10.3 Esophagus

Question 1

Congenital defect resulting in a connection between the esophagus and trachea

Answer 1

TEF

Question 2

presents with vomiting, polyhydramnios, abdominal distention, aspiration

Answer 2

EA/TEF

Question 3

Thin protrusion of esophageal mucosa, most often in upper esophagus that presents with dysphagia for poorly chewed food

Answer 3

Esophageal web

Question 4

Esophageal web increases risk for

Answer 4

esophageal squamous cell carcinoma

Question 5

Severe iron deficiency + esophageal web + beefy-red tongue due to atrophic glottitis

Answer 5

Plummer-Vinson

Question 6

Outpouching of pharyngeal mucosa through an acquired defect in the muscular wall (false diverticulum); arises above the UES at the junction of the esophagus and pharynx

Answer 6

Zenker diverticulum

Question 7

Zenker diverticulum presentation

Answer 7

1. dysphagia
2. obstruction (feels like something in back of throat)
3. halitosis

Question 8

longitudinal laceration fo mucosa at GE junction; caused by severe vomiting (alcoholism or bulimia)

Answer 8

Mallory-Weiss syndrome

Question 9

Mallory-Weiss presentation

Answer 9

painful hematemesis

Question 10

Mallory-Weiss increases risk of

Answer 10

Boerhaave syndrome

Question 11

Rupture of esophagus leading to air in the mediastinum and subcutaneous emphysema

Answer 11

Boerhaave syndrome

Question 12

dilated submucosal vein in the lower esophagus secondary to portal hypertension

Answer 12

esophageal varices

Question 13

distal esophageal vein normally drains into the the portal vein via the

Answer 13

Left gastric vein

Question 14

in portal htn, the left gastric vein backs up into the

Answer 14

esophageal vein –> dilation (varices)

Question 15

rupture of esophageal varices presents with

Answer 15

painless hematemesis

Question 16

what is the most common cause of death in cirrhosis?

Answer 16

esophageal varices –> rupture

Question 17

disordered esophageal motility with inability to relax the LES

Answer 17

Achalasia

Question 18

what causes achalasia?

Answer 18

damaged ganglion cells int eh myenteric plexus

Question 19

ganglion cells of myenteric plexus are located between the inner circular and outer longitudinal lairs of the

Answer 19

muscularis propria

Question 20

damage to ganglion cells –> achalasia can be idiopathic or secondary to a known insult, such as

Answer 20

Chaga’s disease (trypanosome cruse)

Question 21

achalasia on esophageal manometry?

Answer 21

high LES pressure

Question 22

achalasia on barium swallow study?

Answer 22

“bird-beak” sign

Question 23

achalasia increases risk for

Answer 23

esophageal squamous cell carcinoma

Question 24

Achalasia on H&P

Answer 24

dysphagia for solids & liquids; putrid breath

Question 25

GERD is reflux of acid from the stomach due to

Answer 25

reduced LES tone

Question 26

6 risk factors for GERD

Answer 26

1. alcohol 2. tobacco 3. obesity 4. fat-rich diet 5. caffeine 6. hiatal hernia

Question 27

late complications of GERD

Answer 27

Barrett esophagus; ulceration with stricture

Question 28

3 possible clinical features of GERD

Answer 28

1. heartburn (mimics cardiac chest pain) 2. asthma (adult-onset) & cough 3. damage to enamel

Question 29

metaplasia of the lower esophageal mucosa from stratified squamous epithelium to nonciliated columnar epithelium with goblet cells (10% of GERD)

Answer 29

Barrett esophagus

Question 30

Barrett esophagus may progress to

Answer 30

dysphagia and adenocarcinoma

Question 31

2 types of esophageal carcinoma

Answer 31

adenocarcinoma or squamous cell carcinoma

Question 32

arises from preexisting Barrett esophagus; usually involves the lower one-third of the esophagus

Answer 32

esophageal adenocarcinoma

Question 33

most common esophageal carver worldwide; usually arises in upper or middle third of esophagus

Answer 33

squamous cell

Question 34

6 risk factors for esophageal squamous cell carcinoma

Answer 34

1. Alcohol 2. Tobacco 3. Very hot tea 4. Achalasia 5. Esophageal web 6. Esophageal injury (lye ingestion)

Question 35

Progressive dysphagia (solids to liquids), weight loss, pain, hematemesis, hoarse voice, cough

Answer 35

symptoms of esophageal carcinoma

Question 36

damage to what nerve --> hoarse voice

Answer 36

recurrent laryngeal

Question 37

upper 1/3 of esophagus goes to what lymph node?

Answer 37

cervical

Question 38

middle 1/3 of esophagus goes to what lymph node?

Answer 38

mediastinal, tracheobronchial

Question 39

lower 1/3 of esophagus goes to what lymph node?

Answer 39

celiac, gastric