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30 Cards in this Set
- Front
- Back
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ESOPHAGEAL WEBS/RINGS
What/where? |
RINGS:
A ledge-like circumferential protrusion of mucosa into the esophageal lumen. More commonly in the lower esophagus. WEBS: Ledge-like semi-circumferential protrusion of mucosa into the esophageal lumen. More commonly seen in the upper esophagus. |
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What are SCHATZI RINGS?
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This is another name for lower esophageal rings.
(These are located just above the GE junction and the undersurface is usually covered by columnar epithelium.) |
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PLUMMER-VINSON SYNDROME
What are the classic findings associated with this syndrome? What is significant about this diagnosis? |
CLASSIC FINDINGS:
Upper esophageal web causing dysphagia. Iron Deficiency Anemia Glossitis Oral Mucosal Abnormalities Autoimmune Disease (UC, Sjogren's, Thyroiditis, etc.) SIGNIFICANCE: *This syndrome is associated with an increased risk of SQUAMOUS CARCINOMA in the POSTCRICOID AREA!!!* |
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ZENKER'S DIVERTICULUM
Prevalence? What/where? Symptoms? |
PREVALENCE:
This is the most common type of diverticulum. (70% of diverticula are Zenker's) STRUCTURE: -Congenital "True" Diverticulum -Located immediately above the UES. -Can reach many cm. in size, resulting in a palpable neck mass. SYMPTOMS: -Accumulation of food. -Hallitosis -Regurgitation of food without associated dysphagia. |
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HIATAL HERNIA
Definition? Types? |
DEFINITION:
Seperation of the diaphragmatic crura with widening of the space between the crura and esophageal wall. TYPES: 1. Sliding (95%) 2. Paraesophageal (5%)- a separate portion of the stomach (usually superior greater curvature) enters the thorax via the widened space. Doesnt slide back and forth. Higher risk of strangulation and necrosis. |
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MALLORY-WEISS SYNDROME
Definition? Etiology? Findings? Significance? |
DEFINITION:
Painless GI bleeding due to longitudinal tears in the esophagus at the GE junction that occur as a result of severe wretching and vomiting. ETIOLOGY: Most commonly seen in alcoholics due to episodes of excessive vomiting while in a stupor. FINDINGS: Linear irregular lacerations oriented along the long axis of the esophageal lumen. Tears may penetrate just the mucosa or be full thickness perforations. SIGNIFICANCE: Esophageal lacerations are the cause of 5-10% of all upper GI bleeds. Usually the bleeding is not prefuse and no surgery is required. |
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ESOPHAGEAL VARICES
Pathogenesis? Clinical course? Significance? |
PATHOGENESIS:
Portal hypertension induces collateral vascular channels to develop in the lower esophagous. Varices are produced by increased pressure within the esophageal venous plexus. CLINICAL COURSE: Asymptomatic until rupture causes massive hemorrhage. SIGNIFICANCE: 40% die during first episode. Among survivors, 50% have a second episode within 1 year. Each episode carries a 40% chance of death. *50% of all deaths in cirrhosis patients are the result of rupture of esophageal varices. |
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GERD
Gross features? Histological features? |
GROSS FEATURES:
Wide spectrum of findings ranging from mild erythema to mucosal erosions/ulcers, diffusely red/hemorrhagic mucosa, strictures & Barrett's Esophagus. HISTOLOGIC FEATURES: Changes are nonspecific and variable. Intraepithelial squiggle cells (T-cells) Intraepithelial PMN's Acanthosis (overall thickening of the squamous mucosa) |
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GERD
Complications? Clinical Features/Findings? |
COMPLICATIONS:
1. Erosions (submucosa spared) 2. Ulcers 3. Strictures (seen in 10%) 4. BARRETT'S ESOPHAGUS AND ITS ENSUING COMPLICATIONS (Dysplasia, ADENOCARCINOMA, squamous papillomas, peptic ulcers, fistulas) CLINICAL FEATURES: Mostly in adults over 40 years old or in infants/children. Symptoms: Dysphagia, heartburn, regurgitation. |
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What is the most common cause of:
Infectious Esophagitis? Viral Esophagitis? |
INFECTIOUS:
Candidia Esophagitis VIRAL: 1. HERPES Esophagitis 2. CMV Esophagitis |
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ESOPHAGEAL WEBS/RINGS
What/where? |
RINGS:
A ledge-like circumferential protrusion of mucosa into the esophageal lumen. More commonly in the lower esophagus. WEBS: Ledge-like semi-circumferential protrusion of mucosa into the esophageal lumen. More commonly seen in the upper esophagus. |
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What are SCHATZI RINGS?
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This is another name for lower esophageal rings.
