esophageal disease

Question 1

longitudinal tears at GE junction or proximal gastric mucosa. usually due to severe retching associated with alcoholism

Answer 1

esophageal laceration

Question 2

incomplete tear on the gastric side of the gastroesophageal junction which may extend to the distal esophagus

Answer 2

mallory-weiss syndrome

Question 3

complete rupture at the lower thoracic esophagus which leads to bleeding into the posterior mediastinum

Answer 3

boerhaave’s syndrome

Question 4

2 antireflux mechanism

Answer 4

1. lower esophageal sphincter

2. crural diaphragm- external sphincter

Question 5

three different mechanisms of LES incompetence in gastroesophageal reflux

Answer 5

1. hypotensive LES
2. increased intraabdominal pressure- obesity and pregnancy
3. TLESR/ inappropriate LESR

Question 6

factors that increase LES pressure

Answer 6

1. Proteins
2. gastrin
3. metaclopramide

Question 7

factors that decrease LES pressure

Answer 7

1. fatty foods
2. nicotine
3. theophylline

Question 8

transient lower esophageal sphincter relaxations motility disorder (LES hypotension)

Answer 8

GERD

Question 9

NERD

Answer 9

GERD that is non-erosive

Question 10

mechanism of heartburn in pregnancy

Answer 10

1. hormonal due to the increase in estrogen and progesterone that leads to a dysfunctional LES
2. mechanical with the increase in intra-abdominal pressure

Question 11

treatment (2)

Answer 11

1. lifestyle modifications

2. med such as antacids, H2A and PPI

Question 12

causes of esophagitis (4)

Answer 12

1. reflux
2. pill-induced- ulcer formation with acne meds
3. infectious- immunocompromised patient
4. eosinophilic- allergic patient

Question 13

histo triad for reflux esophagitis

Answer 13

1. intraepithelial eosinophilia
2. Basal zone hyperplasia
3. papillary elongation

Question 14

infectious esophagitis can be caused by

Answer 14

candida and herpes simplex

Question 15

what is important about the diagnosis of eosinophilic esophagitis

Answer 15

the count we need > 15 eos in proximal and distal esophagus–> the eos limited to the esophagus

Question 16

eosinophilic esophagitis results in barrett’s and malignancy

Answer 16

nope- no known long term effect

treatment is PPI, inhaled steroid and lifestyle changes to prevent food impaction

Question 17

distal squamous mucosa is replaced by metaplastic columnar epithelium as a response to chronic injury from acid reflux

Answer 17

Barrett’s

Question 18

barretts is a major risk for

Answer 18

esophageal adenocarcinoma

Question 19

barrett’s treatment

Answer 19

1. PPI
2. radio-frequency ablation for those with dysplasia

• endoscopic surveillance every 1-3 years

Question 20

esophageal cancer is the ninth most prevalent cancer worlwide but less than 1% of all cancers in US, but incidence has been increasing with a shift from

Answer 20

squamous cell carcinoma to adenocarcinomas

Question 21

reduced risk in developing esophageal adenocarcinoma

Answer 21

H.pylori infection- there is lower gastric acid

Question 22

location of esophageal adenocarcinoma

Answer 22

distal esophagus

Question 23

location of esophageal squamous cell CA

Answer 23

more proximal esophagus

Question 24

risk factor for esophageal squamous cell CAA

Answer 24

tobacco which might be synergistic with alcohol

Question 25

esophageal squamous cell CAA 1. common in men or female 2. ethnicity

Answer 25

1. men | 2. african american

Question 26

invasion into muscularis propria at presentation but 30-40% have invasion of adjacent mediastinal structures causing fistulas and 50% have lymph node metastases

Answer 26

esophageal squamous cell CAA

Question 27

prevention of esophageal cancer

Answer 27

1. PPI 2. aspirin and NSAIDs 3. statins

Question 28

esophageal dysphagia

Answer 28

food sticks

Question 29

oropharyngeal dysphagia

Answer 29

difficulty in initiating swallowing with coughing, choking and nasal regurgitation

Question 30

solid food only dysphagia is

Answer 30

MECHANICAL OBSTRUCTION

Question 31

solid food and liquids dysphagia

Answer 31

NEUROMUSCULAR DISORDER

Question 32

solid food only dysphagia is a mechanical obstruction 1. progressive symptoms 2. intermittent symptoms

Answer 32

1. progressive symptoms - chronic heartburn? peptic ulcer. age> 50 yr? carcinoma 2. intermittent symptoms - esophageal ring

Question 33

solid food and liquids dysphagia is a neuromuscular disorder 1. progressive symptoms 2. intermittent symptoms

Answer 33

1. progressive symptoms - chronic heartburn? scleroderma. respiratory symptoms? achalasia 2. intermittent symptoms- chest pain? diffuse esophageal spasm

Question 34

esophageal ring can be identified by

Answer 34

barium swallow

Question 35

inflammatory disorder at LES with selective destruction of NO containing neurons. Unopposed ach action at lES leads to excessive contraction

Answer 35

achalasia

Question 36

achalasia can be diagnosed with

Answer 36

1. barium swallowing- bird's beak | 2. motility tracing- LES hypertension

Question 37

treatment of alchalasia

Answer 37

1. nitrates, calcium channel blockers 2. pneumonic dilation 3. myotomy

Question 38

esophageal gastric junction outflow obstruction results in

Answer 38

incompletely expressed achalasia due to the high pressures LES

Question 39

distal esophageal spasm has ______ LES function and multiple premature contractions

Answer 39

normal

Question 40

jackhammer esophagus

Answer 40

hypercontractile motility diosrder with prolonged high amplitude contractions but the LES pressure is normal

Question 41

weak, low amplitude contractions with low LES pressure . associated with reflux esophagitis

Answer 41

scleroderma