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CORE: GI > Esophagus > Flashcards

Esophagus Flashcards

1
Q

boundaries: nasopharynx, oropharynx, hypopharynx

A

Nasopharynx: Extends from the base of the skull to the soft palate.
Oropharynx: Located behind the mouth and extends from the uvula to the hyoid bone.
Hypopharynx: Extends from the hyoid bone to the cricopharyngeus muscle, which is located at the lower end of the cricoid cartilage.

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2
Q

cricopharyngeus muscle location

A

C5-C6

upper esophageal sphincter; pharynx vs cervical esophagus

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3
Q

diaphgragmatic hiatus for esophagus

A

T10

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4
Q

anatomic rings of distal esophagus

A

A: muscular
B: mucosal
C: diaphgragmatic impression

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5
Q

esophageal web

A

anterior infolding/indentation of upper esophagus; cause of dysphagia

association with anemia (Plummer Vinson syndrome) and upper esophageal carcinoma

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6
Q

Schatzi ring

A

focal narrowing of mucosal ring (B) of distal esophagus (intermittent dysphagia)

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7
Q

most sensitive study for schatzi ring

A

upper GI > endoscopy

focal circumferential constriction near GEJ, usually associated with hiatal hernia

do not allow passage of 12 mm tablet

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8
Q

ddx for circumferential esophageal constriction

A

focal striction, muscular esophageal ring (A ring); esophageal cancer, esophageal web (usually in cervical esophagus; rarely circumferential)

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9
Q

types of esophagitis

A

reflux, barret, infectious, medication, Crohn

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10
Q

peptic esophagitis

A

exposure of esophageal mucosa to acidic gastric secretions > ulcerations > strictures

seen with GERD, scleroderma, zollinger ellisen

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11
Q

reflux esophagitis on imaging

A

thickened distal esophageal folds

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12
Q

chronic esophagitis on imaging

A

scarring; smoothly tapered stricture above GEJ

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13
Q

barrett esophagus

A

metaplasia of squamous epithelium to gastric type adenomatous mucosa&raquo_space; esophageal carcinoma

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14
Q

imaging of barrett esophagus

A

featureless distal esophagus

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15
Q

infectious esophagitis types

A

candidiasis, herpes, CMV/HIV

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16
Q

esophageal vs herpes vs CMV/HIV esophagitis imaging

A

esophageal: shaggy, scattered plaque like lesions
herpes: discrete small ulcerations; scattered throughout esophagus
CMV/HIV: large flat ovoid ulcer

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17
Q

medication esophagitis

A

ulcer at aortic arch/distal esophagus (areas of relative narrowing)

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18
Q

crohn esophagitis

A

small bowel/colon, typically

apthous ulcers–discrete ulcers with mounds of edema may become confluent

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19
Q

stricture types

A

peptic, barret esophagus, malignant, caustic/NG, radiation, external compression

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20
Q

location of barrett esophagus

A

mid esophagus above metaplastic adenomatous transition; higher than peptic strictures since adenomatous tissue is acid resistant

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21
Q

shouldered margins with stricture

A

circumferential luminal narrwing by mass

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22
Q

caustic stricture

A

long, smooth, narow

1-3 months after caustic ingestion/NG tube placement&raquo_space; increased risk of cancer wiith long lag time (20 years)

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23
Q

radiations tricture

A

long, smooth, narrow; spares GE junction

24
Q

amount of radiation to cause radiation stricture/time course of radiation stricture

A

> 50 Gy

1-3 weeks after radiation therapy; strictures develop 4-8 months after

25
Q

benign mesenchymal tumors

A

GIST, leomyoma, lipoma, hemangioma

smooth round submucosal filling defect

26
Q

size of esopageal adenomas

A

<1.5, resected endoscopically

benign lesion with malignant potential

27
Q

inflammatory polyp

A

enlarged gastric fold protruding into lower esophagus; usually associated with reflux

28
Q

fibrovascular polyp

A

pedunculated mass of mesenchymal elements; no malignant potential (unlike adenomas)

typically occur in cervical esophagus (regurgitation of fleshy mass)

