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38 Cards in this Set
- Front
- Back
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4 layers of esophagus |
mucosa, submucosa, muscularis propria, adventitia |
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esophageal epithelium |
nonkeratinized stratified squamous |
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inlet patch |
normal gastric mucosa in upper 1/3; present w/ pain & bleeding |
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diaphragmatic hernia |
abd. viscera herniates through diaphragm into chest; cause hypoplasia of lungs |
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most common type of atresia/fistula |
atresia of esophagus w fistula in distal trachea |
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atresia/fistula associations |
congenital heart defect, GU malformations, neurologic disease |
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causes of secondary stenosis |
radiation, GERD, inflammatory conditions |
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esophageal hernias |
sliding (MC) & paraesophageal (risk of strangulation) |
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diverticuli: proximal to distal |
Zenker -> traction -> epiphrenic |
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Zenker diverticuli |
dysphagia, regurg., mass in neck; secondary to excess cricopharyngeus muscle tension |
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epiphrenic diverticuli |
nocturnal regurg of large amts of fluid |
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Nutcracker esophagus |
outer layer of muscle contracts before inner layer => obstruction |
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presentation of mechanical obstruction |
progressive dysphagia (adjusting diet over time) |
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webs |
idiopathic squamous mucosal protrusions; upper esophagus; eccentric; women >40 |
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rings |
concentric mucosa/submucosa proliferations w/ hypertrophied muscle; distal esophagus (A above GEJ, B at GEJ) |
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Plummer-Vinson syndrome |
upper web + iron-deficiency anemia + glossitis + cheilosis; incr. risk SCC; postmenopausal women |
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Achalasia |
incomplete LES relaxation, incr. LES tone -> aperistalsis of esophagus |
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causes of achalasia |
primary = failing distal esophageal inhibitory neurons; secondary = Chagas, peripheral neuropathies |
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Mallory-Weiss tears |
longitudinal tears at GEJ; secondary to acute ETOH intoxication; a/w severe vomiting; no intervention |
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esophageal varices |
dilated submucosal veins due to portal HTN; 50% of pts w/ cirrhosis |
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distal esophagus pathology |
esophagitis, Barrett's esophagus, adenocarcinoma |
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esophagitis |
post-chemo, irritants, uremia, pills (tetracycline, iron) |
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infectious esophagitis |
oral bacteria/fungus, viral (herpes simplex, CMV), GVHD |
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herpes simplex esophagitis |
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Candidal esophagitis |
white plaques in esophagus; mix of infl. cells & acellular material + pseudohyphae; immunosuppressed patients |
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reflux esophagitis |
decr. efficacy of LES (idiopathic, alcohol/tobacco, obesity, depressants, pregnancy); sx = heartburn, dysphagia, regurg (rare) |
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complications of reflux esophagitis |
bleeding, stricture, stenosis, Barrett's metaplasia |
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reflux esophagitis histology |
eosinophilic infl., basal cell hyperplasia, elongation of papillae |
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eosinophilic esophagitis |
no improvement w/ reflux rx; a/w asthma, atopic dermatitis, allergic rhinitis; see diffuse basal cell hyperplasia & eosinophilia throughout the esophagus; rx = topical steroids |
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Barrett's esophagus |
reflux symptoms; 10% of reflux patients; 3-5% develop adenoCa; salmon pink to red velvety patch; hallmark = intestinal goblet cell |
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BE - dysplasia |
neoplastic change w/in glandular epithelium; seen in 5-20% |
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low grade dysplasia - BE |
loss of goblet cells, pseudostratifications, hyperchromaticity, extend to surface of glands |
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high grade dysplasia - BE |
complex architecture, prominent nucleoli, glands fuse together |
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presentation of esophageal carcinoma |
dysphagia, weight loss, hematemesis, vomiting, chest pain |
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Esophageal adenoCA |
>95% a/w BE; other RF = smoking, radiation, obesity; 25% 5ys due to submucosal lymphatic spread |
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early mutations of adenoCa |
TP53, CDKN2A (p16/INK4a) |
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progressive mutations of adenoCa |
EGFR, ERBB2 (Her2Neu association), MET, cyclin D1/E |
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squamous cell carcinoma |
M>F; wide variation geographically; 20% upper 1/3, 50% middle, 30% lower; 5ys 5-10% |
