Esophageal diseases

Question 1

Atresia and TEF- Congenital causes? (2)

Answer 1

Down syndrome
Duodenal atresia

Question 2

Atresia and TEF- Acquired causes? (4)

Answer 2

Trauma
Endotracheal tube
Esophageal TB
Malignant tumors (esophageous, trachea)

Question 3

Atresia and TEF Presentation (4)

Answer 3

Abdominal distension (air in stomach)
Coughing, choking, cyanosis (with feeding)
Vomiting (with feeding)
Aspiration pneumonia (acquired)

Question 4

Heterotopia (4)

Answer 4

Pancreatic tissue
Gastric mucosa

Mimic tumor endoscopy, mucosal ulceration (stomach acid)

Question 5

Esophageal Webs and Rings- Presentation

Answer 5

Ring —> mucosa, submucosa, muscle
Web —> mucosa, submucosa (w/out muscle)

DYSPHAGIA

(‘most common structural abnormality)

Question 6

Esophageal Webs and Rings- causes (4)

Answer 6

Congenital
Iron deficiency anemia
Esophagitis (inflammatory)
Autoimmune disorders

Question 7

Esophageal Diverticulum

Answer 7

Outpouching of esophageal mucosa

(congenital or increased luminal pressure)

Question 8

Esophageal Diverticulum- Presentation (5)

Answer 8

Dysphagia
Regurgitation of food
Aspiration pneumonia
Weight loss
Halitosis

Question 9

Esophageal Diverticulum- Diagnosis and Treatment

Answer 9

Barium swallow NOT Endoscopy (may miss pouch)

Surgery to remove diverticula

Question 10

Causes of Esophagitis (inflammatory disorders) (8)

Answer 10

Infections (candida, HSV)
Chemical (corrosive)
Eosinophilic
Graft vs host disease
Lymphocytic
Pill-induced
Radiation
Reflux (GERD)

Question 11

Differentiate Candida and HSV

Answer 11

Candida —> Hyphae
HSV —> Large abnormal multinucleated cells

Question 12

Presentation of Esophageal infections (3)

Answer 12

Dysphagia
PAIN on swallowing
Vomiting
(fever)

Question 13

Underlying causes of Esophageal infections (3)

Answer 13

HIV
Chemotherapy
Organ transplantation

(IMMUNOSUPRESSED —> reduce immunosupression)

Question 14

Chemical (corrosive) Esophagitis- Presentation (3)

Answer 14

STRICTURE
Barret’s esophageous
Squamous cell carcinoma

(massive and severe ulcerations)

Question 15

Eosinophilic Esophagitis (2)

Answer 15

Chronic immune-mediated
Children with allergic diseases (eczema, asthma)

Question 16

Eosinophilic Esophagitis- Presentation (4)

Answer 16

Food impaction
Dysphagia (adults)
Feeding intolerance (children)
GERD-like symptoms (children)

Question 17

Eosinophilic Esophagitis- Diagnosis

Answer 17

Endoscopy —> rings in upper esophageous

Question 18

Eosinophilic Esophagitis- Treatment

Answer 18

Good response —> steroids (predinoslone)
Poor response —> antacids and PPI

Question 19

Pill-induced Esophagitis (4)

Answer 19

Iron defeciency
Iron pill therapy
Esophageal ulcerations
Usually in women

Question 20

Lymphocytic Esophagitis (2)

Answer 20

Lymphocytic Gastritis, Colitis
Dysphagia (and pain on swallowing)

Question 21

Graft vs Host Disease (4)

Answer 21

Bone marrow transplantation
Inflammation
Damage to basal layer
(HO Organ transplant)

Question 22

Radiation Esophagitis (2)

Answer 22

Giant cells
Ulceration + necrosis
Atypical cells (pleomorphic cells)

Question 23

Reflux Esophagitis / GERD- Causes (3)

Answer 23

Most frequent cause of Esophagitis
Decrease LES tone
Increased abdominal pressure

Question 24

Reflux Esophagitis / GERD- Risk factors (7)

Answer 24

Alcohol
Tobacco
Obesity
CNS depressants
Pregnancy
Hiatal hernia
Delayed gastric emptying

Question 25

Reflux Esophagitis / GERD- Complications (4)

Answer 25

Ulceration Stricture Barret Esophagous (untreated acid reflux —> mucosa turns glandular due to metaplasia) Iron defeciency anemia (chronic bleeding ulcer in GI tract, if elderly —> colon cancer bleed)

Question 26

Achalasia Triad

Answer 26

1- Incomplete LES relaxation 2- Increased LES tone 3- Esophageal aperistalsis

Question 27

Primary Achalasia (2)

Answer 27

Failure of distal esophageal inhibitory neurons Idiopathic

Question 28

Secondary Achalasia (2)

Answer 28

Degenerative changes in intrinsic/extrinsic neural innervation Chagas Disease (Trypanosoma cruzi infection) (damages ganglion cells (myenetric plexus) of esophagus —> Achalasia)

Question 29

Chagas Disease

Answer 29

Achalasia Colonomegaly Heart failure

Question 30

Achalasia-like Disease (5)

Answer 30

Diabetic neuropathy Infiltrative malignancy Amyloidosis Sarcoidosis Surgical ablation

Question 31

True Achalasia

Answer 31

True —> due to Sphincter Achalasia like —> Esophagus gets dilated, nothing to do with relaxation of sphincter

Question 32

Collagen Vascular Disease (2)

Answer 32

Chronic inflammation in connective tissues FEVER, SKIN RASH, VASCULITIS, DYSPHAGIA, DILATED ESOPHAGUS

Question 33

Collagen Vascular Disease- Pathological changes (3)

Answer 33

Fibrosis Inflammation Vasculitis

Question 34

Collagen Vascular Disease- Effect on Esophagus (3)

Answer 34

Reduced peristalsis Reduced sphincter tone REFLUX esophagitis

Question 35

Collagen Vascular Disease- CREST Syndrome

Answer 35

Calcinosis Raynaud’s phenomenon Esophageal involvement (acid reflux + decreased motility) Sclerodactylyl Telengecstasia

Question 36

Collagen Vascular Disease- Examples (8)

Answer 36

Ankylosying spondylitis Dermatomyotitis Polyarteries nodosa Polymyositis Psoriatic arthritis Rheumatoid arthritis Scleroderma SLE

Question 37

Autoimmune bullous (2)

Answer 37

Bullous pemphigoid Pemphigus vulgaris

Question 38

Lichen planus

Answer 38

Inflammation of esophagus Squamous cell carcinoma (red-purple)