Pathology of Esophagus
32 Questions
1 Views

Choose a study mode

Play Quiz
Study Flashcards
Spaced Repetition
Chat to Lesson

Podcast

Play an AI-generated podcast conversation about this lesson

Questions and Answers

What distinguishes true diverticula from false diverticula in the esophagus?

  • False diverticula involve all layers of the esophageal wall.
  • False diverticula are more common in the lower esophagus.
  • True diverticula include all layers of the esophageal wall. (correct)
  • True diverticula contain only mucosal layers.
  • Which condition is most commonly associated with esophageal varices?

  • Gastric ulcers
  • Heart failure
  • Esophagitis
  • Portal hypertension (correct)
  • In which part of the esophagus do mucosal webs primarily occur?

  • Upper esophagus (correct)
  • Mid-esophagus
  • Distal esophagus
  • Lower third
  • What is a common clinical manifestation of reflux esophagitis?

    <p>Heartburn (B)</p> Signup and view all the answers

    Which therapy is indicated for Barrett's esophagus due to its association with complications?

    <p>Routine surveillance (B)</p> Signup and view all the answers

    Which changes are seen microscopically in esophagitis due to reflux?

    <p>Thinning of the superficial layer (D)</p> Signup and view all the answers

    What percentage of esophageal varices cases leads to massive hematemesis?

    <p>20-30% (B)</p> Signup and view all the answers

    Which condition has a 5% risk of developing into esophageal carcinoma?

    <p>Esophageal webs and rings (D)</p> Signup and view all the answers

    What characterizes congenital esophageal stenosis?

    <p>Incomplete separation of the respiratory tract from the primitive foregut (B)</p> Signup and view all the answers

    Which type of esophageal atresia involves two fistulae connecting both parts of the esophagus to the trachea?

    <p>Type D (C)</p> Signup and view all the answers

    What is a common presenting symptom of esophageal duplication cysts?

    <p>Dysphagia (C)</p> Signup and view all the answers

    Which type of esophageal atresia is the most common?

    <p>Type C (C)</p> Signup and view all the answers

    What defines a laryngotracheoesophageal cleft?

    <p>An abnormal communication between the larynx and pharynx (D)</p> Signup and view all the answers

    Which statement is false regarding congenital esophageal anomalies?

    <p>Esophageal duplication cysts are common in the anterior mediastinum. (A)</p> Signup and view all the answers

    What condition is esophageal atresia most commonly associated with?

    <p>Congenital heart disease (C)</p> Signup and view all the answers

    What complication can arise from esophageal atresia due to its structure?

    <p>Infection from aspiration (B)</p> Signup and view all the answers

    What is a significant characteristic of esophageal achalasia?

    <p>Difficulty in swallowing due to sphincter dysfunction (D)</p> Signup and view all the answers

    What is the typical age range for the peak incidence of achalasia?

    <p>30 to 60 years (D)</p> Signup and view all the answers

    Which type of hiatal hernia is the most common?

    <p>Sliding hernia (B)</p> Signup and view all the answers

    What might indicate the presence of a paraesophageal hernia?

    <p>Heartburn and acid reflux (B)</p> Signup and view all the answers

    What is a common cause of a traction diverticulum?

    <p>Mediastinal inflammation or infection (D)</p> Signup and view all the answers

    Esophageal varices are mostly associated with which condition?

    <p>Liver cirrhosis and portal hypertension (A)</p> Signup and view all the answers

    What is an underlying event that can lead to esophageal achalasia in South America?

    <p>Chagas disease (D)</p> Signup and view all the answers

    Which histopathological finding is associated with advanced achalasia?

    <p>Complete absence of myenteric ganglion cells (A)</p> Signup and view all the answers

    What type of epithelium is found in Barrett's esophagus?

    <p>A mixture of gastric and intestinal epithelium (B)</p> Signup and view all the answers

    Which factor is NOT associated with the pathogenesis of squamous cell carcinoma of the esophagus?

    <p>Obesity (C)</p> Signup and view all the answers

    Which type of esophageal cancer is characterized as the most common?

    <p>Squamous cell carcinoma (A)</p> Signup and view all the answers

    What clinical manifestation is most commonly associated with esophageal squamous carcinoma?

    <p>Dysphagia (A)</p> Signup and view all the answers

    Which of the following best describes the survival rate for the superficial type of squamous cell carcinoma of the esophagus?

    <p>75% over 5 years (C)</p> Signup and view all the answers

    Which of the following types best describes the gross appearance of esophageal adenocarcinoma?

    <p>Ulcerative and infiltrative (A)</p> Signup and view all the answers

    What demographic is most affected by squamous cell carcinoma of the esophagus?

