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    GI Esophagus - UPDATED PDF

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    Batool Sherbini
    This document discusses various gastrointestinal pathologies of the esophagus. It describes normal esophageal anatomy and covers congenital anomalies, acquired disorders like stenosis, webs and rings, and motor dysfunctions such as achalasia. It also discusses vascular, infectious, and inflammatory conditions including varices, esophagitis, and reflux disease. Precancerous conditions like Barrett's esophagus and risks of developing dysplasia and adenocarcinoma are explained. Both benign and malignant tumors of the esophagus are outlined.

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    GI Esophagus - UPDATED PDF

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    Batool Sherbini
    38 views46 pages
    This document discusses various gastrointestinal pathologies of the esophagus. It describes normal esophageal anatomy and covers congenital anomalies, acquired disorders like stenosis, webs and rings, and motor dysfunctions such as achalasia. It also discusses vascular, infectious, and inflammatory conditions including varices, esophagitis, and reflux disease. Precancerous conditions like Barrett's esophagus and risks of developing dysplasia and adenocarcinoma are explained. Both benign and malignant tumors of the esophagus are outlined.

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    This document discusses various gastrointestinal pathologies of the esophagus. It describes normal esophageal anatomy and covers congenital anomalies, acquired disorders like stenosis, webs and rings, and motor dysfunctions such as achalasia. It also discusses vascular, infectious, and inflammatory conditions including varices, esophagitis, and reflux disease. Precancerous conditions like Barrett's esophagus and risks of developing dysplasia and adenocarcinoma are explained. Both benign and malignant tumors of the esophagus are outlined.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    38 views46 pages

    GI Esophagus - UPDATED PDF

    Uploaded by

    Batool Sherbini
    This document discusses various gastrointestinal pathologies of the esophagus. It describes normal esophageal anatomy and covers congenital anomalies, acquired disorders like stenosis, webs and rings, and motor dysfunctions such as achalasia. It also discusses vascular, infectious, and inflammatory conditions including varices, esophagitis, and reflux disease. Precancerous conditions like Barrett's esophagus and risks of developing dysplasia and adenocarcinoma are explained. Both benign and malignant tumors of the esophagus are outlined.

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    Gastro-Intestinal Pathology

    Esophagus

    Husni Maqboul, M.D.


    Normal esophagus

    Squamous
    esophagus

    Glandular
    stomach
    Normal esophageal squamous mucosa
    Normal GE
    junction;
    squamous mucosa
    on the right, and
    gastric cardiac
    glandular mucosa
    on the left
    Symptoms of Esophageal Disorders

    ■ Dysphagia: difficulty swallowing


    ■ Odynophagia: pain upon swallowing
    ■ Heartburn: retrosternal burning pain
    ■ Hematemesis: vomiting of blood
    ■ Melena: blood in stools
    – May be of upper GI origin
    Esophagus, Congenital Anomalies

    ■ Atresia and Fistulae


    – At or near Tracheal bifurcation
    – Fistula connects lower or upper
    pouch with a bronchus or trachea
    – Other associated anomalies include
    congenital heart disease and GI
    malformations
    Esophagus, Atresia and Fistulae
    Esophagus, Anatomic Disorders

    ■ Stenosis : Narrowing of lumen due to


    fibrous thickening of the wall
    – Progressive dysphagia
    – G/E reflux
    – Radiation
    – Scleroderma
    – Caustic injury
    Esophageal
    Stenosis

    Markedly narrowed lumen


    Esophagus, Anatomic Disorders

    ■ Webs and Rings : Narrowing of lumen


    due to mucosal protrusions
    – Upper webs, lower Schatzki rings
    – Episodic dysphagia
    – Mostly women over 40 years
    – Plummer-Vinson Syndrome : Upper
    esophageal webs, iron deficiency,
    glossitis, cheilosis
    Motor Dysfunctions, Achalasia
    ■ Failure of the lower esophageal sphincter to
    relax following swallowing
    – Functional obstruction
    – Dilation of upper esophagus
    – Primary vs. secondary
    ■ Dysphagia, nocturnal regurgitation,
    aspiration
    ■ Increased risk of SCC, HH, Candidiasis
    ■ Disorder of innervation, not muscle
    – May have absent myenteric plexi
    Motor Dysfunctions, Achalasia
    ■ Manometric studies
    » Aperistalsis
    » Incomplete relaxation of LES with swallowing
    » Increased resting tone of LES
    ■ Primary
    » Loss of intrinsic inhibitory innervation of
    LES (autoimmune, previous viral infections?)
    ■ Secondary
    » Chagas, polio, autonomic diabetic neuropathy
    Achalasia
    Motor Dysfunctions,
    Hiatal Hernias
    ■ Caused by widening of space between
    esophagus and diaphragm
    – Portion of stomach protrudes above
    diaphragm
    – 1-20% of adults
    – Significant because they may contribute to
    reflux
    ■ Sliding : 95 % of cases
    ■ Rolling or Paraesophageal
    Hiatal Hernia
    Hiatal Hernia-Radiograph
    Ectopia
    ● Mostly gastric type mucosa in the
    upper third (Inlet patch)
    ● Usually asymptomatic, but may lead to
    dysphagia, esophagitis and Barrett's
    esophagus
    Lacerations ( Mallory-Weiss )
    ■ Longitudinal tears at the G-E junction
    ■ Inadequate relaxation of muscles of
    LES following retching
    – Usually in chronic alcoholics
    ■ May be superficial or transmural
    – Infection
    – Upper GI bleeding or massive
    hemorrhage
    Diverticulae

