Chapter 8The diseases of digestive systemTreZenkerdiverticulumTracheo-esophagealfistulaTraction diverticulunner-VinsonsyndromeWeb(PluStrictureSclerodermeRelux esophagitisMallory-Weisssyndrome (laceration)BarelceonhanTeDiaphragnVaricesStomachNon-neoplasticdisordersoftheesophagus
Chapter 8 The diseases of digestive system
8.1.1ESOPHAGITIS1.reflux esophagitisDefinition: esophageal irritation and inflammation due to reflux ofgastric secretions into the esophagusPathologicchanges.Eosinophiles,with or withoutneutrophils,in the epithelial福layerBasal zone hyperplasia福Elongation of lamina propria papillaeIntraepithelial neutrophils are markers of more severe injury福Presentation: heartburn and reguritationComplications: bleeding, stricture, bronchospasm and asthma,barrett esophagus
1. reflux esophagitis Definition: esophageal irritation and inflammation due to reflux of gastric secretions into the esophagus Pathologic changes: Eosinophiles, with or without neutrophils, in the epithelial layer Basal zone hyperplasia Elongation of lamina propria papillae Intraepithelial neutrophils are markers of more severe injury Presentation: heartburn and reguritation Complications: bleeding, stricture, bronchospasm and asthma, barrett esophagus 8.1.1 ESOPHAGITIS
2.BarretesophagusDefinition: metaplasia of the squamous eosphagealmucosa to a more protective columnar typebecause of chronic exposure to gastric secretionsCause:gastroesophageal reflux disease福Gross: irregular gastroesophageal junction withtongues of red granular mucosa extending up intothe esophagusIncreased risk of dysplasia and esophagealadenocarcinoma
2.Barret esophagus Definition: metaplasia of the squamous eosphageal mucosa to a more protective columnar type because of chronic exposure to gastric secretions Cause: gastroesophageal reflux disease Gross: irregular gastroesophageal junction with tongues of red granular mucosa extending up into the esophagus Increased risk of dysplasia and esophageal adenocarcinoma
Esophageal carcinomaSquamous cell carcinomaAdenocarcinomaEpidemiologyArises inthe distal esophagusThe most common type of esophageal cancerAssociatedwithBarrettesophagusMales>females; age usually>50and dysplasiaRisk factorsPrognosis: poorHeavy smoking and alchol useAchalasiaPlummer-vinson syndromeUpperthird20%TylosisADENOCARCINOMAPriorlye ingestion(%06)Middle third50%Presentation(10%)Often asymptomatic until late in the courseLowerthird30%Progressive dysphagiaWeight loss and anorexiaBleedingHoarseness or cough (advanced cancers)Diagnosis: endoscopy and biopsyTreatment:surgeryPrognosis: poorFIGURE18.3Carcinoma oesophagus-sites of predilection for squamous cellcarcinoma and adenocarcinoma
Esophageal carcinoma Squamous cell carcinoma Epidemiology The most common type of esophageal cancer Males>females; age usually>50 Risk factors Heavy smoking and alchol use Achalasia Plummer-vinson syndrome Tylosis Prior lye ingestion Presentation Often asymptomatic until late in the course Progressive dysphagia Weight loss and anorexia Bleeding Hoarseness or cough (advanced cancers) Diagnosis: endoscopy and biopsy Treatment: surgery Prognosis: poor Adenocarcinoma Arises in the distal esophagus Associated with Barrett esophagus and dysplasia Prognosis: poor
A.POLYPOIDB.ULCERATINGC.DIFFUSETYPEFUNGATINGTYPEINFILTRATINGTYPEFIGURE18.4Macroscopictypesof squamouscell carcinomaof theoesophagus