Esophageal disorders

Question 1

Common site of esophageal atresia

Answer 1

At or near the tracheal bifurcation

Question 2

Common association with esophageal atresia

Answer 2

Tracheoesophageal fistula

Question 3

Genetic defect associated with esophageal atresia

Answer 3

Altering of SHH signaling

Question 4

What germ layer is tracheoesophageal septum derived from?

Answer 4

Mesoderm

Question 5

Genetic syndromes associated with tracheoesophageal fistula

Answer 5

Trisomy 21, 18, and partial 13

Question 6

VACTERAL syndrome

Answer 6

Vertebral defects
Anal atresia
Cardiac defects
Tracheoesophageal fistula
Renal dysplasia
Limb abnormalities

Question 7

Genetic defect associated with radiologic finding of distal esophagus and stomach filled with air

Answer 7

Tracheoesophageal fistula

Question 8

Possible esophageal causes of dysphagia

Answer 8

Stenosis
Webs
Rings
Diverticulum
Motility disorders
Achalasia
Ectopic tissue

Question 9

Causes of acquired esophageal stenosis

Answer 9

Inflammatory scarring caused by GERD, irradiation, systemic sclerosis, or caustic injury

Question 10

Ledge-like/semi-circumferential protrusions of mucosa seen in the upper esophagus, typically in women over 40 yo

Answer 10

Esophageal webs

Question 11

Composition of esophageal webs

Answer 11

Fibrovascular CT and overlying epithelium

Question 12

Triad of Plummer-Vinson syndrome

Answer 12

Cervical esophageal web
Mucosal lesions of mouth and pharynx
Iron deficiency anemia

Question 13

Complication of Plummer-Vinson syndrome

Answer 13

Carcinoma of oropharynx and upper esophagus

Question 14

How to diagnose esophageal web?

Answer 14

EGD
Barium esophagogram

Question 15

2 circumferential rings of distal esophagus

Answer 15

Muscular A ring
Schatzki or mucosal B ring

Question 16

Band of hypertrophied muscle at the proximal border of LES. Lined by squamous epithelium.

Answer 16

Muscular A ring

Question 17

Lower esophageal narrowing, usually seen at GE junction. Composed mainly of mucosa and submucosa.

Answer 17

Schatzki ring (B ring)

Question 18

Epithelium of upper surface of Schatzki ring

Answer 18

Stratified squamous epithelium

Question 19

Epithelium of lower surface of Schatzki ring

Answer 19

Columnar epithelium

Question 20

Symptoms of Schatzki ring

Answer 20

Usually asymptomatic, may have intermittent dysphagia

Question 21

Weak area between cricopharyngeus and thyropharyngeus

Answer 21

Killian’s triangle

Question 22

Caused by increased pressure within the distal pharynx

Answer 22

Zenker’s diverticulum

Question 23

Complication of middle esophageal diverticulum

Answer 23

Adhesions to mediastinal lymph nodes

Question 24

Association of middle esophageal diverticulum

Answer 24

Tuberculosis

Question 25

Clinical features of large Zenker's diverticulum

Answer 25

Halitosis Dysphagia *Regurgitation of food from several hours before*

Question 26

Abnormal, simultaneous and repetitive contraction of the distal esophageal smooth muscle with normal LES tone

Answer 26

Diffuse/distal esophageal spasm

Question 27

High amplitude contractions of the distal esophagus due to loss of the normal coordination of the inner circular and outer longitudinal layer

Answer 27

Nutcracker esophagus

Question 28

Triad of achalasia cardia

Answer 28

Incomplete LES relaxation Increase LES tone Aperistalsis of the esophagus

Question 29

Due to degeneration of the NO producing neurons that normally induce LES relaxation

Answer 29

Primary achalasia cardia

Question 30

Causal organism of Chagas disease

Answer 30

Trypanosoma cruzi

Question 31

Secondary causes of achalasia cardia

Answer 31

Chagas disease Diabetic autonomic neuropathy Malignancy Amyloidosis Sarcoidosis

Question 32

Causes destruction of myenteric plexus leading to failure of peristalsis and esophageal dilation. May also effect duodenal, colonic, and ureteric myenteric plexuses.

