Chapter 69 : Diseases of the Esophagus

Question 1

Dysphagia refers to the sensation of food being delayed in its normal passage from mouth to stomach. Differentiate Oropharyngeal from Esophageal Dysphagia

Answer 1

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

Question 2

______ is defined as a sensation of a lump in the throat in which food transport is not limited

Answer 2

Globus

Question 3

oropharyngeal swallow is best assessed by _______

Answer 3

Videofluoroscopy

Question 4

______ is the fined as appearance of acid or bitter taste in the mouth

Answer 4

Regurgitation

Question 5

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.

Answer 5

Water Brash - the mechanism is vagally mediated

Question 6

The squamocolumnar junction can be recognized by the _____ which demarcates the interface between the light pink squamous mucosa and the red columnar gastric mucosa

Answer 6

Z line

Question 7

The gastroesophageal junction is defined by this specific part of the gastric mucosa

Answer 7

proximal margin of the gastric folds

Question 8

True or False, the squamocolumnar junction and GEJ are synonymous

Answer 8

The two are not synonymous, In patients with Barrett esophagus (BE), the squamocolumnar junction is more proximal in the esophagus than the GEJ is

Question 9

In normal esophageal manometry, the distal wave amplitudes measured range from ___ to ___ mm Hg while the basal LES pressure is about?

Answer 9

30 to 180 mm Hg ; 10 to 45 mm Hg

Question 10

In 24 hour pH probe monitoring, a reflux episode is defined as a drop in pH below _____

Answer 10

pH drops below 4.0. This value is chosen on the basis of the proteolytic activity of pepsin

Question 11

_____ refers to regurgitation of duodenal contents through the pylorus into the stomach with subsequent reflux into the esophagus

Answer 11

Duodenogastroesophageal reflux

Question 12

Only diagnostic tool that allows for measurement of both acidic and nonacidic refluxate of liquid ang gas consistency

Answer 12

Multichannel intraluminal impedance (MII)

Question 13

_____ 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

Answer 13

Bernstein test - rarely used and mostly of historic value only

Question 14

_____ is a primary esophageal motility disorder of unknown etiology characterized by insufficient LES relaxation and loss of esophageal peristalsis.

Answer 14

Achalasia

Question 15

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

Answer 15

Diffuse esophageal spasm

Question 16

The classic radiologic finding in Diffuse Esophageal Spasm

Answer 16

“Corkscrew” Esophagus

Question 17

_____is another common manometric diagnosis in patients with noncardiac chest pain. It is defined by high-amplitude peristalsis

Answer 17

Nut Cracker Esophagus

Question 18

Ineffective esophageal motility is a hypocontractile disorder, defined by a distal esophageal contraction amplitude of less than ______ in 30% or more of wet swallows

Answer 18

30 mm Hg

Question 19

Secondary motility disorders are commonly a result of systemic conditions. The most common condition that affects esophageal motility is___,or___

Answer 19

scleroderma, or progressive systemic sclerosis (PSS)

Question 20

The normal esophagus measures _____ in diameter

Answer 20

20 mm

Question 21

The predominant clinical symptom of strictures is dysphagia, which is usually most prevalent when the luminal diameter is less than _____.

Answer 21

15 mm

Question 22

The goal of esophageal dilation is to obtain an objective diameter greater than _____

Answer 22

15 mm

Question 23

In dilation of esophageal strictures, to minimize this risk, the so-called rule of threes applies defined as ____

Answer 23

no more than three sequential dilators are to be used per session

Question 24

Plummer-Vinson or Paterson-Kelly syndrome to the triad that consists of _____

Answer 24

proximal esophageal webs, iron deficiency anemia, and dysphagia

Question 25

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

Answer 25

Schatzki ring, also known as a B-ring,

Question 26

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

Answer 26

A-ring

Question 27

This disease entity is often consists of endoscopic findings of multiple esophageal rings in patients with dysphagia

Answer 27

Esosinophilic Esophagitis AKA ringed, feline, or corrugated esophagus

Question 28

The eosinophil density required for the diagnosis of eosinophilic esophagitis is generally _____(diagnostic criteria) on both proximal and distal esophageal biopsies

Answer 28

more than 15 eosinophils per high-power field

Question 29

Most common classification system to characterize the severity of esophagitis

Answer 29

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)

Question 30

Gross pathognomonic endoscopy finding of barret esophagus

Answer 30

Salmon pink mucosa

Question 31

Classification of Barrett Esophagus

Answer 31

Short sgement <3 cm vs Long segment >3cm from the gastroesophageal junction

Question 32

Presence of these cells is characteristic of intenstinal metaplasia seen in Barrett Esophagus

Answer 32

Mucin-containing Goblet cells

Question 33

Most comon site for esophageal SCC? (proximal, middle, and distal esophagus) what about for esophageal adenocarcinoma?

Answer 33

SCC: middle esophagus / Adenoca: distal esophagus (at the GEJ)

Question 34

Zenker’s Diverticulum form as a result of increased pressure in this specific area and its borders

Answer 34

Killian triangle (between cricopharyngeus and inferior pharyngeal constrictor muscle)

Question 35

Esophageal diverticula are most practically classified anatomically into the following four categories

Answer 35

1) Zenker diverticula, 2) midesophageal diverticula, 3) epiphrenic diverticula, and 4) intramural pseudodiverticulosis.

Question 36

2 types of mid esophageal diverticula

Answer 36

Traction midesophageal diverticula (Only true diverticula in the esophagus) VS Pulsion midesophageal diverticula

Question 37

Three most common causes of infectious esophagitis

Answer 37

Candida albicans, Cytomegalovirus, Herpes Simplex Virus

Question 38

Differentiate CMV vs HSV esophagitis in terms of 1) Endoscopic finding 2)Histologic examination

Answer 38

CMV - Serpiginous Ulcers and invades the endothelial and fibroblast cells // HSV - Esophageal Vesicles and invades the epithelial cells

Question 39

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

Answer 39

Scleroderma / Progressive systemic sclerosis