Clinical Esophageal Symptoms.

Question 1

List five esophageal symptoms.

Answer 1

Dysphagia, odynophagia, chest pain, heartburn, regurgitation

Question 2

What are the symptoms of dysphagia? What does it mean if the problem is with solids? solids and liquids? How is it diagnosed?

Answer 2

Dysphagia

Difficulty eating

Anatomic abnormalities (solids)

Motility disorders (solids+liquids)

Mechanical narrowing vs abnormal
sensory perception

Symptoms vary with degree of
obstruction

Endoscopy +/- barium radiograph

Question 3

What is odynophagia? What is the cause? What causes that? How is it diagnosed?

Answer 3

Odynophagia

Pain with swallowing

Ulcerations in esophagus

Infections/inflammation, medications/irritants

Endoscopy

Question 4

What should you do if a patient has chest pain? What esophogeal diseases might cause chest pain?

Answer 4

Chest pain

Squeezing, burning in epigastric

Rule out cardiac

Look for co-existent esophageal symptoms
(50%)

Motility disorders, hypersensitivity, GERD,
ulcers

Question 5

What are 3 esophageal diverticuli?

Answer 5

Most are acquired outpouchings of the esophagus

Zenker?s diverticulum

Traction diverticulum-

Epiphrenic diverticulum-

Question 6

What is a zenkers diverticulum? What causes it? When does it present? What are the symptoms? How do you diagnose it? Treat it?

Answer 6

Posterior to the cricopharyngeous muscle

? Disordered UES coordination

5th-8th decades, usually male

Mass lesion, regurgitation, oropharyngeal
dysphagia, halitosis, respiratory complications

Barium swallow

Surgical myotomy

Question 7

Where does a traction diverticulum occur? What might it be related to?

Answer 7

midpoint of esophagus

May be related to granulomatous inflammation
histoplasmosis/TB in adjacent lymph nodes

Question 8

Where does an epiphrenic diverticulum occur? What might it be associated with?

Answer 8

above LES

Associated motility disorder

Question 9

What are esophageal rings? What is one name for them? Where do they occur? What causes them? What are the symptoms? How are they treated?

Answer 9

Schiatzki?s ring - Mucousal ring at GE
junction

Marks the squamocolumnar junction

Congenital or acquired (acid related)

5-10% of patients (via radiography

or endoscopy)

Intermittent solid food dysphagia

Treat with dilation if symptomatic

Question 10

Where do esophageal webs occur? What are they like? Which patients do they occur in? What are the symptoms?

Answer 10

Cervical/Mid esophagus

Anterior projections usually

Thin stratified squamous epithelium

Older women, skin blistering diseases,
chronic GVHD, GERD

Solid food dysphagia

Question 11

Describe Plummer Vinson Syndrome? What are they more at risk for?

Answer 11

Plummer Vinson syndrome

Dysphagia

Cervical web

Glossitis/Cheilosis

Iron deficiency anemia

May be at increased risk of squamous cell
carcinomas of pharynx/esophagus

Question 12

What is an esophageal stricture? What are some causes? What are some risk factors? How does it present? How is it diagnosed?

Answer 12

Peptic is one cause (infectious, radiation,
caustic,etc)

Risk factors: acid reflux, male, long
duration, weak LES

Symptoms: progressive dysphagia over
months

EGD: symptoms if lumen
< 13 mm diameter

Question 13

Describe the two types of hiatal herniation.

Answer 13

Herniation of abdominal
contents through
esophageal hiatus

Type 1: GE junction
slides above diaphragm

Most common

Type 2: Paraesophageal-
GE junction fixed

Most incidentally
found

Treat if symptomatic

Elective indications
(dysphagia, anemia,
vomiting, GERD)

Acute complications
(volvulus, bleeding,
respiratory distress,
obstruction)