Esophageal Diseases

Question 1

erosion vs ulcer

Answer 1

superficial w/ only mucosa, heals by regeneration w/o scar

ulcer: deeper, mucosa and deeper layers, has scar

Question 2

pryosis

Answer 2

heartburn

Question 3

pathophys of achalasia

Answer 3

lack of peristalsis in esophagus, non relaxation of LES

can be caused by chagas disease T cruzi (inflammatory infiltrate in myenteric plexus)

Question 4

clinical pres of achalasia

Answer 4

dysphagia, chest pain, heartburn, regurg

bird beak on barium swallow, (dilated esophagus)

Question 5

tx for achalasia

Answer 5

botulinum toxin injection (ACh presynaptic blocker)

pneumatic (balloon) dilation

Heller myotomy

Question 6

jackhammer esophagus

Answer 6

hypercontractile peristalsis causing chest pain and dysphagia

Question 7

ineffective esophageal motility

Answer 7

weakened peristalsis- the CHF of esophageal disease

Question 8

manometry of scleroderma esophagus

Answer 8

aperistalsis of the esophagus, weak LES, retained upper esophageal motility

Question 9

causes of esophagitis

Answer 9

infection- candida, CMV, herpes

drug/pill

corrosive/chem- lye

eosinophilic

GERD

often in immunocompromised, DM, ETOH, old age

Question 10

most common esophageal pathogen

Answer 10

candida

Question 11

pseudomembranes

Answer 11

white plaques seen in candidiasis

made of psuedohyphea, necrotic debris, PMNs

Question 12

histopath of herpetic esophagitis

Answer 12

infects epithelial cells, collects in nucleus w/ ground glass appearance

3 Ms- margination, multinucleation, molding

Question 13

CMV histopath

Answer 13

infection of lamina propria cells like endothelium and fibroblasts

nuclear inclusions and cytomegaly

Question 14

alkali vs acid esophagitis

Answer 14

alkali- liquifactive (worse)

acid- coagulative

Question 15

gross path of eos esophagitis

Answer 15

edema rings, white plaques from eo abscesses

Question 16

list some red flags for GERD Dx

Answer 16

weight loss, vomiting, bleeding, anemia, dysphagia, jaundice, abdominal mass, older age at onset

Question 17

non medical tx for GERD

Answer 17

avoid reflux foods, acidic foods, weight loss, smoking cessation, raise head of bed

Question 18

barretts esophagus

Answer 18

metaplasia of normal esophageal epithelium to intestinal columnar

Question 19

risks for squamous vs adeno

Answer 19

squamous: tobacco, alcohol, maybe HPV
adeno: GERD/Barretts, obesity, tobacco

Question 20

histopath of dysplasia

Answer 20

nuclear changes- dark, mitotic, prominent nucleoli

Question 21

histopath of squamous cell

Answer 21

nets of atypical squamous epithelium, no glands

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