Path Blcok 3 (Esophagus)
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What are the 4 hystological layers in the GI track?
- Mucosa--- Squamus, Non keratinized
- Submucosa-- BV, Nerves, Lymph, glands
What are the congenital Anomalies in the Esophagus?
- Ectopic Tissue
- Diaphragmatic herniation
- Atresia and fistulas
- Congenital fore gut cysts
What is the most common Esophageal atresia?
Blind Upper segment, fistula between blind lower segment and trachea.
What is Oropharyngeal Disphagia?
What is Esophageal Dyspha
- - difficulty in transfering food to the esophagus. Trouble INITIATING swollow.
- - Difficulty in transporting down esophagus.
Atypical Chest Pain
- Heart burn
- Pain associated wit h swollowing
- Atypical chest pain
What is this? Who does it occur in the most?
This is a SCHATZKI RING
Seen in Women over 40 years old
95% of Hiatal Hernias are ?
- Hiatal Hernia (slidding
- Paraesophageal Hernia
- zenker diverticulum (propulsion)
- Epiphrenic diverticulum
- Mallory-weis-- due to alcohol
What is Achalasia?
IS it common in the US?
What is it associated with?
What are you at increase risk for?
- •Failure of lower esophageal sphincter to relax
- •Degeneration of neural plexus
- •Aperistaltic contractions of the esophagus
- Rare in the US
- Associated with Chagas Disease
- YOung adults
- At increased risk for SCC (5%)
What is Mallory Weiss Laceration?
What causes it?
Does it bleed?
What kind of lascerations?
- •Severe retching or violent vomiting
- •Usually alcoholics
- •5-10% of UGI bleeds, but usually not profuse
- •Heals promptly
- •Longitudinal Lacerations
- This is Mallory Weiss syndrome
- see longitudinal lasceration
Schistosomiasis world wide
- •Asymptomatic, until rupture causes massive hematemesis
- •40-50% fatality rate per episode
What is esophagitis?
What causes it?
what is it associated with?
- It is infection of the Esophagus
- - caused by Lye strictures
- -associated with: Altered immune sustem. Candidiasis, herpes, CMV
- - Bacterial infection is RARE
- - reflex esophagitis = GERD
What is this and what caused it?
Punched out lesion on the esophagus due to Herpes = Herpes Esophagius
What do you see?
See Cowdry Type A incranuclear inclusions = Herpes Esophagitis
What is GERD?
WHat age and sex affected?
–> 40 years old, M>F
- –Regurgitation of gastric contents into pharynx
- –Dysphagia (suggests complication of stricture)
- •Esophageal ulceration
- •Barrett Mucosa (Esophagus)
- •Stricture with stenosis (narrowing)
- •Long-term risk adenocarcinoma
IF you see alot of Epsinophils in the esophagus, what might be going on?
Reflux Esophagitis (GERD)
What is Barrets esophagus?
What age and sex effected?
What is it a complication of?
What is it a risk factor for?
Replacement of Squamus cells of the esophagus with Glandular mucosa with GOBET CELLS
- seen in 40-60 White males
- Complication of GERD
- It is a riskfactor for ADCA---30-40X increase if greater than 3cm
What is Plummer Vinson Syndrome?
- esophageal webs
- glossitis--- Thick tongue
- iron deficiency anemia
What are the Malignant tumors of the Esophagus?
- –Squamous Cell Carcinoma
- –Rare tumors (Leiomyosarcoma, GIST)
Sex and age?
- Old White Males
- GERD and Barrets
- Tobacco, Obesity
SCC of the Esophagus
Sex and age?
% in world, in US
BLACK 50 year old Male
- - World 90% of malignant Esophageal cancers
- - US: 50%
- Seen in the MID esophagus 50% of the time
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