

Where are webs most often found?

most commonly in the upper esophagus

Main symptom of webs?

dysphagia

Achalasia

increased tone of the LES due to impaired smooth m. relaxation

*Triad of achalasia

incomplete LES relaxation, increased LES tone and aperistalsis of the esophagus

primary achalasia

failure of inhibitory neurons

achalasia degenerative changes

neural innervation either w/in vagus n. itself or the dorsal motor nucleus

2ndary achalasia

Trypanosoma cruzi infection destroying the myenteric plexus

Mallory-Weiss

linear and longitudinal tears near gastroesophageal junction associated with vomiting due to alcohol intox

Boerhaave syndrome

distal esophageal rupture

Esophagitis due to chemical injury cause ___ and ___ of the esophageal wall

dysphagia, necrosis

what will you see in CBC with infectious esophagitis?

neutrophil infiltrates in the lamina propria and necrosis of overlying mucosa

Pill-induced esophagitis

impedes passage of luminal contents causing ulceration, superficial necrosis , granulation tissue with fibrosis

esophageal irradiation

intimal prolif and luminal narrowing of submucosa

pathogenic infectious esophagitis***

pseudomembranes*** composed of densely matted fungal hypahe and inflammatory cells covering the esophageal mucosa

viral esophagitis

punched-out ulcer in endoscopy with rim of degenerating epithelium

CMV

shallow ulceration with nuclear and cytoplasmic inclusions within capillary endothelium and stromal cells

graft vs host

apoptosis, mucosal atrophy, submucosal fibrosis with out inflammatory infiltrates

___ glands in the proximal and distal esophagus secrete ___ and bicarbonate

submucosal glands secrete mucin and bicarbonate

conditions that decrease LES tone or increase abdominal pressure (8)

alcohol and tobacco use, CNS depressants, obesity, pregnancy, hiatal hernia*, delayed gastric emptying or increased gastric vol

Endoscopy findings in GERD

hyperemia, eosinophils* (and neutrophils) in significant disease,basal zone hyperplasia

common symptoms of GERD

dysphagia, heartburn, regurg of acid

GERD is common in adults over age of?

40

Complications of GERD

ulceration, hematemesis, melena, stricture, Barret

eosinophilic esophagitis

food impaction, dysphagia, feeding intolerance, abundance of eosinophils, do not respond to therapy with proton pump inhibitor, absence of reflux

eosinophilic esophagitis associated with

dermatitis, asthma, food allergies

Barret esophagus

intestinal metaplasia: esophageal squamous mucosa --> nonciliated columnar w/goblet

Barret esophagus common in what ethnicity? gender? age?

white males 40-60

Barret esophagus confers an increased risk of *

adenocarcinoma

Morphology of Barret

patches of red mucosa extending upward from the gastro esopha junc

Esophageal varices

dilated submucosal veins in the lower esophagus

common in patients with portal hypertension due to?

cirrhosis associated with alcoholic liver disease

varices are asymptomatic unless they rupture which causes?

hematemesis

possible factors that lead to rupture?

erosion of mucosa, increased tension of dilated veins, increased vascular hydrostatic pressure due to vomiting

Adenocarcinoma is secondary to?

Barret esophagus (dysplasia of lower 1/3rd of esophagus) causing proliferation of glands

Adenocarcinoma occurs more frequently in?

West, caucasians, men

Adenocarcinoma may show overexpression of?

p53

common symptoms of Adenocarcinoma

progressive dysphagia, weight loss, pain, hematemesis

Squamous cell carcinoma of esophagus affects adults over age ___ and more common in which gender and ethnicity in America?

45, males, african americans

risk factors for Squamous cell carcinoma

alcohol and tobacco, achalasia (food is stuck and rots causing irritation), consumption of very hot beverages, esophageal webs, injury

Squamous cell carcinoma regions oh highest incidence?

iran, china (hong kong), brazil, south africa

Squamous cell carcinoma occurs in what area of the esophagus?

upper 1/3 or middle 1/3

early lesions of Squamous cell carcinoma appear as?

small, gray-white, plaque-like thickening that may cause luminal narrowing

site of lymph node metasases in upper 1/3rd

cervical nodes

site of lymph node metasases in middle 1/3rd

mediastinal, tracheobronchial and paratracheal

site of lymph node metasases in lower 1/3rd

gastric and celiac nodes

first symptom of Squamous cell carcinoma?

aspiration of food due to tracheoesophageal fistula

Traction diverticulum occurs due to___, and is located _____

1) mediastinal or pulmonary tuberculosis
2) near the midpoint of the esophagus

epiphrenic diverticulum occurs due to ____, and is located____

1) dysfunction of LES
2) immediately above LES

Squamous cell carcinoma of the esophagus commonly occurs in the ___ 1/3 of the esophagus causing ___

middle, strictures

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