Esophagus Pathology by Hetal Vithalani

Zenker Diverticulumoutopuching of phyryngeal mucosa throgh an acquired defect in the muscular wall (false diverticulum) Arises above the upper esophageal sphincter at the junction of the esophagus and pharynx presents with dyphagia, obstruction, an halitosis ( bad breath)

Mallory -Weiss Syndrome Longitudinal laceration of mucosa at the gastroesophageal (GE) junction caoused by severe vomiting(usually due to alcoholism or bulmia) present with painfull hematemesia risk of boerhaave syndrome - repture of esophagus leading to air in the mediastinum and sbeutaneous emphysema.

Benign Esophageal Tumors: leiomyoma is the most common

Squamous cell carcinoma in upper 2/3 of esophagusSCC of the esophagus is the most common type of esophageal cancer in the world, but not in the United states. SCC affects males more then females, and African American more than caucasins the typical age is usally older than 50 years. Risk Factors Heavy somoking Alcohol AchalasiaPlummer vinston syndrometylosis prior lye ingestion. Presentation SCC of the esophagus is often asymptomatic until late in the course. When symptoms do develpo, they may include progressive dysphagia; weight loss and anerexia; bleeding or hoarseness or cough DS: Endoscopy with biopsy Treatment surgery with the prognosis being poor

Adenocarcinoma adenoCA in lower 1/3more common than SCC in the United States and affects Caucasians more than African American. Adenocarcinoma arises in the distal esophagus. associated wtih Barrett Esophagus and dysplasia prognosis is poor.

A-chalasia [a=not, chalao (greek)= to loosen/relax]: failure of LES relaxation + loss of distal esophageal peristalsis.Failure of complete LES relaxation: damage to inhibitory (NO synthase producing) neurons that enable relaxationDegeneration of neurons in esophageal wall (Auerbach’s / myenteric plexus) → loss of smooth muscle contraction/motility → uncoordinated, or lack of, peristalsisNote: Inflammation of esophageal myenteric plexus is pathognomonic↑ risk of esophageal squamous cell carcinomamost common neuromuscular disorder of the esophagusSx: progressive dysphagia to solids and liquids, nocturnal regurgitation of undigested foodWorsening dysphagia (difficulty swallowing) to solid AND liquids indicates motility disorders→ achalasia, myasthenia gravis, stroke, CREST syndromeNote: Dysphagia limited to solids indicates an obstructive lesion (i.e esophageal web/cancer)Bird’s beak: proximal esophagus is chronically dilated; LES stays closed during swallowing (acute esophageal tapering at the lower esophageal sphincter and narrowing at the gastro-esophageal junction forms the “beak” of the bird)Primary achalasia: etiology unknown.Secondary causes of achalasia: Chagas disease, diabetic neuropathy, esophageal CA, infiltrative disorders such as malignancy, amyloidosis, sarcoidosis

A hiatus hernia or hiatal hernia is the protrusion (or herniation) of the upper part of the stomach into the thorax through a tear or weakness in the diaphragm.Risk factorsIncreased pressure within the abdomen caused by:Heavy lifting or bending overFrequent or hard coughingHard sneezingPregnancy and deliveryViolent vomitingStraining with constipationObesity (extra weight pushes down on the abdomen increasing the pressure)Use of the sitting position for defecationHereditySmoking[citation needed]Drug use, such as cocaineStress * Diaphragm weakness

The most common (95%) is the sliding hiatus hernia, where the gastroesophageal junction moves above the diaphragm together with some of the stomach.

Rolling (or paraesophageal) hiatus hernia, when a part of the stomach herniates through the esophageal hiatus and lies beside the esophagus, without movement of the gastroesophageal junction. It accounts for the remaining 5% of hiatus hernias.

Tracheoesophageal Fistulaabnormal connection (fistula) between trachea and esophagus, commonly congenitalClinical presentation Maternal polyhydramnios → excess amniotic can be detected prenatally → amniotic fluid is not recycled as efficiently but is still produced by fetal kidney. Connection between stomach and trachea: stomach/abdominal distention in newborn (CXR→air bubble in stomach) & ↑ risk of chemical pneumonia (pneumonitis)Blind ending esophagus: Difficulty feeding (choking and vomiting), can’t pass feeding tube into newborns stomach

Esophageal Web Thin protrusion of esophageal mocosa, most often in the upper esophagus. Present with dysphagia for poorly chewed food increased risk for esophageal squamous cell carcinoma plummer - winson sysndromes characterized by severe iron deficiency anemia, esophageal web, and beefy red toungue due to atrophic glossitis. Middle age women Schatzki ring are web like narrowings at the gastroesophageal junction.

GERD Reflux of acid from the stomach due to reduce LES tone Risk factors includes Alcohol TobaccoObesityFat rich diet caffeine hital hernia Clinical features Heartburn ( mimics cardia chest pain) Asthma (adult onset) and coughDamage to enamel of teeth Ulceration with stricture and Barrett esophagus are late complication

Barrett Esophagus Metaplasia of the lower esophageal mucosa from stratified Squamous epithelium to nonciliated columnar epithelium with goblet cells. 1. response of lower esophageal stem cells to acidic stress May progress to dysplasia and adenocarcinoma