Chapter 17: GIT- Esophagus Obstruction

Question 1

For food and fluids to be delivered efficiently from the esophagus to the stomach, swallowing
must be accompanied by a coordinated waveofperistaltic contractions.

Esophageal dysmotility
interferes with this process and can take several forms.

Question 2

What is nutcracker esophagus?

Answer 2

High-amplitude esophageal
contractions in which the outer longitudinal layer of smooth muscle contracts before the inner
circular layer occur in some patients.

Such lack of coordination results in a syndrome termed
nutcracker esophagus that can cause periodic short-lived esophageal obstruction.

Question 3

What is diffuse esophageal spasm?

Answer 3

motor disorders of the esophagus which can also result in functional obstruction.

Because it increases esophageal wall stress, diffuse esophageal spasm can cause small diverticulae to form.

These small mucosal outpouchings, which are more
accurately described as pseudo-diverticulaebecausethey lack a true muscularis, are
uncommon, probably because of the dense and continuous esophageal musculature.

Question 4

Where is the Zenker diverticulum (pharyngoesophageal diverticulum) located?

Answer 4

is located immediately above the upper
esophageal sphincter

What’s ZUp?

Question 5

The traction diverticulum occurs near where?

Answer 5

midpoint of the esophagus;

TM

Question 6

Epiphrenic diverticulum is located where?

Answer 6

immediately above the lower esophageal sphincter.

Mnemonic: Elow

Question 7

Why does Zenker diverticulae may produce symptoms that include regurgitation and producing a mass ?

Answer 7

may reach several centimeters in size and accumulate significant amounts of food

Question 8

Passage of food can also be impeded by esophageal stenosis, or narrowing of the lumen, what is the general cause of this?

Answer 8

. This is generally caused by fibrous thickening of the submucosa and is associated with atrophy of
the muscularis propria as well as secondary epithelial damage.

Question 9

Although occasionallycongenital, stenosis is most often due to what?

Answer 9

• inflammation and scarring that may be caused by:
  
  • chronic gastroesophageal reflux,
  • irradiation, or
  • caustic injury.

Question 10

The course of dysphagia is associated with
stenosis is usuailly what?

Answer 10

progressive, first affecting the ability to eat solids and only later interfering with ingestion of liquids.

Because obstruction develops slowly, patients may subconsciously modify their diet to favor soft foods and liquids and be unaware of their condition until the
obstruction is nearly complete.

Question 11

What is an Esophageal mucosal webs?

Answer 11

are uncommon ledge-like protrusions of mucosa that may causeobstruction.

The pathogenesis is unknown, but webs are encountered most frequently in
women over age 40.

Question 12

Esophageal mucosal webs encountered most frequently in what sex and age?

Answer 12

women over age 40.

Question 13

Webs are often associated with what?

Answer 13

• gastroesophageal reflux,
• chronic graftversus- host disease
• , or blistering skin diseases

Question 14

Upper esophageal webs accompanied by .what?

Answer 14

• irondeficiency anemia,
• glossitis, and cheilosis are part of the Paterson-Brown-Kelly or Plummer- Vinson syndrome

Question 15

Esophageal webs are most common where?

Answer 15

in the upper esophagus

Question 16

What is the apperance of Esophageal Web esp in the upper esophagus?

Answer 16

• generally semicircumferential,
• eccentric lesions that protrude less than 5 mm and
• have athickness of 2 to 4 mm.

Question 17

What is the microscopic appearance of Esophageal Web?

Answer 17

composed of a fibrovascular connective

tissue and overlying epithelium.

Question 18

What is the main symptom of Webs?

Answer 18

• *dysphagi**a associated with
• *incompletely chewed food.**

Question 19

What is Plummer-Vinson or Paterson-Kelly syndrome?

Answer 19

presents as a classical triad of dysphagia, iron-deficiency anemia and esophageal webs

Question 20

What is Plummer-Vinson or Paterson-Kelly syndrome?

Answer 20

presents as a classical triad of:

• dysphagia,
• iron-deficiency anemia
• and esophageal webs

Question 21

What are Esophageal rings, or Schatzki rings?

Answer 21

, are similar to webs, but are circumferential and thicker.
Rings include mucosa, submucosa, and, in some cases, hypertrophic muscularis propria.

Question 22

When will the Esophageal rings, or Schatzki rings be termed A rings?

Answer 22

When
present in the distal esophagus, above the gastroesophageal junction, they are termed A rings
and are covered by squamous mucosa

Question 23

When will the Esophageal rings, or Schatzki rings be termed B rings?

Answer 23

located at the squamocolumnar
junction of the lower esophagus are designated B rings and may have gastric cardia-type mucosa on their undersurface.

Babang esophagus

Question 24

What is ACHALASIA?

Answer 24

Increased tone of the lower esophageal sphincter (LES), as a result of impaired smooth muscle
relaxation, is animportant cause of esophageal obstruction.

Question 25

What allows the LES to relax during swallowing?

Answer 25

Release of nitric oxide and
vasoactive intestinal polypeptide from inhibitory neurons, along with interruption of normal
cholinergic signaling, allows the LES to relax during swallowing.

Question 26

Achalasia is characterized by
the triad of what?

Answer 26

• incomplete LES relaxation,
• increased LES tone, and
• aperistalsis of the esophagus.

Question 27

Primary achalasia is caused by what?

Answer 27

• *failure of distal esophageal inhibitory neuron**s and is, by
• *definition, idiopathic**. [5]

Degenerative changes in neural innervation, either intrinsic to the esophagus or within the extraesophageal vagus nerve or the dorsal motor nucleus of the
vagus, may also occur

Question 28

When does secondary achalasia arise?

Answer 28

Secondary achalasia may arise in Chagas disease, in which Trypanosoma cruzi infection causes destruction of the myenteric plexus, failure of peristalsis,
and esophageal dilatation.

Duodenal, colonic, and ureteric myenteric plexi can also be affected in Chagas disease.

Question 29

Achalasia-like disease may be caused by what?

Answer 29

• diabetic autonomic neuropathy;
• infiltrative disorders such as malignancy, amyloidosis, or sarcoidosis;
• and lesions of dorsal motor nuclei, particularly polio or surgical ablation.

Question 30

What are treatment options for primary and

secondary achalasia?

Answer 30

• include laparoscopic myotomy and
• pneumatic balloon dilatation.
• Botulinum neurotoxin (Botox) injection, to inhibit LES cholinergic neurons, can also be effective.