Robbins GI tract

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What kinds of ectopic tissue can you have in the esophagus and where?: Gastrointestinal, also pancratic and sebaceous glands (but are less frequent). Acid secretions of the gastric mucosa can cause localized inflammation in that area.
Bronchial tissue can also arise in the upper gut causing a bronchogenic cyst.
What are the most common esophageal abnormalities? What are they associated with?: The most common esophageal abnormalities are attresias/fistulas. Most common is an esophageal atresia with a distal esophageal/bronchial fistula.
What are esopahgeal webs? What causes them? What else should you look for?: Esophageal webs are flaps of tissue that are obstructing the proximal esophagus. They can be caused congenitally, by GVHD, or GERD.
Look for cheilitis, iron defenciency anemia, glossitis and cheilosis for possible plummer vinson syndrome or paterson-brown-kelly.
What are esophageal rings?: These occur at the distal portion of the esophagus and are sometimes caled schatski rings if they are at the squamocolumnnar junction.
What causes esophageal stenosis? Clinical progression.... solids, liquids or what?: This is when you have fibrous thickening of the muscularis propia with atrophy of the muscularis propia. The lining of the epithelium is usually thin and sometimes ulcerated. This usualy occurs secondary to scleroderma, radiation, GERD, or somesort of caustic injury.

Starts with solids but moves to liquids.
What three components to the you have (in terms of pathophysiology) in achalasia?: Increased tone of the LES, LES can't relax and you also have problems withthe actual peristalisis.
What is the most common cause of achalasia? What infectious, what iatrogenic?: Idiopathic, shoudl also think about chagas which can take out the myenteric plexus. Radiation can also do this.
Achalasia thought to have something to do with problems with nos/vip as far as dilation of the LES.
What kind of morphology would you see on a microscope with achalasia?: Sometimes hypertrophy/sometimes atrophy.
Usually ganglia are absent.
How does achalasia usually present?: Proggressive dysphagia... Sometimes nocturnal regurgitation and aspiration of undigested food may occur.
What are the risks of achalasia?: The biggest thing would be esophageal squamous cell carcinoma, said to occur in aboiut 5% of patiens., typcially at an earlier age than those without this disease.

Candida, lower esophageal diverticula, adn aspiration pneumonia.
What two types of hiatal hernias are there...: You have a sliding hiatal hernia nad a paraesophageal hernia. Paraesophageal hernia gets a nissen for fear of strangulation. Only about 8% of those with hiatal have GERD (obesity, position are afactor). LES is a player in this but this is probably actually just secondary to the reflux in the first place (chicken/egg sort of deal).
What are the three types of diverticulum?: You have zenker's, traction adn epiphrenic.
What causes a zenker's diverticulum?: Diminished luminal size of the UES, GERED.
What causes epiphrenic diverticula?: Failure of LES relation and peristalisis.
What kinds of sx will you get with epiphrenic, zenker's?: Zenker's, dysphagia, food regurge
Epiphrenic, GERD
What is the pathophysiology of mallory-weis syndrome?: reverse peristalisis against a muscle that refuses to relax.
Worldwide what is the most common cause of variceal bleeding? What%of alchoholics get it? What % of the time is it responsible for hematemesis?: hepatic schisto, 90%. It is responsible for hematemesis
What is the prevalence of esophagitis in the population?: 5%
What kind of causes do you have of reflux esophagitis?: Decreased efficacy of esophageal antireflux mechanisms
What are the morphological changes that you see with reflux esophagitis?: uncomplicated- inflammatory cells (eosinophils, neutrophils, and excessive numbers of lymphocytes in the squamous epithelial layer).
Basal zone hyperplasia, elongation of the lamina propia into the top 3rd of the epithelial layer.

Intraepithelial eosinophils are believed to be an early histological abnormality.
What indications pathologically does severity of sx have with the extent of disease with reflux esophagitis?: none
What is the most important risk factor for esophageal adenocarcinoma?: Barett esophagus, although the actual incidence of carcinoma who get adenocarcinoma is relatively low.
What are the criteria for dx of barett's esophagus?: Endoscopic evidence of columnar epithelial lining above the gastroesophageal junction.
Histological evidence of intestinal metabplasia in the biopsy specimens from teh comnar epithelium.
What are the subtypes of of baret's?: extending more than 3 cm from the manometric ge junction or short segment (extending less than 3 cm cephalad).
ultrastructurally what do the cells look like?: adminxed with intestinal mucin secreting goblet cells are columnar cells showing secreatory and absobrptive ultrastructural features.
What does it look like grossly?: Grossly it tends to look more granular.
What should you comment on when you see barrett's?: Commen on the dysplasia (low grade versus high grade)
In low grade the nuclei are all basal.. in high grade you have nuclei consistnetly reaching the apex of the epithelial cells.

50% of patient's with high grade may already have some adjacent adnocarcinoma.
Who gets barrett's: white males, 40-60

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