(These are located just above the GE junction and the undersurface is usually covered by columnar epithelium.) |
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PLUMMER-VINSON SYNDROME
What are the classic findings associated with this syndrome? What is significant about this diagnosis? |
CLASSIC FINDINGS:
Upper esophageal web causing dysphagia. Iron Deficiency Anemia Glossitis Oral Mucosal Abnormalities Autoimmune Disease (UC, Sjogren's, Thyroiditis, etc.) SIGNIFICANCE: *This syndrome is associated with an increased risk of SQUAMOUS CARCINOMA in the POSTCRICOID AREA!!!* |
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ZENKER'S DIVERTICULUM
Prevalence? What/where? Symptoms? |
PREVALENCE:
This is the most common type of diverticulum. (70% of diverticula are Zenker's) STRUCTURE: -Congenital "True" Diverticulum -Located immediately above the UES. -Can reach many cm. in size, resulting in a palpable neck mass. SYMPTOMS: -Accumulation of food. -Hallitosis -Regurgitation of food without associated dysphagia. |
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HIATAL HERNIA
Definition? Types? |
DEFINITION:
Seperation of the diaphragmatic crura with widening of the space between the crura and esophageal wall. TYPES: 1. Sliding (95%) 2. Paraesophageal (5%)- a separate portion of the stomach (usually superior greater curvature) enters the thorax via the widened space. Doesnt slide back and forth. Higher risk of strangulation and necrosis. |
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MALLORY-WEISS SYNDROME
Definition? Etiology? Findings? Significance? |
DEFINITION:
Painless GI bleeding due to longitudinal tears in the esophagus at the GE junction that occur as a result of severe wretching and vomiting. ETIOLOGY: Most commonly seen in alcoholics due to episodes of excessive vomiting while in a stupor. FINDINGS: Linear irregular lacerations oriented along the long axis of the esophageal lumen. Tears may penetrate just the mucosa or be full thickness perforations. SIGNIFICANCE: Esophageal lacerations are the cause of 5-10% of all upper GI bleeds. Usually the bleeding is not prefuse and no surgery is required. |
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ESOPHAGEAL VARICES
Pathogenesis? Clinical course? Significance? |
PATHOGENESIS:
Portal hypertension induces collateral vascular channels to develop in the lower esophagous. Varices are produced by increased pressure within the esophageal venous plexus. CLINICAL COURSE: Asymptomatic until rupture causes massive hemorrhage. SIGNIFICANCE: 40% die during first episode. Among survivors, 50% have a second episode within 1 year. Each episode carries a 40% chance of death. *50% of all deaths in cirrhosis patients are the result of rupture of esophageal varices. |
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GERD
Gross features? Histological features? |
GROSS FEATURES:
Wide spectrum of findings ranging from mild erythema to mucosal erosions/ulcers, diffusely red/hemorrhagic mucosa, strictures & Barrett's Esophagus. HISTOLOGIC FEATURES: Changes are nonspecific and variable. Intraepithelial squiggle cells (T-cells) Intraepithelial PMN's Acanthosis (overall thickening of the squamous mucosa) |
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GERD
Complications? Clinical Features/Findings? |
COMPLICATIONS:
1. Erosions (submucosa spared) 2. Ulcers 3. Strictures (seen in 10%) 4. BARRETT'S ESOPHAGUS AND ITS ENSUING COMPLICATIONS (Dysplasia, ADENOCARCINOMA, squamous papillomas, peptic ulcers, fistulas) CLINICAL FEATURES: Mostly in adults over 40 years old or in infants/children. Symptoms: Dysphagia, heartburn, regurgitation. |
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What is the most common cause of:
Infectious Esophagitis? Viral Esophagitis? |
INFECTIOUS:
Candidia Esophagitis VIRAL: CMV Esophagitis |
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EOSINOPHILIC (ALLERGIC) ESOPHAGITIS
Gross Features? Histologic Features? |
GROSS FEATURES:
White plaques Linear fissures Trachealization of the esophagus HISTOLOGIC FEATURES: 15 or more eosinophils in 2 or more HPF's OR 30 or more eosinophils in 1 or more HPF's. *Eosinophilic microabscesses |
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BARRETT'S ESOPHAGUS
Definition? |
An acquired condition in which the simple squamous epithelium of the esophagus is replaced by Barrett's intestinal type columnar metaplastic epithelium, defined by the presence of goblet cells.
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BARRETT'S ESOPHAGUS
Gross Features? Histologic Features? |
GROSS FEATURES:
-Red, velvety mucosa extending between the smooth, pale esophageal squamous mucosa. -Tongues, patches, or isolated lakes extending up from the GEJ or a broad circumferential band moving from the GEJ upward. MICRO FEATURES: Presence of barrett's intestinal type columnar epithelium and goblet cells in areas that should be simple squamous. |
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BARRETT'S ESOPHAGUS
Significance of- Dysplasia? Adenocarcinoma? |
DYSPLASIA:
By definition, dysplasia occurs in the setting of Barrett's esophagus. This is the precursor to esophageal adenocarcinoma. ADENOCARCINOMA: In patient's with greater than 3 cm. of Barrett's metaplastic mucosa, the risk of developing esophageal adenocarcinoma is approximately 30-40 times greater than in the general population. |
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SQUAMOUS CELL CARCINOMA of the ESOPHAGUS
Gross Features? Micro Features? |
GROSS FEATURES:
-Grayish/white plaque-like elevations of mucosa MICRO FEATURES: -Most tumors are moderately to well differentiated. -Form nests of cells -Keratin -Intercellular bridges -Pink cytoplasm -Distict cytoplasmic borders (hard cytoplasm) |
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ESOPHAGEAL ADENOCARCINOMA
Gross Features? Micro Features? |
GROSS FEATURES:
Tumors may be polypoid/exophytic, ulcerative or infiltrative. MICRO FEATURES: Most are moderately well differentiated with mucous and gland formation and resemble intestinal adenocarcinoma. PROGNOSIS IS HORRIBLE. (15% 5 year survival.) |
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What percentage of people with Barrett's Esophagus will develop esophageal adenocarcinoma at some point?
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40%
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Are tumors of the esophagus most likely benign or malignant?
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Much more likely to be MALIGNANT!
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What is the most common type of BENIGN esophageal tumor?
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Leiomyomas (smooth muscle tumors)
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What are the major risk factors for developing:
ESOPHAGEAL SCCA? ESOPHAGEAL ADENOCARCINOMA? |
SQUAMOUS CELL CARCINOMA:
Tobacco & Alcohol Diet (increased incidence in Iran & Central Asia) M:F 4:1 Black:White 4:1 ADENOCARCINOMA: Chronic GERD (Hiatal hernias & strictures) Barrett's Esophagus High grade dysplasia |
