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Difference between revisions of "Esophagus"
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*Pyrosis = heartburn.<ref>URL: [http://dictionary.reference.com/browse/pyrosis http://dictionary.reference.com/browse/pyrosis]. Accessed on: 21 June 2010.</ref> | *Pyrosis = heartburn.<ref>URL: [http://dictionary.reference.com/browse/pyrosis http://dictionary.reference.com/browse/pyrosis]. Accessed on: 21 June 2010.</ref> | ||
= | =Infectious esophagitis= | ||
{{main|Microorganisms}} | {{main|Microorganisms}} | ||
Is a relatively common problem, especially in those that live at the margins (EtOH abusers) and immunosuppressed individuals ([[HIV|HIV/AIDS]]). | Is a relatively common problem, especially in those that live at the margins (EtOH abusers) and immunosuppressed individuals ([[HIV|HIV/AIDS]]). | ||
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*[[HIV]] - non-specific. | *[[HIV]] - non-specific. | ||
=== | ===Candida esophagitis=== | ||
{{Main|Candidiasis}} | |||
*[[AKA]] ''esophageal candidiasis''. | |||
====Gross (endoscopic)==== | ====Gross (endoscopic)==== | ||
Features: | Features: | ||
*White patches. | *White patches. | ||
DDx (endoscopic):<ref name=Ref_Odze244>{{Ref Odze|244}}</ref> | |||
*[[Eosinophilic esophagitis]]. | |||
====Microscopic==== | ====Microscopic==== | ||
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*[[AKA]] [[CMV]] esophagitis. | *[[AKA]] [[CMV]] esophagitis. | ||
Microscopic: | ====Microscopic==== | ||
Features: | |||
*Classically at the base of the ulcer; within endothelial cells - '''key point'''. | *Classically at the base of the ulcer; within endothelial cells - '''key point'''. | ||
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*[[Herpes simplex virus]]. | *[[Herpes simplex virus]]. | ||
===Gross/endoscopic=== | ====Gross/endoscopic==== | ||
Features: | Features: | ||
*Ulcers with a "punched-out" appearance with a brown/red edge. | *Ulcers with a "punched-out" appearance with a brown/red edge. | ||
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Notes: | Notes: | ||
*Eosinophilic esophagitis | *Intraepithelial cells with irregular nuclear contours, "squiggle cells" (T lymphocytes<ref name=pmid7587806>PMID: 7587806.</ref>), may mimic [[neutrophil]]s. | ||
DDx: | |||
*[[Eosinophilic esophagitis]] - characterized by similar histomorphologic features. The key difference is: more [[eosinophil]]s. | |||
Images: | Images: | ||
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==Eosinophilic esophagitis== | ==Eosinophilic esophagitis== | ||
*Abbreviated ''EE''. | |||
===General=== | ===General=== | ||
*The current thinking is that it is a clinico-pathologic diagnosis.<ref name=pmid20524860>{{Cite journal | last1 = Genevay | first1 = M. | last2 = Rubbia-Brandt | first2 = L. | last3 = Rougemont | first3 = AL. | title = Do eosinophil numbers differentiate eosinophilic esophagitis from gastroesophageal reflux disease? | journal = Arch Pathol Lab Med | volume = 134 | issue = 6 | pages = 815-25 | month = Jun | year = 2010 | doi = 10.1043/1543-2165-134.6.815 | PMID = 20524860 | url = http://www.archivesofpathology.org/doi/full/10.1043/1543-2165-134.6.815 }}</ref> | *The current thinking is that it is a clinico-pathologic diagnosis.<ref name=pmid20524860>{{Cite journal | last1 = Genevay | first1 = M. | last2 = Rubbia-Brandt | first2 = L. | last3 = Rougemont | first3 = AL. | title = Do eosinophil numbers differentiate eosinophilic esophagitis from gastroesophageal reflux disease? | journal = Arch Pathol Lab Med | volume = 134 | issue = 6 | pages = 815-25 | month = Jun | year = 2010 | doi = 10.1043/1543-2165-134.6.815 | PMID = 20524860 | url = http://www.archivesofpathology.org/doi/full/10.1043/1543-2165-134.6.815 }}</ref> | ||