    <p>Adults over 50 years (B)</p> Signup and view all the answers

    Which of the following conditions is considered a predisposing factor for the development of esophageal adenocarcinoma?

    <p>Plummer-Vinson syndrome (C)</p> Signup and view all the answers

    Flashcards

    True Diverticula

    Outpouchings of the esophageal wall that include all layers, including the mucosa, submucosa, muscularis propria, and serosa.

    False Diverticula

    Outpouchings of the esophageal wall that only include the mucosa and submucosa.

    Esophageal Varices

    Dilated sub-mucosal veins in the lower third of the esophagus, often caused by portal hypertension and liver cirrhosis.

    Esophageal Webs

    Acquired smooth ledges of mucosa usually occurring in the upper esophagus, causing dysphagia to solid foods.

    Signup and view all the flashcards

    Esophageal Rings

    Concentric tissue rings protruding into the distal esophageal lumen, causing dysphagia to solid foods.

    Signup and view all the flashcards

    Esophagitis

    Inflammation of the esophagus, most commonly caused by reflux of gastric contents.

    Signup and view all the flashcards

    Barrett's Esophagus

    Metaplasia of the distal esophageal squamous epithelium to columnar epithelium, caused by chronic esophageal reflux.

    Signup and view all the flashcards

    What is Barrett's esophagus and what causes it?

    A condition where the lining of the esophagus changes from squamous epithelium to columnar epithelium due to prolonged irritation, often caused by chronic esophageal reflux.

    Signup and view all the flashcards

    What is esophageal achalasia?

    A condition where the lower esophageal sphincter (LES) fails to relax properly, preventing food and liquids from moving into the stomach.

    Signup and view all the flashcards

    What is a hiatal hernia?

    A condition where a portion of the stomach protrudes through the diaphragm into the chest cavity.

    Signup and view all the flashcards

    What is a sliding hiatal hernia?

    The most common type of hiatal hernia, where the stomach slides up and down through the weakened diaphragm.

    Signup and view all the flashcards

    What is a paraesophageal hiatal hernia?

    A less common type of hiatal hernia, where a part of the stomach gets trapped in the chest cavity.

    Signup and view all the flashcards

    What is an esophageal diverticulum?

    A rare condition where a pouch forms in the esophageal wall.

    Signup and view all the flashcards

    What is a pulsion esophageal diverticulum?

    A type of diverticulum caused by increased pressure inside the esophagus, pushing the wall outward.

    Signup and view all the flashcards

    What is a traction esophageal diverticulum?

    This type of diverticulum develops when an outside force, like inflammation, pulls on the esophageal wall.

    Signup and view all the flashcards

    What is Chagas disease?

    The most common cause of esophageal achalasia in South America.

    Signup and view all the flashcards

    Esophageal Adenocarcinoma

    A type of cancer that arises from the lining of the esophagus.

    Signup and view all the flashcards

    Fibrovascular Polyp

    A type of benign tumor that occurs in the esophagus. They are usually asymptomatic and can be found during routine endoscopy.

    Signup and view all the flashcards

    Leiomyoma

    A type of tumor arising from muscle tissue that can be found in the esophagus. They are usually asymptomatic and rarely become cancerous.

    Signup and view all the flashcards

    Squamous Cell Carcinoma of Esophagus

    The most common type of esophageal cancer, occurring in adults over 50 years old, with a higher prevalence in males. It often develops from chronic esophagitis, heavy smoking, alcohol abuse, and Plummer-Vinson syndrome.

    Signup and view all the flashcards

    Adenocarcinoma of Esophagus

    A type of esophageal cancer that accounts for about 25% of cancer cases. It is often associated with Barrett's Esophagus and epithelial dysplasia.

    Signup and view all the flashcards

    Esophageal Endoscopy

    A procedure where a flexible tube with a camera is inserted into the esophagus to visualize the lining. It helps detect abnormalities like Barrett's Esophagus, ulcers, and tumors.

    Signup and view all the flashcards

    Epithelial Dysplasia

    Abnormal changes in the cells lining the esophagus, often associated with an increased risk of cancer. It's a precancerous condition that can progress to adenocarcinoma.

    Signup and view all the flashcards

    Esophageal Atresia

    A birth defect where the esophagus is completely divided into two segments, the upper and lower parts, with no connection between them. This hinders the passage of food from the mouth to the stomach and may also cause breathing difficulties.

    Signup and view all the flashcards

    Congenital Esophageal Stenosis (CES)

    Congenital malformation arising from a failure of the respiratory tract to fully separate from the primitive foregut. It leads to narrowing of the esophagus, affecting swallowing.

