Esophageal Disorders

Question 1

What is dysphagia?

Answer 1

Inability to swallow

Question 2

What is odynophagia?

Answer 2

Painful swallowing

Question 3

About how far is it from the mouth to the stomach?

Answer 3

40 cm

Question 4

Name 3 normal indentations in the esophagus.

Answer 4

1. Arch of the Aorta
2. Left main bronchus
3. Left Atrium

Question 5

Name 2 congenital aorta malformations that affect the esophagus and describe them.

Answer 5

1. Double Aorta Arch: two arches form and surround the esophagus
2. Dysphagia Lusoria: right subclavian artery forms behind the esophagus and compresses it.

Question 6

Name 3 muscles that make up the UES.

Answer 6

1. Inferior constrictor
2. Cricopharygeus
3. Proximal Esophagus

Question 7

Structure that signifies transition from esophagus to stomach.

Answer 7

Z-line

switch from stratified squamous to columnar cells

Question 8

What are Zenker’s Diverticula?

Answer 8

Pharyngeal pouch that herniates thru the posterior part of the UES during cricopharyngeus spasm. Can collect food during swallowing.

Question 9

What is a Plummer Vinson Web?

Answer 9

Fold of mucosa tissue that causes narrowing of the esophagus usually proximally.

Question 10

What two other things accompany a Plummer Vinson Web?

Answer 10

This triad is made up of:

1. The web
2. Dysphagia
3. Iron deficiency anemia

most often seen in post menopausal women

Question 11

What is a Schatzki Ring?

Answer 11

Actually a web of mucosa that forms just above the LES. Associated with steakhouse syndrome since it can be caused by not properly chewing food.

Question 12

Name the two most common types of infections in the esophagus and who is prone to these infections.

Answer 12

1. Fungal
2. Larval
   - immunocompromised patients

Question 13

How do Cowdry Bodies relate to the esophagus?

Answer 13

The are eosinophilic inclusions found in cells infected with Herpes Simplex viruses.

Question 14

Most common benign tumor in the esophagus and how is it treated?

Answer 14

Leiomyoma: don’t biopsy, remove it completely and if necessary biopsy the removed tissue. Most often occurs distally.

Question 15

What is a benign stricture and how is it most often caused?

Answer 15

Narrowing of the esophagus due to try swallowing. Usually patients taking pills without water. Disrupts peristalsis.

Question 16

Name the two major types of caustic ingestions and how they damage the GI tract.

Answer 16

1. Acidic: mostly damage the stomach thru coagulation necrosis.
   ex. battery acid
2. Alkaline: mostly damage the esophagus thru liquefactive necrosis.
   ex. drain cleaners

Question 17

What is a paraesophageal hernia?

Answer 17

Herniation of the fundus of the stomach thru the esophageal hiatus of the diaphragm. Can create a volvulus resulting in necrotic tissue.

Question 18

How are a hiatal hernia and a paraesophageal hernia treated?

Answer 18

Hiatal: usually benign. Only large ones need treatment if the compromise breathing.

Para: requires emergent surgical repair.

Question 19

What is Boerhaave Syndrome?

Answer 19

Esophageal Rupture do to increased pressure in the esophagus due to possibly vomitting. Most often occurs to the left resulting in a left pleural effusion.

Question 20

What is a Mallory Weiss tear?

Answer 20

Laceration of the distal esophagus. Patients often vomit bright red blood that does not clot.

Question 21

What does sialorrhea often indicate?

Answer 21

Esophageal obstruction.

Question 22

What is the rule for removing coins that were swallowed?

Answer 22

Rule of 7’s.
If the coin remains in the esophagus for longer than 7 min. remove it

If it remain in the stomach for more than 7 hrs. remove it.

Question 23

Name 3 conditions that can lead to the loss of peristaltic drive in the esophagus.

Answer 23

1. Degeneration of dorsal motor nucleus of the vagus
2. Degeneration of vagus nerve fibers
3. Loss of enteric ganglion (ex. chagas disease)

Question 24

What is the bird beak sign?

Answer 24

Chest X-rays with barium contrast will show a dilated esophagus with a sharp narrowing in the area of the LES. This indicates achalasia.

Question 25

How can scleroderma lead to esophageal pathology?

Answer 25

Originally called CREST syndrome (calcinosis, Raynaud’s, esophageal dysfunction, sclerodactyly, telangiectasia). This autoimmune disease results in fibrosis of smooth muscle leading to:

1. hypotonic LES and reflux
2. poor peristalsis

(remember anti-nuclear antibodies for diagnosis)

Question 26

What is necessary for endoscopic diagnosis of Eosinophilic Esophagitis?

Answer 26

Endoscopic Confirmation: 15eos/hpf
(15 eosinophils / high powered field)

Furrows, strictures, rings

Question 27

What is the general primary treatment for EoE?

Answer 27

Swallowed steroids

Question 28

What is a secondary treatment for EoE?

Answer 28

The pathophys of EoE is not fully understood but most research points toward allergic reaction to certain foods. Restriction of certain common food allergy groups is another treatment.
(wheat, nuts, eggs, soy, milk, seafood)

Question 29

Major risk in treating EoE with swallowed steroids.

Answer 29

Candidiasis

Question 30

How can you differentiate a hypertensive LES from achalasia?

Answer 30

Achalasia is a neurologic issue. Manometry will show high pressure at the LES along with inconsistent or absent peristalsis.

A hypertensive LES will show high pressure at the LES in manometry with normal peristalsis.

Question 31

What is the most common esophageal motility disorder?

Answer 31

Nutcracker Esophagus.

-manometry will show “off the chart” peaks in multiple locations