29
Q

esophageal varices

A

commonly due to portal hypertnesion

uphill varices: portal HTN; distal esophagus (left gastric, periesophageal venous plexus)

downhill varices: SVC obstruction, proximal esophagus (supreme intercostal veins, bronchial, inferior thyroid)

30
Q

foregut duplication cysts

A

esophagus: squamous epithelium; posterior mediastinum (appears similar to leiomyoma on esophagram)
bronchogenic: respiratory epithelium

neurenteric cyst: associated with vertebral body anomalies

31
Q

common location for bony vs meat foreign objects to get stuck

A

bony: cervical esophagus
meat: GE junction

32
Q

how long does food impaction raise concern for transmural ischemia

A

> 24 hrs; transmural ischemia > esophageal perforation

33
Q

esophageal carcinoma

A

SCC or adenocarcinoma

SCC: upper/mid esophagus; smoking/alcohol, celiac, plummer-vinson, achalasia, HPV
adenocarcinoma: distal esophagus/stomach; chronic reflux/Barrett esophagus

34
Q

appearance of esophageal carcinoma

A

esophagram: plaque like lesion, polypoid lesion, focal wall irregularity ; stricture with shouldered edge/irregular contour

varicoid appearance that does not change shape with peristaltic waves (unlike real varices)

35
Q

common mets to esophagus

A

gastric, lung, breast; mediastinal mets from mid esophagus common

36
Q

contraction wave types

A

primary: normal, physiologic wave initated by swallow
secondary: norma, physiologic wave initiated by bolus
tertiary: nonpropulsive contraction; no esophageal clearing

37
Q

vigorous achalasia

A

less severe form; repetitive nonpropulsive contractions

38
Q

achalasia; treatment

A

motility disorder; unable to relax due to abnormality of myenteric ganglia in Auerbach plexus

treat: heller myomectomy

39
Q

secondary achalasia

A

Chagas disease

40
Q

complications of achalasia

A

esophageal cancer; candida infection from stasis

41
Q

imaging appearance of achalasia

A

dilated esophagus with birds beak stricture at GE junction

42
Q

pseudoachalasia

A

obstructing GE junction cancer

43
Q

diffuse esophageal spasm

A

nonpropulsive esophageal contractions which cause corkscrew or shish kebab appearance

44
Q

nutcracker esophagus

A

high amplitude contractions on manometry with chest pain; related to esophageal spasm

45
Q

types of esophageal dierticula

A

pulsion diverticula, traction diverticula, zenker, KJ, pseudodiverticulosis

46
Q

pulsion vs traction diverticula

A

pulsion: increased pressure; common in US
traction: traction of adjacent structures; TB mediastinal adenopathy (RARE)

47
Q

Zenker diverticula

A

failure of cricopharyngeus to relax > elevated hypopharyngeal pressure&raquo_space; posterior protrusion

hypertrophy of cricopharyngeus muscle

treatment: myotomy cripharyngeus, diverticulopexy/diverticulectomy
presentation: halitosis, aspiration, regurgitation of undigested food

48
Q

KJ diverticulum

A

weakness below attachment of cricopharyngeus muscle; more often bilateral

protrude anteriorly; seen on lateral view

49
Q

pseudo Zenker

A

barium trapped in pharyngeal contraction wave

50
Q

pseudodiverticulosis

A

multiple tiny outpouchings caused by dilated submucosal glands

analogous to Rokitansky Aschoof sinuses of gallbladder

smooth stricture

51
Q

feline esophagus

A

normal variant; multiple transverse folds

52
Q

aberrant right subclavian artery (normal left arch) on esophagus

A

travels posterior to esophagus; rarely produces dysphagia

smooth indentation on posterior esophagus

53
Q

scleroderma sophagus

A

excess collagen deposition&raquo_space; lack of peristalsis in distal esophagus due to smooth muscle atrophy and fibrosis&raquo_space; esophageal dilation

secondary candidiasis/aspiration pneumonia

can be seen before skin changes

54
Q

types of esophageal hernias

A

hiatal vs paraesophageal hernia

55
Q

hiatal hernia

A

gastric fold seen above diaphragm; sliding (common) or short (secondary to reflux)

56
Q

paraesophageal hernia

A

GE junction below diphragm; stomach herniates through to chest

more prone to strangulation

CORE: GI (9 decks)

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