Answer 32

Chagas disease

Question 33

Pt presents with progressive dysphagia, inability to burp, regurgitation, and chest pain. Bird beak deformity on barium swallow.

Answer 33

Achalasia cardia

Question 34

Possible complication of achalasia cardia

Answer 34

Esophageal cancer

Question 35

Microscopy of distal esophagus shows inflammation surrounding ganglion cells or absent ganglion with hypertrophic nerve bundle.

Answer 35

Achalasia cardia

Question 36

Longitudinal mucosal tears near GE junction, mostly associated with severe vomiting/retching

Answer 36

Mallory-Weiss tears

Question 37

Transmural perforation of the esophagus extending into the mediastinum.

Answer 37

Boerhaave syndrome

Question 38

Mackler triad in Boerhaave syndrome

Answer 38

Vomiting Chest pain Subcutaneous emphysema

Question 39

LES findings in reflux esophagitis

Answer 39

Decreased LES tone Incompetent LES

Question 40

Extraesophageal manifestations of reflux esophagitis

Answer 40

Asthma Posterior laryngitis Chronic cough Recurrent pneumonitis Dental erosions Disordered sleep

Question 41

Complications of reflux esophagitis

Answer 41

Hemorrhage Barrett esophagus Strictures Ulcerations

Question 42

Associations of eosinophilic esophagitis

Answer 42

Atopic dermatitis Allergic rhinitis Asthma Modest peripheral eosinophilia

Question 43

Endoscopy of esophagus shows stacked circular rings with strictures and linear furrows

Answer 43

Eosinophilic esophagitis

Question 44

Microscopy of EGD biopsy shows intraepithelial eosinophils that form clusters and sheets

Answer 44

Eosinophilic esophagitis

Question 45

Is eosinophilic esophagitis associated with an increased risk of Barrett esophagus?

Answer 45

No

Question 46

Complication of chronic GERD associated with increased risk of esophageal adenocarcinoma

Answer 46

Barrett esophagus

Question 47

Intestinal metaplasia within the esophageal squamous mucosa

Answer 47

Barrett esophagus

Question 48

EGD shows tongue of red, velvety, metaplasia mucosa extending form the GE junction

Answer 48

Barrett esophagus

Question 49

Diagnostic finding on microscopy for Barrett esophagus

Answer 49

Goblet cells

Question 50

Signs of dysplasia in Barrett esophagus microscopy

Answer 50

Atypical mitoses Nuclear hyperchromasia Irregularly clumped chromatin Increased N:C ratio Failure to epithelial cells to mature as they migrate to surface

Question 51

Features of dysplastic glands on microscopy in Barrett esophagus

Answer 51

Display budding Irregular shapes Cellular crowning

Question 52

Common cancer of upper and mid-esophagus

Answer 52

SCC

Question 53

Common cancer of lower esophagus

Answer 53

Adenocarcinoma

Question 54

Most common benign tumor of the esophagus

Answer 54

Leiomyomas

Question 55

Genetic mutations in early stage esophageal adenocarcinoma

Answer 55

TP53 CDKN2A (p16 and p19-ARF)

Question 56

Oncogenes associated with progression of esophageal adenocarcnoma

Answer 56

EGFR ERBB2 MET Cyclin D1 Cyclin E

Question 57

Microscopy of distal esophageal biopsy shows mucin, atypical glands with high N:C ratio, abnormal chromatin pattern, and intestinal type morphology. Sometimes with diffusely infiltrative signet-ring cells.

Answer 57

Esophageal adenocarcinoma

Question 58

Poor prognosis finding of esophageal adenocarcinoma

Answer 58

Spread to submucosal lymphatic vessels

Question 59

Mutations associated of SCC

Answer 59

SOX2 amplification Cyclin D1 overexpression TP53 CDH1 NOTCH1

Question 60

Gross appearance of early lesions of esophageal SCC

Answer 60

Small, gray-white, plaque-like thickenings

Question 61

Associated with poor prognosis in esophageal SCC

Answer 61

Lymph mode metastases