Liver & Gall Bladder
An alcholic patient has portal hypertension and varices.
Which of following histologic changes is most likely to be seen in a biopsy specimen taken from his esophagus? (LQ)
|A||Metaplastic columnar epithelium|
|B||Decreased ganglion cells in the myenteric plexus|
|C||Dilated blood vessels in the submucosa|
a. Most lesions of the esophagus present with similar symptoms, such as heartburn and dysphagia, but the most serious disease, which carries the risk of exsanguination, is bleeding esophageal varices.
b. Varices occur in about two-thirds of all patients with cirrhosis, and in the majority of patients the etiology is alcoholic cirrhosis.
c. The cirrhosis causes portal hypertension, which shunts blood into connecting channels between the portal and caval systems, such as the subepithelial plexus of veins in the lower esophagus.
d. Varices produce no symptoms until they rupture and cause massive bleeding (hematemesis), which may lead to death.
e. Other diseases, such as gastritis, esophageal laceration (Mallory- Weiss tears), or peptic ulcer disease, may cause hematemesis.
f. In contrast, columnar epithelium in the distal esophagus is seen with Barrett’s esophagus; decreased ganglion cells in the myenteric plexus are seen with achalasia, a disorder that is characterized by aperistalsis, incomplete relaxation of the lower esophageal sphincter (LES) with swallowing, and increased resting tone of the LES, all of which lead to esophageal dilation and symptoms of progressive dysphagia.