Pathology S3

• Esophagus


  Muscular tube-like structure that carries the food to the stomach after it has been chewed in the mouth
• Swallowing action


  Becomes involuntary and is controlled by the esophagus once the food reaches the esophagus
• Esophagus congenital Abnormalities


  • Atresia: An abnormal development of the esophagus, esophagus does not form, prevents food and fluids from reaching the stomach
• Esophagus atresia is a congenital malformation
• Morphological changes in esophagus atresia


  • Blind Pouches: 1. Proximal Pouch upper eso, 2. Distal pouch lower eso
  • Absence of luminal continuity
  • Fibrous or membranous septum

  
• Clinical features of esophagus atresia


  • Polyhydraminos: increased amiotic fluid
  • Excessive salivation
  • Coughing and choking
  • Inability to feed
  • Cyanosis and respiratory distress
• 90% of babies with esophageal atresia develop tracheoesophageal fistula
• Complications of esophageal atresia


  • Difficulty eating, swallowing
  • Gastroesophageal reflux: stomach acid flows back
  • Nutritional deficiencies: difficulty absorption of nutrients
• Tracheoesophageal fistula (TEF)


  An abnormal connection between the esophagus and the trachea that occurs during fetal development

  
• Causes and Pathogenesis of Tracheoesophageal fistula


  • Condition is congenital
  • Can be acquired due to cancer, infection, trauma

  
• Morphological Features of Tracheoesophageal fistula


  • Anatomical location: Proximal TEF, Distal TEF, H-type TEF
  • Fistula size
  • Mucosal lining

  
• Clinical Features of Tracheoesophageal fistula


  • Choking & Cyanosis
  • Respiratory Distress
  • Pneumonitis & Pneumonia
  • Polyhydraminos

  
• Complications of Tracheoesophageal fistula


  • Brassy honking type cough
  • Dysphagia (difficulty swallowing)
  • Recurrent pneumonia
  • Airway hyperreactivity
• In esophageal atresia, the esophagus narrows or comes to a blind end and does not connect with the stomach
• A tracheoesophageal fistula is an abnormal connection between the esophagus and the trachea

  
• Achalasia


  Motility disorder of the esophagus muscle and or the lower esophageal sphincter where the muscle does not relax as well and the normal muscle activity of the esophagus is reduced
• Causes and pathogenesis of Achalasia


  • Neural dysfunction
  • Autoimmune response
  • Infectious triggers: Viral infection, Herpes Simplex Virus HSV
  • Genetic factors
• Morphological Features of Achalasia


  • Esophageal Dilation
  • Food Retention
• Clinical features of Achalasia


  • Dysphagia: difficulty swallowing solids and liquids
  • Regurgitation: Incomplete emptying of the esophagus
  • Chest Pain
  • Weight Loss
• Complications of Achalasia


  • Esophageal dilation
  • Esophageal candidiasis or esophagitis
  • Aspiration pneumonia
  • Barrett's Esophagus
• Esophagitis


  Inflammation / Irritation of the esophagus
• Causes of Esophagitis


  • Gastroesophageal Reflux Disease (GERD)
  • Infections: Candida, herpes simplex virus
  • Medications: NSAIDs, Biphosphonstes, Potassium Chloride
• Pathogenesis of Esophagitis


  • Direct injury to the esophageal mucosa by gastric acid
  • Infection
• Morphological Features of Esophagitis


  • Erythema(Redness) and edema
  • Mucosal erosions / Ulcers

  
• Clinical features of Esophagitis


  • Heartburn
  • Dysphagia
  • Odynophagia
  • Regurgitation
  • Nausea and vomitting
  • Chest pain
• Complications of Esophagitis


  • Esophageal strictures
  • Barrett's esophagus
  • Esophageal ulcers
• Barrett's Esophagus


  A condition in which the tissue lining of the esophagus is replaced with tissue that is similar to the tissue that lines the intestine
• Barrett's Esophagus is a serious condition as it can increase the risk of developing esophageal cancer
• Morphological Changes in Barrett's Esophagus


  • Pinkish colored muscosa
  • Visible Columnar Epithelium
  • Intestinal Metaplasia

  
• Complications of Barrett's Esophagus


  • Esophageal Adenocarcinoma
  • Dysplasia

  
• Barrett's Esophagus is asymptomatic
• Diseases of Esophagus
• Adenocarcinoma


  Very common type of cancer that starts either in the skin or in one of the body cavities
• Squamous cell carcinoma


  Second most common form of skin cancer, characterized by abnormal, accelerated growth of squamous cells
• Pathogenesis of Adenocarcinoma


  Chronic gastroesophageal reflux disease (GERD) -> Development of Barrett's Disease -> Metaplasia of the esophageal epithelium
• Pathogenesis of Squamous Cell Carcinoma

  Combination of genetic, environmental, and lifestyle factors, often due to tobacco smoking and alcohol consumption
• Esophageal Tumors
• Adenocarcinoma


  Very common type of cancer that starts either in the skin or in one of the body cavities
• Squamous cell carcinoma


  Second most common form of skin cancer, characterized by abnormal, accelerated growth of squamous cells
• Pathogenesis of Adenocarcinoma


  Chronic gastroesophageal reflux disease (GERD) -> Development of Barrett's Disease -> Metaplasia of the esophageal epithelium