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GI II > Esophageal disorders > Flashcards

Esophageal disorders Flashcards

1
Q

Common site of esophageal atresia

A

At or near the tracheal bifurcation

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2
Q

Common association with esophageal atresia

A

Tracheoesophageal fistula

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3
Q

Genetic defect associated with esophageal atresia

A

Altering of SHH signaling

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4
Q

What germ layer is tracheoesophageal septum derived from?

A

Mesoderm

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5
Q

Genetic syndromes associated with tracheoesophageal fistula

A

Trisomy 21, 18, and partial 13

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6
Q

VACTERAL syndrome

A

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

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7
Q

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

A

Tracheoesophageal fistula

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8
Q

Possible esophageal causes of dysphagia

A

Stenosis
Webs
Rings
Diverticulum
Motility disorders
Achalasia
Ectopic tissue

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9
Q

Causes of acquired esophageal stenosis

A

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

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10
Q

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

A

Esophageal webs

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11
Q

Composition of esophageal webs

A

Fibrovascular CT and overlying epithelium

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12
Q

Triad of Plummer-Vinson syndrome

A

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

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13
Q

Complication of Plummer-Vinson syndrome

A

Carcinoma of oropharynx and upper esophagus

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14
Q

How to diagnose esophageal web?

A

EGD
Barium esophagogram

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15
Q

2 circumferential rings of distal esophagus

A

Muscular A ring
Schatzki or mucosal B ring

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16
Q

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

A

Muscular A ring

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17
Q

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

A

Schatzki ring (B ring)

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18
Q

Epithelium of upper surface of Schatzki ring

A

Stratified squamous epithelium

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19
Q

Epithelium of lower surface of Schatzki ring

A

Columnar epithelium

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20
Q

Symptoms of Schatzki ring

A

Usually asymptomatic, may have intermittent dysphagia

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21
Q

Weak area between cricopharyngeus and thyropharyngeus

A

Killian’s triangle

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22
Q

Caused by increased pressure within the distal pharynx

A

Zenker’s diverticulum

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23
Q

Complication of middle esophageal diverticulum

A

Adhesions to mediastinal lymph nodes

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24
Q

Association of middle esophageal diverticulum

A

Tuberculosis

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25
Q

Clinical features of large Zenker’s diverticulum

A

Halitosis
Dysphagia
Regurgitation of food from several hours before

26
Q

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

A

Diffuse/distal esophageal spasm

27
Q

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

A

Nutcracker esophagus

28
Q

Triad of achalasia cardia

A

Incomplete LES relaxation
Increase LES tone
Aperistalsis of the esophagus

29
Q

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

A

Primary achalasia cardia

30
Q

Causal organism of Chagas disease

A

Trypanosoma cruzi

31
Q

Secondary causes of achalasia cardia

A

Chagas disease
Diabetic autonomic neuropathy
Malignancy
Amyloidosis
Sarcoidosis

32
Q

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

A

Chagas disease

33
Q

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

A

Achalasia cardia

34
Q

Possible complication of achalasia cardia

A

Esophageal cancer

35
Q

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

A

Achalasia cardia

36
Q

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

A

Mallory-Weiss tears

37
Q

Transmural perforation of the esophagus extending into the mediastinum.

A

Boerhaave syndrome

38
Q

Mackler triad in Boerhaave syndrome

A

Vomiting
Chest pain
Subcutaneous emphysema

39
Q

LES findings in reflux esophagitis

A

Decreased LES tone
Incompetent LES

40
Q

Extraesophageal manifestations of reflux esophagitis

A

Asthma
Posterior laryngitis
Chronic cough
Recurrent pneumonitis
Dental erosions
Disordered sleep

41
Q

Complications of reflux esophagitis

A

Hemorrhage
Barrett esophagus
Strictures
Ulcerations

42
Q

Associations of eosinophilic esophagitis

A

Atopic dermatitis
Allergic rhinitis
Asthma
Modest peripheral eosinophilia

43
Q

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

A

Eosinophilic esophagitis

44
Q

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

A

Eosinophilic esophagitis

45
Q

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

A

No

46
Q

Complication of chronic GERD associated with increased risk of esophageal adenocarcinoma

A

Barrett esophagus

47
Q

Intestinal metaplasia within the esophageal squamous mucosa

A

Barrett esophagus

48
Q

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

A

Barrett esophagus

49
Q

Diagnostic finding on microscopy for Barrett esophagus

A

Goblet cells

50
Q

Signs of dysplasia in Barrett esophagus microscopy

A

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

51
Q

Features of dysplastic glands on microscopy in Barrett esophagus

A

Display budding
Irregular shapes
Cellular crowning

52
Q

Common cancer of upper and mid-esophagus

A

SCC

53
Q

Common cancer of lower esophagus

A

Adenocarcinoma

54
Q

Most common benign tumor of the esophagus

A

Leiomyomas

55
Q

Genetic mutations in early stage esophageal adenocarcinoma

A

TP53
CDKN2A (p16 and p19-ARF)

56
Q

Oncogenes associated with progression of esophageal adenocarcnoma

A

EGFR
ERBB2
MET
Cyclin D1
Cyclin E

57
Q

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.

A

Esophageal adenocarcinoma

58
Q

Poor prognosis finding of esophageal adenocarcinoma

A

Spread to submucosal lymphatic vessels

59
Q

Mutations associated of SCC

A

SOX2 amplification
Cyclin D1 overexpression
TP53
CDH1
NOTCH1

60
Q

Gross appearance of early lesions of esophageal SCC

A

Small, gray-white, plaque-like thickenings

61
Q

Associated with poor prognosis in esophageal SCC

A

Lymph mode metastases

62
Q
A

GI II (31 decks)

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