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*'''Trachealization'''; eosphagus looks like trachea.<ref name=pmid19636182>{{Cite journal | last1 = Al-Hussaini | first1 = AA. | last2 = Semaan | first2 = T. | last3 = El Hag | first3 = IA. | title = Esophageal trachealization: a feature of eosinophilic esophagitis. | journal = Saudi J Gastroenterol | volume = 15 | issue = 3 | pages = 193-5 | month = | year = | doi = 10.4103/1319-3767.54747 | PMID = 19636182 }} | *'''Trachealization'''; eosphagus looks like trachea.<ref name=pmid19636182>{{Cite journal | last1 = Al-Hussaini | first1 = AA. | last2 = Semaan | first2 = T. | last3 = El Hag | first3 = IA. | title = Esophageal trachealization: a feature of eosinophilic esophagitis. | journal = Saudi J Gastroenterol | volume = 15 | issue = 3 | pages = 193-5 | month = | year = | doi = 10.4103/1319-3767.54747 | PMID = 19636182 }} | ||
</ref> | </ref> | ||
**[[AKA]] feline esophagus.<ref>URL: [http://www.ajronline.org/cgi/reprint/164/4/900.pdf http://www.ajronline.org/cgi/reprint/164/4/900.pdf]. Accessed on: 4 October 2010.</ref> | **[[AKA]] ''feline esophagus''.<ref>URL: [http://www.ajronline.org/cgi/reprint/164/4/900.pdf http://www.ajronline.org/cgi/reprint/164/4/900.pdf]. Accessed on: 4 October 2010.</ref> | ||
*White. | *White. | ||
Image: [http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2841420/figure/F0001/ Trachealization - radiograph (nih.gov)]. | DDx (endoscopic): | ||
*[[Candida esophagitis]] | |||
Image: | |||
*[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2841420/figure/F0001/ Trachealization - radiograph (nih.gov)]. | |||
===Microscopic=== | ===Microscopic=== | ||
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**There is a consensus paper<ref>{{cite journal |author=Furuta GT, Liacouras CA, Collins MH, ''et al.'' |title=Eosinophilic esophagitis in children and adults: a systematic review and consensus recommendations for diagnosis and treatment |journal=Gastroenterology |volume=133 |issue=4 |pages=1342–63 |year=2007 |month=October |pmid=17919504 |doi=10.1053/j.gastro.2007.08.017 |url=}}</ref> that makes note of [[HPFitis]]... and then goes on to ignore to whole issue by defining EE as 15/HPF. It blows my mind that the people could be so will fully blind and that the idiotic reviewers didn't understand this. | **There is a consensus paper<ref>{{cite journal |author=Furuta GT, Liacouras CA, Collins MH, ''et al.'' |title=Eosinophilic esophagitis in children and adults: a systematic review and consensus recommendations for diagnosis and treatment |journal=Gastroenterology |volume=133 |issue=4 |pages=1342–63 |year=2007 |month=October |pmid=17919504 |doi=10.1053/j.gastro.2007.08.017 |url=}}</ref> that makes note of [[HPFitis]]... and then goes on to ignore to whole issue by defining EE as 15/HPF. It blows my mind that the people could be so will fully blind and that the idiotic reviewers didn't understand this. | ||
**Most resident microscopes at the Toronto teaching hospitals have 22 mm eye pieces and have for their highest magnification objective a 40X. De facto, this means most people in Toronto are using the Liacouras ''et al.'' definition.<ref name=pmid16361045>{{cite journal |author=Liacouras CA, Spergel JM, Ruchelli E, ''et al.'' |title=Eosinophilic esophagitis: a 10-year experience in 381 children |journal=Clin. Gastroenterol. Hepatol. |volume=3 |issue=12 |pages=1198–206 |year=2005 |month=December |pmid=16361045 |doi= |url=}}</ref> | **Most resident microscopes at the Toronto teaching hospitals have 22 mm eye pieces and have for their highest magnification objective a 40X. De facto, this means most people in Toronto are using the Liacouras ''et al.'' definition.<ref name=pmid16361045>{{cite journal |author=Liacouras CA, Spergel JM, Ruchelli E, ''et al.'' |title=Eosinophilic esophagitis: a 10-year experience in 381 children |journal=Clin. Gastroenterol. Hepatol. |volume=3 |issue=12 |pages=1198–206 |year=2005 |month=December |pmid=16361045 |doi= |url=}}</ref> | ||
DDx:<ref name=Ref_Odze244>{{Ref Odze|244}}</ref> | |||
*[[Gastroesophageal reflux disease]] - no mid and proximal involvement. | |||
*[[Infectious esophagitis]]. | |||
*Eosinophilic gastroenteritis. | |||
*Hypereosinophilic syndrome. | |||
Images: | Images: | ||