    Signup and view all the flashcards

    Laryngo-tracheo-esophageal Cleft (LC)

    An abnormal communication between the larynx and pharynx, often extending between the trachea and esophagus. It can be a serious birth defect affecting breathing and swallowing.

    Signup and view all the flashcards

    Esophageal Duplication Cyst

    A rare malformation where a second, non-functional esophagus develops. It typically occurs in the right postero-inferior mediastinum, the space behind the heart, and can cause respiratory distress.

    Signup and view all the flashcards

    Esophageal Atresia Type C

    A type of esophageal atresia where the upper segment of the esophagus ends blindly, not connected to the trachea, while the lower segment is attached to the trachea, forming a fistula. This is the most common type of esophageal atresia.

    Signup and view all the flashcards

    Esophageal Atresia Type D

    Variety of esophageal atresia where both ends of the esophagus are attached to the trachea, forming two fistulae. This is the rarest and most severe type of esophageal atresia.

    Signup and view all the flashcards

    Esophageal Atresia Type B

    Characterized by a connection between the upper esophagus and trachea, with the lower esophagus ending blindly. This type is less common.

    Signup and view all the flashcards

    Esophageal Atresia Type A

    A type of esophageal atresia where both ends of the esophagus end blindly, with no connection to the trachea. This is the simplest form of esophageal atresia but less common.

    Signup and view all the flashcards

    Study Notes

    Pathology of Esophagus

    • Esophageal anomalies are pediatric disorders, including congenital esophageal stenosis (CES), esophageal atresia (with or without tracheoesophageal fistula), laryngotracheoesophageal cleft, and esophageal duplication cyst.

    • CES results from incomplete separation of the respiratory tract from the primitive foregut.

    • Historically, CES was sometimes confused with esophageal strictures caused by gastroesophageal reflux.

    • Initial symptoms of esophageal anomalies often involve swallowing problems.

    • Esophageal atresia is a malformation where the esophagus is divided into two sections that do not connect.

    • This can lead to difficulty in passing food from the mouth to the stomach, and sometimes breathing difficulties, potentially being incompatible with life.

    • There are five types of esophageal atresia:

      • Type A: The upper and lower parts of the esophagus do not connect and each end is closed. No portion of the esophagus connects to the trachea.
      • Type B: The upper part of the esophagus connects to the trachea (fistula). The lower part of the esophagus is closed.
      • Type C: The upper esophagus is closed. The lower portion connects to the trachea (fistula).
      • Type D: Each portion of the divided esophagus separately connects to the trachea (two fistulas).
      • Type E: A variation of Type C, where the upper portion connects to the trachea.
    • A laryngotracheoesophageal cleft (LC) is a congenital malformation characterized by an abnormal communication between the larynx and pharynx, sometimes extending to the trachea and esophagus.

    • Esophageal duplication cysts are rare, typically located in the right postero-inferior mediastinum. This is the second most common cause of posterior mediastinal masses in children (after nerve tissue tumors).

    • Clinical symptoms usually involve respiratory distress and stridor from airway compression, as well as dysphagia.

    Acquired Non-inflammatory Disorders of the Esophagus

    • Esophageal achalasia is a rare disorder where the esophagus cannot move food and liquids into the stomach due to impaired relaxation of the lower esophageal sphincter.
    • Etiology is not fully understood in most cases, but thought to be due to myenteric plexus and vagus nerve degeneration. Chagas disease (in South America) can damage the myenteric plexus leading to achalasia.
    • Achalasia usually presents with dysphagia (difficulty swallowing) in both males and females, with the peak incidence between 30 and 60 years of age. Cases in children under 16 are less common (less than 2-5%).
    • Histological (tissue) analyses of advanced achalasia cases show reduced or absent myenteric ganglion cells in some patients.

    Hiatal Hernia

    • A hiatal hernia is an upward protrusion of a part of the stomach through the diaphragm into the chest cavity.
    • It occurs in approximately 1-20% of adults.
    • Two main types:
      • Sliding hiatal hernia (95% of cases): The stomach slides up through the widened hiatus and then back down.
      • Paraesophageal hiatal hernia: The stomach doesn't slide up and down, but sits next to the esophagus.
    • Symptoms frequently relate to acid reflux; heartburn is common. Complications like ulcers, bleeding, and perforation are possible.

