Esophagus Diseases PDF

DISEASES OF ESOPHAGUS ESOPHAGUS Pathology Many diseases of esophagus produce similar symptoms: 1. Dysphagia – difficulty in swallowing deranged motor function narrowing/obstruction of lumen 2. Heartburn – retrosternal chest pain regurgitation of gastric contents...

DISEASES OF ESOPHAGUS ESOPHAGUS Pathology Many diseases of esophagus produce similar symptoms: 1. Dysphagia – difficulty in swallowing deranged motor function narrowing/obstruction of lumen 2. Heartburn – retrosternal chest pain regurgitation of gastric contents 3. Pain 4. Haematemasis ESOPHAGUS Congenital anomalies Atresia/Fistula Incompatible with life – early feeding problems Esophageal atresia usually associated with TOF Stenosis, Webs, Rings Stenosis – result of inflammatory scarring by reflux, radiation, caustic injury Dysphagia the major problem, women affected Mucosal webs and rings protrude into lumen Associated anemia Plummer-Vinson syndrome Esophageal atresia and tracheaesophageal fistula ESOPHAGUS Major Lesions with motor dysfunction Achalasia Hiatal hernia Diverticulum Mallory-Weiss tear Achalasia (“Failure to relax”) Mostly as primary disorder of uncertain etio. Progressive dilatation of esophagus Secondary cause – Chagas disease (T. cruzi) Progressive dysphagia classical symptom Risk of developing esophageal carcinoma Esophagus – motor dysfunctions ESOPHAGUS Motor dysfunctions Hiatal hernia Sac-like protrusion of stomach above diaphragm Cause unknown Complications include ulceration, bleeding Regurgitation and heartburn Diverticulum Outpouching of all layers of esophagus Mallory-Weiss tear Result of severe retching: alcoholics Upper GI bleeding - hematemesis ESOPHAGUS Reflux esophagitis (Gastroesophageal reflux disease) Reflux of gastric contents into lower esophagus Many causative factors involved Acid-pepsin action cause mucosal injury Clinically – dysphagia, heartburn Mucosa reddened with increased inflammatory cells, basal zone hyperplasia Complication – bleeding, ulceration, stricture, Barrett esophagus and its risks.  Reflux Oesophagitis superficial portion of the mucosa. Numerous eosinophils within the squamous epithelium, elongation of the lamina propria papillae, and basal zone hyperplasia are present Reflux esophagitis of superficial mucosa ESOPHAGUS Barrett Esophagus Complication of long-standing gastro- esophageal reflux in 10% of GERD Endoscopy – red, velvety mucosa Distal squamous mucosa replaced by metaplastic columnar epithelium containing gastric or intestinal/goblet cell types Important to search for dysplasia and grade it Clinically – bleeding, stricture Most important risk factor for esophageal adenocarcinoma 40x Barrett esophagus Barrett esophagus – red, granular zone Barrett esophagus – squamous mucosa and intestinal goblet cells in glandular mucosa ESOPHAGUS Esophagitis: Infections/Chemicals Mucosal irritants – alcohol,corrosive acids and alkalis Cytotoxic anticancer therapy Herpes simplex, CMV Fungals – Candida Uraemia Radiation injury Graft vs Host disease ESOPHAGUS Varices Portal hypertension induce formation of collateral channels at lower esophagus Varices – dilated esophageal submucosal plexus 90% of cirrhotics No symptom until rupture – upper GI bleeding hematemesis Fatal 40% Esophageal varices of submucosal veins ESOPHAGUS Squamous cell carcinoma Differences in incidence and epidemiology worldwide Dietary and environmental factors modified by genetic factors Alcohol, tobacco (Europe and USA) Fungal contamination and nitrosamine containing foodstuffs (China) Distribution: middle third 50% lower third 30% upper third 20% ESOPHAGUS Squamous cell carcinoma Grossly: polypoid, diffuse infiltrating, ulcerated Histology: moderate to well differentiated Spread: Local extension to adjacent mediastinal structures occurs early – rich lymphatics Upper third: cervical nodes Middle third: mediastinal, tracheal nodes Lower third: gastric, coeliac nodes Clinical: Insidious dysphagia, weight loss haemorrhage, sepsis from ulceration, fistula Treatment: surgery  ESOPHAGUS Squamous cell carcinoma of esophagus  ESOPHAGUS SCC of esophagus with invasion into submucosa ESOPHAGUS Adenocarcinoma Complication of Barrett esophagus Multistep process with development of dysplasia Lower third esophagus and GE junction About 50% of all esophageal cancers in US Nodular masses with ulceration Adenocarcinoma mucin secreting, intestinal type Males>females, whites>blacks (c.f. squamous) Clinical features similar to SCC Adenocarcinoma of gastro-eso. junction arising from Barrett mucosa Figure 17-12 Anatomy and histology of the stomach. A, Gross anatomy. B, Microscopic view of antral mucosa. C, Microscopic view of fundic mucosa. Downloaded from: Robbins & Cotran Pathologic Basis of Disease (on 27 March 2006 09:23 AM) © 2005 Elsevier