Chapter 69 : Diseases of the Esophagus Flashcards
Dysphagia refers to the sensation of food being delayed in its normal passage from mouth to stomach. Differentiate Oropharyngeal from Esophageal Dysphagia
Oropharyngeal Dysphagia is difficulty in initiating a swallow while esophageal dysphagia is difficulty transporting food down the esophagus secondary to structural or neuromuscular defects in the smooth muscle of the esophagus
______ is defined as a sensation of a lump in the throat in which food transport is not limited
Globus
oropharyngeal swallow is best assessed by _______
Videofluoroscopy
______ is the fined as appearance of acid or bitter taste in the mouth
Regurgitation
In GERD, ______ is defined as a sudden filling of the mouth with clear, slightly salty fluid which is later found out to be salivary secretions not regurgitated acid contents.
Water Brash - the mechanism is vagally mediated
The squamocolumnar junction can be recognized by the _____ which demarcates the interface between the light pink squamous mucosa and the red columnar gastric mucosa
Z line
The gastroesophageal junction is defined by this specific part of the gastric mucosa
proximal margin of the gastric folds
True or False, the squamocolumnar junction and GEJ are synonymous
The two are not synonymous, In patients with Barrett esophagus (BE), the squamocolumnar junction is more proximal in the esophagus than the GEJ is
In normal esophageal manometry, the distal wave amplitudes measured range from ___ to ___ mm Hg while the basal LES pressure is about?
30 to 180 mm Hg ; 10 to 45 mm Hg
In 24 hour pH probe monitoring, a reflux episode is defined as a drop in pH below _____
pH drops below 4.0. This value is chosen on the basis of the proteolytic activity of pepsin
_____ refers to regurgitation of duodenal contents through the pylorus into the stomach with subsequent reflux into the esophagus
Duodenogastroesophageal reflux
Only diagnostic tool that allows for measurement of both acidic and nonacidic refluxate of liquid ang gas consistency
Multichannel intraluminal impedance (MII)
_____ is a provocative test for GERD wherin 0.1N hydrochloric acid is infused in the esophagus where in a patient’s chest pain is considered a positive test
Bernstein test - rarely used and mostly of historic value only
_____ is a primary esophageal motility disorder of unknown etiology characterized by insufficient LES relaxation and loss of esophageal peristalsis.
Achalasia
In this disease entity, manometric changes include the presence of simultaneous and repetitive contractions in the esophageal body, but unlike in achalasia, some normal peristalsis is maintained
Diffuse esophageal spasm
The classic radiologic finding in Diffuse Esophageal Spasm
“Corkscrew” Esophagus
_____is another common manometric diagnosis in patients with noncardiac chest pain. It is defined by high-amplitude peristalsis
Nut Cracker Esophagus
Ineffective esophageal motility is a hypocontractile disorder, defined by a distal esophageal contraction amplitude of less than ______ in 30% or more of wet swallows
30 mm Hg
Secondary motility disorders are commonly a result of systemic conditions. The most common condition that affects esophageal motility is___,or___
scleroderma, or progressive systemic sclerosis (PSS)
The normal esophagus measures _____ in diameter
20 mm
The predominant clinical symptom of strictures is dysphagia, which is usually most prevalent when the luminal diameter is less than _____.
15 mm
The goal of esophageal dilation is to obtain an objective diameter greater than _____
15 mm
In dilation of esophageal strictures, to minimize this risk, the so-called rule of threes applies defined as ____
no more than three sequential dilators are to be used per session
Plummer-Vinson or Paterson-Kelly syndrome to the triad that consists of _____
proximal esophageal webs, iron deficiency anemia, and dysphagia
The _____(anatomic abnormality of the esophagus) occurs at the GEJ at the distal margin of the LES and is the most common cause of intermittent solid food dysphagia and food impaction
Schatzki ring, also known as a B-ring,
This _____(anatomic abnormality of the esophagus) which is rarely symptomatic, occurs at the proximal margin of the LES approximately 2 cm proximal to the squamocolumnar junction
A-ring
This disease entity is often consists of endoscopic findings of multiple esophageal rings in patients with dysphagia
Esosinophilic Esophagitis AKA ringed, feline, or corrugated esophagus
The eosinophil density required for the diagnosis of eosinophilic esophagitis is generally _____(diagnostic criteria) on both proximal and distal esophageal biopsies
more than 15 eosinophils per high-power field
Most common classification system to characterize the severity of esophagitis
Los Angeles Classification system Grade A (mucosal breaks < 5mm long), Grade B (mucosal breaks >5mm long), Grade C (mucosal breaks involving <75% of the circumference), Grade D (mucosal breaks involving >75% of the circumference)
Gross pathognomonic endoscopy finding of barret esophagus
Salmon pink mucosa
Classification of Barrett Esophagus
Short sgement <3 cm vs Long segment >3cm from the gastroesophageal junction
Presence of these cells is characteristic of intenstinal metaplasia seen in Barrett Esophagus
Mucin-containing Goblet cells
Most comon site for esophageal SCC? (proximal, middle, and distal esophagus) what about for esophageal adenocarcinoma?
SCC: middle esophagus / Adenoca: distal esophagus (at the GEJ)
Zenker’s Diverticulum form as a result of increased pressure in this specific area and its borders
Killian triangle (between cricopharyngeus and inferior pharyngeal constrictor muscle)
Esophageal diverticula are most practically classified anatomically into the following four categories
1) Zenker diverticula, 2) midesophageal diverticula, 3) epiphrenic diverticula, and 4) intramural pseudodiverticulosis.
2 types of mid esophageal diverticula
Traction midesophageal diverticula (Only true diverticula in the esophagus) VS Pulsion midesophageal diverticula
Three most common causes of infectious esophagitis
Candida albicans, Cytomegalovirus, Herpes Simplex Virus
Differentiate CMV vs HSV esophagitis in terms of 1) Endoscopic finding 2)Histologic examination
CMV - Serpiginous Ulcers and invades the endothelial and fibroblast cells // HSV - Esophageal Vesicles and invades the epithelial cells
This connective tissue disease known for its significant esophageal involvement caused by small-vessal vasculitis and proliferation of connective tissue fibrosis of multiple organs particualrly the smooth muscle in the GI tract
Scleroderma / Progressive systemic sclerosis
