GI: Pathology: Upper Aerodigestive Tract

The esophagus extends from where to where?

Extends from the cricoid cartilage to esophagogastric junction

What type of epithelium is the esophagus?

Normal- non-keratinizing squamous epithelium

Esophageal obstruction can be divided into two main categories:

- Mechanical

- Functional

What esophageal pathology is discovered shortly after birth due to regurgitation while feeding (atresia and fistulas)?

Esophageal obstruction

What are the 2 mechanical esophageal obstructions?

Atresia

Stenosis

What is the functional esophageal obstruction

Achalasia

What is associated with fistula-connects esophageal pouch to bronchus or trachea?

Atresia

Where is an atresia usually located?

near tracheal bifurcation

Atresia results in...

aspiration, suffocation, pneumonia

A Thin, non-canalized cord replaces part of esophagus is known as...

Atresia

Narrowing of esophagus is known as

Stenosis

What is the most common esophageal stenosis?

Acquired

- can be congenital as well, tho

Fibrous thickening of submucosa and atrophy of muscularis propria describes what esophageal pathology?

Stenosis

What may result from inflammation and scarring caused by chronic GERD or irradiation?

Stenosis

What can result from impaired smooth muscle relaxation of lower esophageal sphincter (LES)?

Functional obstruction

What is Associated with triad of incomplete relaxation of LES, increased LES tone, esophageal aperistalsis

Achalasia

How many forms of Achalasia are there?

2, primary and secondary

What Can arise in Chagas disease- caused by Trypanosoma cruzi infection

Secondary Achalasia

What pathology does this describe:

Failure of LES to relax, esophageal dilatation, destruction of myenteric plexus

Secondary Achalasia

the following describes what:

Venous blood from gastro-intestinal tract goes to liver via portal vein

first pass effect

What pathology is the result of portal hypertension

esophageal varices

What is an Important cause of esophageal bleeding?

Esophageal varices

The following describes what pathology?

Dilated vessels that can protrude into lumen of distal esophagus

Esophageal varices

Esophageal varices are seen in what % of patients with cirrhosis

50%

What pathology is seen in 50% of patients with cirrhosis and can rupture and cause massive bleeding?

Esophageal varices

2 causes of lacerations of the esophagus:

Mallory-Weiss syndrome

Boerhaave syndrome

Mallory-Weiss syndrome is the most common cause of what?

esophageal lacerations

The following describes what pathology?

Esophagus will have linear and superficial tears and crosses gastro-esophageal junction

Esophageal lacerations due to Mallory-Weiss syndrome

Is surgery necessary for Esophageal lacerations due to Mallory-Weiss syndrome?

NO

What is the result of acute alcohol intoxication with severe vomiting

Lacerations of the esophagus in Mallory-Weiss syndrome

- Esophagus will have linear and superficial tears and crosses gastro-esophageal junction

What pathology includes Rupture of distal esophagus?

Esophageal lacerations due to Boerhaave syndrome

What pathology does this describe?

Transmural (all layers) tears can affect mediastinum and result in mediastinitis

Esophageal lacerations due to Boerhaave syndrome

Between Boerhaave syndrome and Mallory-Weiss syndrome, which requires surgery?

Boerhaave syndrome

What are the 3 types of esophagitis?

Infectious

Eosinophilic

Reflux

Infectious esophagitis is more common in which patients?

Immunocompromised patients

What are the Most common infections associated with Infectious esophagitis?

Fungal (Candidiasis)

Cytomegalovirus

Herpes simplex virus

What disease causes presentation of punched out ulcers in the esophagus?

Herpes simplex virus

What disease causes presentation with shallow ulcers and nuclear/cytoplasmic inclusions of the esophagus, histologically

Cytomegalovirus

food impaction and dysphagia is characteristic of eosinophilic esophagitis in what group?

Adult

food intolerance or GERD-like symptoms is characteristic of eosinophilic esophagitis in what group?

Children

The following histophathology describes what disease?

Infiltration of eosinophils in superficial aspect of lamina propria and epithelium

Eosinophilic esophagitis

How do you distinguish between eosinophilic esophagitis, Crohn's disease, and GERD

Histopathologic presentation:

Infiltration of eosinophils in superficial aspect of lamina propria and epithelium is a histopathologic finding in eosinophilic esophagitis

What is the Most frequent cause of esophagitis and most common outpatient gastrointestinal diagnosis?

GERD

Gastric contents enter the lower esophagus

——Lower esophageal sphincter is relaxed or decreased in tone

GERD

What contributes to GERD?

Increased abdominal pressure, Alcohol/tobacco use, Pregnancy, Hiatal hernia

Heartburn

Dysphagia

Regurgitation of sour-tasting gastric contents

Are symptoms of...

GERD

Esophageal ulceration

Hematemesis-vomiting blood

Stricture development

Barrett esophagus

Are complications of...

GERD

Treatment of GERD

Proton pump inhibitors

What pathology has symptoms that are similar to gastro-esophageal reflux disease (GERD)?:

Heartburn

Regurgitation of gastric juices

Hiatal hernia

What is a Complication of chronic gastro-esophageal reflux disease (GERD)(10%)?

Barrett's esophagus

Metaplasia of columnar squamous cells to tall, columnar glandular epithelium (resembles intestinal epithelium)- affects lower third of esophagus describes what pathology?

Barrett's esophagus

What presents an Increased risk for adenocarcinoma but most do not develop (0-2-1% per year)?

Barrett's esophagus

What Can arise from Barrett esophagus and long-standing gastro-esophageal reflux disease (GERD)?

Esophageal adenocarcinoma

What pathology Occurs usually in distal or lower third of esophagus & can invade gastric cardia (stomach)?

Esophageal adenocarcinoma

Risk factors including:

Alcohol and Tobacco use

Achalasia

Frequent consumption of very hot beverages

Plummer-Vinson syndrome

Apply to what pathology?

Esophageal squamous cell carcinoma

What pathology Occurs usually in the middle third of the esophagus?

Esophageal squamous cell carcinoma

What is a Risk factor for esophageal squamous cell carcinoma?

Plummer-Vinson syndrome

In Plummer-Vinson syndrome, where does Esophageal squamous cell carcinoma occur?

(a rare condition characterized by a triad of iron deficiency anemia, difficulty swallowing (dysphagia), and esophageal webs (thin membranes in the esophagus)

upper one-third in posterior cricoid area

What disease Affects middle-aged and elderly women of Scandinavian origin?

Plummer-Vinson syndrome

In which pathology discussed do patients have severe iron deficiency anemia

Plummer-Vinson syndrome