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22 Cards in this Set
- Front
- Back
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barrett's esophagus
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abnL intestinal epi [columnar] replaces the stratifed squamous epi that usually lines distal esophagus
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barrett's esophagus is the most important risk factor for?
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adenocarcinoma
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what is the reason why there's a certain age population where barrett's esophagus is present?
what is the age group? |
- chronicicty due to chronic or prolonged injury
- >50 yo w/ hx of reflux |
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who get's barrett's esophagus?
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- mean = 55 yoa
- most prev in Caucasian and men - **symp not dx'd but chronicity is predictive (10-15 yr hx of GERD) - acquired ds - 1/3 people w/ GERD |
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10-15 year hx of GERD leads to what?
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- have an endoscopy done to ensure no Barrett's present
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nL anatomy:
1. esophagus 2. Z-line |
1. stratified squamous epi
2. indicates the squamo-columnar jnction; this is elevated in Barrett's esophagus -->columnar should start at Z-line |
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function of esophagus
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- food from pharynx --> stomach
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pathology of barrett's
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- complete spectrum from dangerous ca to simply annoying "heart burn
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heart burn
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retrosternal burning d/t regurgitation of gastric contents
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dysphagia
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deranged motor function or obstruction of the esophagus
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pain and hematemesis is particularly found with?
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- inflammation or ulceration of esophageal mucosa
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causes of GERD
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- low tone of LES
- sliding hiatal hernia - delayed gastric emptying & inc gastric vol |
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histology:
1. layers of esophagus |
1. mucosa, submucosa, muscularis propria, adventitia
--> squamous epi; NO SEROSA |
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what is found in the submucosa?
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have involvement of Meissner's plexus ganglia (diff swallowing b/c these nerves control motility)
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what is found in the muscularis propria?
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Auerbach's plexus in inner & circular layer of longitudinal smooth muscle can cause dysphagia d/t altered neural activity
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pathology of Barrett's (histo level)
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- columnar epi but there are different types in the stomach
- cardiac: mucus secreting cells - gastric - chief & parietal cells |
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what are the MC and involved in Barrett's?
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-**specialized intestinal metaplasia (specialized columnar crypts & goblet cells)
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gross on Barrett's
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see transition from columnar to squamous above the Z line
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savory-miller classification for esophagitis
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grade I: few spots
grade II: some erosions of mucosa *garde III: circumferential erosions in distal esophagitis grade IV: *Barrett's (deep ulcers or tenosis) |
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diagnosis
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**must have documented evidence of columnar epi lining esophagus above the gastroesophageal junction
-**biopsy, histo evidence of intestinal metaplasia - then must identify squamocolumnar and GE junction and see the visible Z-line |
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screening (controversial)
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- determined by degree of ds in pt
- if reflux symp controlled w/ PPIs, do surveillance - if low-grade dysplasia: f/up endo in 6 mos - high-grade: f/up endo in 3 mos |
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tx
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*depends on grade/severity
- esophagectomy (high grade) - endoscopy ablation of neoplastic tissue - endoscopic mucosal resection - intensive endo surveillance until biopsy shows adenocarcinoma (3m/6m/1yr) - chemo (min effective) |