    Esophageal Diverticula

    • Esophageal diverticula are rare, acquired disorders characterized by a partial out-pouching of the esophageal wall.
    • Two main types:
      • Pulsion diverticula are caused by increased intraluminal pressure that pushes the esophageal wall into a weakened area. This typically happens due to esophageal dysmotility (problems with movement). Often occur in areas where relaxation of the upper or lower esophageal sphincters is inadequate. These can be upper esophageal Zenker diverticula, or lower esophageal (Epiphrenic) diverticula.
      • Traction diverticula are caused by an external force (like inflammation, such as TB) pulling on the esophageal wall. This typically leads to an esophageal mid-portion (Rokitansky) out-pouching. True diverticula include all layers of the esophagus, while false diverticula include only the mucosa or submucosa.
    • Esophageal diverticula can cause episodic regurgitation, especially at night, and may be accompanied by pain and dysphagia (difficulty swallowing).

    Esophageal Varices

    • Esophageal varices are dilated submucosal veins in the lower third of the esophagus.
    • Portal hypertension and liver cirrhosis are the main causes.
    • A significant portion (50%) of cases experience massive hematemesis (vomiting blood).
    • Mortality is relatively high, with 20-30% of cases dying during the initial episode.

    Esophageal Webs and Rings

    • Mucosal webs are acquired smooth ledges of mucosa, frequently occurring in the upper esophagus.
    • Rings are concentric tissue rings that protrude into the distal esophageal lumen.
    • Both webs and rings can cause episodic dysphagia (difficulty swallowing), particularly of solid foods. This can also be associated with nocturnal regurgitation (food coming back up).
    • A small risk (5%) of esophageal carcinoma exists in these cases.

    Esophagitis

    • Esophagitis is inflammation of the esophagus.
    • Predisposing conditions include reflux of gastric contents (most common in western countries), corrosive substances, excessive hot fluids/foods, smoking, bacterial/viral/fungal infections, and certain medications (such as antibiotics or pain relievers).

    Barrett's Esophagus

    • Barrett's esophagus involves the metaplasia (change) of the distal esophageal squamous epithelium to columnar epithelium.
    • This change typically occurs due to prolonged esophageal irritation from chronic reflux.
    • Barrett's esophagus is commonly seen in adults.
    • Dysplasia (abnormal cell growth) may develop.
    • A significant increased risk of esophageal adenocarcinoma exists (30-40 times higher).

    Esophageal Tumors

    • Benign esophageal tumors include squamous cell papilloma, fibrovascular polyp, leiomyoma, fibroma, lipoma, hemangioma, neurofibroma, and lymphangioma.
    • Malignant esophageal tumors include squamous cell carcinoma (common), adenocarcinoma, and rare stromal sarcomas.

    Squamous Cell Carcinoma of the Esophagus

    • Squamous cell carcinoma is the most common type of esophageal cancer.
    • Primarily affecting adults over 50 years old, males are more commonly affected than females.
    • This cancer is multifactorial, but risk factors include chronic esophagitis, heavy smoking, alcohol abuse, Plummer-Vinson syndrome (associated with esophageal webs, anemia, and glossitis), and achalasia.
    • Gross appearance can vary but may include polypoid, ulcerative, or infiltrative patterns.
    • Microscopy typically shows well-differentiated squamous cell carcinoma in the majority (90%) of cases.
    • Clinical symptoms include progressive dysphagia, weight loss, anorexia, pain related to swallowing, and or hemorrhage.
    • 5-year survival rates for the superficial type of this cancer are near 75%.

    Adenocarcinoma of the Esophagus

    • Adenocarcinoma accounts for about 25% of esophageal cancers.
    • The most prevalent risk factor is Barrett's esophagus and epithelial dysplasia.
    • Typically found in the distal third of the esophagus. A variety of gross appearance types are present: polypoid, ulcerative, or infiltrative.
    • Microscopically, malignant columnar cells with intestinal features (or a signet ring pattern) are common.
    • Clinical symptoms of this cancer are similar to those of squamous cell carcinoma (progressive dysphagia, weight loss, anorexia, pain related to swallowing, and hemorrhage).
    • 5-year survival rates are typically less than 20%.

    Studying That Suits You

    Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

    Quiz Team

    Related Documents

    Pathology of Esophagus PDF

    Description

    Explore the various pediatric disorders related to esophageal anomalies, including congenital esophageal stenosis and esophageal atresia. Learn about their symptoms, classifications, and historical confusions with gastroesophageal reflux. This quiz provides critical insights into the anatomy and pathology of the esophagus.

    More Like This

    Tracheoesophageal Fistula & Esophageal Atresia
    27 questions
    Esophageal Atresia Overview
    5 questions
    Congenital Anomalies and Hernias
    48 questions
    Esophageal Anomalies and Atresia Quiz
    32 questions
    Use Quizgecko on...
    Browser
    Browser