Diseases and pathology of the esophagus

Question 1

difficulty swallowing –> nasal regurgitation, aspiration

Answer 1

dysphagia

Question 2

neurologic etiologies of propulsive/motility oropharyngeal diseases

Answer 2

stroke, ALS, Parkinson’s, MS, Polio

Question 3

muscular etiologies of propulsive/motility oropharyngeal diseases

Answer 3

myasthenia gravis, muscular dystrophy, muscle injury (surgery, radiation therapy)

Question 4

Zenker’s diverticulum, crycopharyngeal bar, thyromegaly, fibrosis

Answer 4

benign structural oropharyngeal diseases

Question 5

outpouching of esophagus –> food regurgitation or bacterial colonization (halitosis)

Answer 5

Zenker’s diverticulum

Question 6

Malignant structural oropharyngeal diseases

Answer 6

Squamous cell carcinoma of the tongue, oropharynx, soft palate or upper larynx

Question 7

dysphagia to BOTH solids and liquids, chest pain

excluding structural lesion

Answer 7

esophageal motility disorders

Question 8

Etiologies of esophageal motility disorders

Answer 8

Achalasia, spastic disorders of the esophagus, weak peristalsis, scleroderma

Question 9

diagnosis of esophageal motility disorders

Answer 9

exclude structural lesion (upper endoscopy or barium esophagram), esophageal manometry

Question 10

idiopathic, impaired relaxation of LES

Answer 10

achalasia

Question 11

achalasia epidemiology

Answer 11

both genders, all races, adults

Question 12

Achalasia manometry findings

Answer 12

Type I (classic) = swallowing –> no significant change in esophageal pressurization

Type II = swallowing –> simultaneous pressurization spanning entire esophagus length

Type III (spastic) = swallowing –> abnormal, lumen obliterating contractions/spasms

Question 13

treatment of Type II achalasia

Answer 13

botox, pneumatic dilation, surgical myotomy

Question 14

pathophysiology of achalasia

Answer 14

loss of inhibitory neurons in myenteric plexus –> unopposed excitatory (cholinergic) neurons –> hypertensive nonrelaxed esophageal sphincter

Question 15

Direct mechanical obstruction of LES

Answer 15

pseudoachalasia

Question 16

Causes of pseudoachalasia

Answer 16

infiltrative submucosal invasion, paraneoplastic, Chagas disease

Question 17

medical treatment for achalasia

Answer 17

if contraindications to dilation or surgery

nitrates, Ca channel blockers, sildenafil

Question 18

multisystem disorder featuring obliterative small vessel vasculitis, fibroses of mutiple organs

GI = smooth muscle atrophy and gut wall fibrosis

Answer 18

scleroderma

Question 19

peristalsis preserved

due to overactivity of excitatory nerves or overreactivity of smooth muscle response

Answer 19

spastic disorders of the esophagus

Question 20

dysphagia to solids, and eventually liquids much later
weight loss (ominous)
heartburn (sometimes)

Answer 20

structural esophageal dysfunction

Question 21

strictures (GERD, caustic), Schatzki’s ring, eosinophilic esophagitis, extrinsic compression

Answer 21

benign structural esophageal disorders

Question 22

Malignant structural esophageal disorders

Answer 22

Esophageal cancer (adenocarcinoma, SCC), metastasis (rare), direct invasion

Question 23

DYSPHAGIA TO SOLIDS, painless, regular/daily basis sx, weight loss

Answer 23

esophageal stricture

Question 24

treatment of benign esophageal stricture

Answer 24

endoscopic dilation using balloons or sequential commercial dilators

Question 25

infiltration of eosinophils in esophagus. food avoidance, dysphagia

Answer 25

eosinophilic esophagitis

Question 26

EoE demographics

Answer 26

white, middle aged men associated with atopy, asthma, allergies

Question 27

EoE treatment

Answer 27

3D's | Drugs (TOPICAL steroids), diet, dilation

Question 28

dietary treatment of EoE

Answer 28

eliminate milk, eggs, wheat, soy, seafood, nuts

Question 29

post-prandial (after meal) heartburn, regurgitation with acidic taste, relieved by antacids or anti-secretory meds

Answer 29

GERD

Question 30

Causes of GERD

Answer 30

inappropriate LES relaxation, hiatal hernia, surgery rare: Zollinger-Ellison, Sjogren's, Scleroderma

Question 31

Risk factors for GERD

Answer 31

obesity, tobacco, meds, pregnancy

Question 32

complications of GERD

Answer 32

erosive esophagitis, Barrett's esophagitis

Question 33

Barrett's esophagus

Answer 33

acid --> change in esophageal epithelium from squamous to columnar

Question 34

risk factors for Barrett's esophagus

Answer 34

old, fat, white men

Question 35

Complications of Barrett's esophagus

Answer 35

risk of adenocarcinoma

Question 36

Treatment of Barrett's esophagus

Answer 36

Endoscopic ablation of Barrett's tissue | endoscopic resection of visible lesions

Question 37

infectious etiologies of esophagitis

Answer 37

fungal (candida), viral (HSV)

Question 38

EGD --> punched out ulcers | histology --> viral inclusions

Answer 38

herpetic esophagitis

Question 39

EGD --> white plaques | histology --> long, thin eosinophilic inclusions

Answer 39

candida esophagitis

Question 40

EGD --> ringed esophagus, linear furrows | histology --> many eosinophils

Answer 40

eosinophilic esophagitis

Question 41

disorders leading to functional esophageal obstruction

Answer 41

nutcracker esophagus, diffuse esophageal spasm, hypertensive LES, achalasia

Question 42

disorders leading to structural esophageal obstruction

Answer 42

diverticula, esophageal mucosal webs/rings, congenital abnormalities, benign esophageal stenosis, tumors

Question 43

congenital anomalies resulting from failure of the foregut to divide into trachea and esophagus during the 4th week of embryonic development

Answer 43

esophageal atresia and tracheoesophageal fistula

Question 44

food regurgitation, drooling, aspiration

Answer 44

esophageal atresia and tracheoesophageal fistula

Question 45

which form of tracheoesophageal fistula is associated with repeated bouts of pneumonia?

Answer 45

H shape

Question 46

diffuse esophageal spasms | barium swallow --> corkscrew pattern

Answer 46

corkscrew esophagus

Question 47

barium swallow --> megaesophagus with "bird beak" at lower esophagus

Answer 47

achalasia

Question 48

EGD --> Mallory-Weiss tears

Answer 48

alcohol intoxication --> severe retching or vomiting

Question 49

esophageal varicies

Answer 49

cirrhosis

Question 50

Barrett's esophagus histology --> elongated dark nuclei

Answer 50

low-grade dysplasia

Question 51

Barrett's esophagus histology --> rounded nuclei, crowded glands

Answer 51

high-grade dysplasia --> high risk for adenocarcinoma progression