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Pathology of 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
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?
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
failure of inhibitory neurons
achalasia degenerative changes
neural innervation either w/in vagus n. itself or the dorsal motor nucleus
Trypanosoma cruzi infection destroying the myenteric plexus
linear and longitudinal tears near gastroesophageal junction associated with vomiting due to alcohol intox
distal esophageal rupture
Esophagitis due to chemical injury cause ___ and ___ of the esophageal wall
what will you see in CBC with infectious esophagitis?
neutrophil infiltrates in the lamina propria and necrosis of overlying mucosa
impedes passage of luminal contents causing ulceration, superficial necrosis , granulation tissue with fibrosis
intimal prolif and luminal narrowing of submucosa
pathogenic infectious esophagitis***
pseudomembranes*** composed of densely matted fungal hypahe and inflammatory cells covering the esophageal mucosa
punched-out ulcer in endoscopy with rim of degenerating epithelium
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?
Complications of GERD
ulceration, hematemesis, melena, stricture, Barret
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
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 *
Morphology of Barret
patches of red mucosa extending upward from the gastro esopha junc
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?
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?
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
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 ___