Path-Case 1
Terms
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copy deck
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Episodic dysphagia
w/GERD, GVHD, blistering skin dz - esophageal web
- complic of esophageal web
- postcricoid CA
- Patterson-Brown Kelly or Plummer-Vinson Syndrome
- esoph web
-
progressive dysphagia,
caused by severe esoph injury w/inflam scarring, as from GERD, radiation, scleroderma (scarring), or caustic injury - esophageal stenosis (stricture)
- what causes esophageal stenosis (stricture)
- severe esoph injury w/inflam scarring, as from GERD, radiation, scleroderma (scarring), or caustic injury
- MC motility d/o
- achalasia
- progressive dysphagia
-
*achalasia (classic Sx!)
also, esoph stenosis/stricutre - bird beak appearance
- achalasia
- assoc w/Chaga's Dz
-
achalasia
(Chaga's Dz caused by T. cruzi-->destroy myenteric plexus of esoph) -
*1. non-relaxing LES
2. aperistalsis
3. incomplete relax of LES - achalasia
- absent myenteric ganglia
- achalasia
- complic of achalasia
- sq cell CA
- inc w/positions favoring reflux (bending fwd, lying supine) & obesity
- hiatal (diaphragmatic) hernia
- bell-shaped dilation
- hiatal (diaphragmatic) hernia
- hiatal (diaphragmatic) hernia is assoc w/what?
- GERD
- mass in neck
- Zenker esoph diverticula
- nocturnal regurg
- epiphrenic esoph diverticula
- where is zenker diverticula?
- above UES
- where is epiphrenic diverticula?
- above LES
- massive hematemesis in alcoholics
- mallory weiss tear
- where are mallory weiss tears?
- on both sides of GEJ
- what causes esoph varicies
-
portal HTN d/t alcoholic cirrhosis
-->increased pressure in the esophageal plexus produces dilated tortuous vessels, "varices" - what layer are esoph varicies in?
- submucosa
- what do most ppl w/cirrhosis die from?
- ruptured esoph varicies
- how Tx esoph varicies?
- endoscopic injection of thrombotic agents ("sclerotherapy") or balloon tamponade is usually req'd to stop bleeding
-
Dysphagia
Heartburn
Regurgitation - GERD
- what causes esophagitis
- Reflux of gastric contents into the lower esophagus
- tobacco exposure inc risk of
-
GERD
sq cell CA - MCC of GERD
- incompetent LES
- mmorphological features of GERD
-
1.inflam cells (PMNs, lymphs, eos) in sq epi layer
2. basal zone hyperplasia
3.elongation of lp papillae - elongation of lp papillae
- GERD
- basal zone hyperplasia
- GERD
- Red, velvety mucosa
- Barrett
- Definitive Dx of Barrett's
- intestinal goblet cells
- imm-s increases risk of
- infectious esophagitis
- punched out ulcer
- HSV, assoc w/infectious esophagitis (imm-s)
- linear ulceration
- CMV, assoc w/infectious esophagitis (imm-s)
- gray-white (like oral thrush) pseudomembranes
- candidiasis, assoc w/infectious esophagitis (imm-s)
- how do adults get chemical esophagitis
-
1.suicide attempt
2. anticancer therapy
3.uremia - what do you see grossly in chemical esophagitis?
- erthema and edema, sloughing of the mucosa (acid), or outright necrosis of the entire esophageal wall
- Most common are benign tumors of smooth muscle origin
- leiomyoma
- what is leiomyoma
- MC benign tumors of smooth muscle origin
- progressive dysphagia and wt loss
- sq cell CA
- what inc risk of sq cell CA
- SYNERGISTIC effect of tobacco and alcohol
- carcinoma in situ
- sq cell CA
- where does sq cell CA occur?
- upper & middle 1/3 of esoph
- what is precursor to adenocarcinoma?
- Barretts
- where does adenocarcinoma of esoph occur?
- lower 1/3 of esoph