    ■ Out pouching of alimentary tract


    containing all viscera layers
    ■ Zenkers, traction, and epiphrenic
    ■ Food regurgitation without dysphagia
    ■ Aspiration
    Diverticulae
    Vascular Disorders: Varices
    ■ Collateral bypass channels where the
    portal and systemic circulation
    communicate
    ■ Dilated tortuous veins in the submucosa
    – In 2/3 of all cirrhotic patients
    – Asymptomatic until rupture, when
    massive bleeding occurs
    – 40% mortality, most survivors rebleed
    within one year
    Varices
    Varices
    Esophagitis
    ■ Reflux
    ■ Uremia
    ■ Corrosives/irritants
    ■ Radiation/Chemotherapy
    ■ Infection
    – Viral HSV, CMV
    – Fungal candida , mucor, aspergillus
    – Bacterial
    Herpetic
    Esophagiti
    note marked
    ulceration
    and
    hemorrhage
    Herpetic
    Esophagitis

    Herpetic
    Inclusions
    Eosinophilic Esophagitis
    - Immune mediated disorder
    - Dysphagia in adults
    - Feeding intolerance and GERD like symptoms in
    children
    - Rings in upper and mid esophagus
    - Rich eosinophilic infiltrate (away from GE junction)
    - No response to PPIs
    - Avoid allergens such as cow milk and soya
    - Often associated with atopy. allergic dermatitis and
    asthma
    Reflux Esophagitis

    ■ 10-20% percent of adults in Western


    countries
    – Children and adults
    ■ Heartburn, regurgitation, chest pain
    ■ Sequelae
    – Bleeding, stricture, Barrett’s esophagus
    ■ Pathogenesis (usually multifactorial)
    – Incompetent LES, hiatal hernia, increased
    gastric volume, SS, alcoholism, hypothyroidism
    Reflux esophagitis

    ■ Gross
    – Mucosal redness
    – Erosions and/or ulceration
    ■ Microscopic
    – Elongation of papillae
    – Basal layer hyperplasia
    – Eosinophils +/- other inflammatory
    cells
    Linear erosions
    Typical of reflux
    esophagitis
    Reflux esophagitis. Note rete peg elongation and basal
    layer hyperplasia.
    Eosinophils in reflux
    esophagitis
    Barrett’s Esophagus
    ■ Probable complication of longstanding
    reflux (up to 11% reflux patients)
    ■ Replacement of normal distal stratified
    squamous mucosal by intestinal-type
    glandular mucosa
    ■ Possible pathogenesis
    – Reflux induces inflammation and mucosal
    injury
    – Healing occurs by ingrowth of stem cells and
    re-epithelialization and metaplasia
    Barrett’s esophagus-pathology
    ■ Irregular band of dark pink, velvety
    mucosa extending upward as tongues
    of mucosa
    ■ May be very patchy or focal
    ■ Histology
    – Metaplastic columnar epithelium with
    goblet cells
    ❖ Genetically, cells resemble
    adenocarcinoma
    Barrett’s esophagus

    Normal white
    Squamous
    mucosa

    Pink abnormal
    Glandular
    mucosa
    Barrett’s esophagus
    Note goblet cell metaplasia
    Barrett’s esophagus-sequelae

    ■ Ulceration
    ■ Bleeding
    ■ Stricture
    ■ Adenocarcinoma
    Dysplasia/Carcinoma Sequence

    Barrett’s

    Dysplasia

    Carcinoma
    Barrett’s esophagus with dysplasia. Note lack of mucin,
    nuclear hyperchromasia,, and variation in size and shape.
    High power
    view of dysplasia in
    Barrett’s esophagus..
    Note
    nuclear variation,
    prominent nucleoli, and
    increased mitoses.
    Squamous mucosa

    Carcinoma arising in
    Barrett’s
    esophagus
    Benign Tumors

    ■ Mostly of mesenchymal origin


    – Leiomyomas, lipomas, hemangiomas
    ■ Other Types
    – Mucosal polyps
    – Squamous papillomas
    Malignant Tumors

    ■ Squamous Cell Carcinoma


    – Usually > 50 years with M : F ratio of 4 : 1
    – Dietary and environmental factors
    – Middle third (50%), lower third (30%), and upper third
    (20%)
    – Gradual and late dysphagia
    ■ Adenocarcinoma
    – Most adenocarcinomas of lower third are actually
    esophageal cancers
    – Barrett’s esophagus
    Squamous Cell Carcinoma

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