Esophagus

Question 1

Esophagus blood supply (3)

Answer 1

inferior thyroid artery (cervical), bronchial arteries (thoracic), left gastric artery (abdominal)

Question 2

Type I achalasia description

Answer 2

classic - complete failure of LES relaxation and absent peristalsis

Question 3

Type II achalasia description

Answer 3

achalasia w/ pressurization - panesophageal pressurization w/ incomplete relaxation of LES

Question 4

Type III achalasia description

Answer 4

spastic - spasms or rapid, premature contractions along the esophagus, without relaxation

Question 5

Prague Criteria: esophagitis severity (degree of damage)

Answer 5

0: no injury
1: erythema
2: inflammation with erosions
3: ulcerations

Question 6

Prague Criteria: extent of involvement

Answer 6

0: none
1: <25%
2: 25-50%
3: 50-75%
4: >75%

Question 7

Prague Criteria: type of lesion

Answer 7

mild
moderate
severe stricture formation

Question 8

Normal LES pressure

Answer 8

10-30 mmHg

Question 9

Normal integrated relaxation pressure (IRP)

Answer 9

<15 mmHg

Question 10

Normal esophageal pressures

Answer 10

30-40 mmHg

Question 11

Normal amplitude for distal contractions

Answer 11

20-80 mmHg

Question 12

Type I achalasia treatment (2)

Answer 12

pneumatic dilation or Heller myotomy

Question 13

Type III achalasia treatment (2)

Answer 13

botox or surgery (due to spastic nature)

Question 14

Mucosa type w/ Barrett’s

Answer 14

columnar, intestinal metaplasia

Question 15

Octreotide dose for bleeding varices

Answer 15

50 mcg IV bolus, then 50 mcg/hr infusion

Question 16

Biopsy results diagnostic for EoE

Answer 16

> /= 15 eosinophils/hpf

Question 17

Follow-up study needed when EoE is diagnosed

Answer 17

repeat endoscopy after 8 weeks of PPI therapy to confirm diagnosis

Question 18

Indications for dilation of esophageal webs (2)

Answer 18

webs > 1 cm
webs causing dysphagia

Question 19

LA grade A esophagitis

Answer 19

1+ break < 5mm
doesn’t extend 2 mucosal folds

Question 20

LA grade B esophagitis

Answer 20

1+ break > 5mm
doesn’t extend 2 mucosal folds

Question 21

LA grade C esophagitis

Answer 21

1+ break extends 2+ folds
involves < 75% of the esophageal circumference

Question 22

LA grade D esophagitis

Answer 22

1+ break >/= 75% of the esophageal circumference

Question 23

Oropharyngeal dysphagia vs esophageal onset

Answer 23

oropharyngeal: immediate (initiation of swallowing)
esophageal: delayed (after swallowing)

Question 24

Oropharyngeal dysphagia vs esophageal solids and liquids symptoms

Answer 24

oropharyngeal: difficulty w/ both
esophageal: start w/ solids, can progress to liquids

Question 25

Regurgitation as a common symptom (oropharyngeal vs esophageal dysphagia)

Answer 25

esophageal

Question 26

Oropharyngeal dysphagia diagnosis (3)

Answer 26

1) clinical
2) video fluoroscopic swallow study
3) endoscopy

Question 27

Esophageal dysphagia diagnosis (3)

Answer 27

1) barium swallow
2) manometry
3) endoscopy

Question 28

Manometry findings associated w/ hyper contractile esophagus

Answer 28

high amplitude contractions, > 180 mmHg

Question 29

Manometry findings associated w/ scleroderma

Answer 29

hypotensive LES, absent peristalsis

Question 30

Findings for positive ambulatory pH monitor for GERD

Answer 30

pH < 4 for > 4.2% of the time

Question 31

Risk factors for squamous cell carcinoma (4)

Answer 31

smoking
alcohol
achalasia
HPV infection

Question 32

Risk factors for adenocarcinoma (3)

Answer 32

GERD
Barrett’s esophagus
obesity

Question 33

SCC vs adenocarcinoma location

Answer 33

SCC: mid- to upper esophagus
adenocarcinoma: distal esophagus

Question 34

SCC vs adenocarcinoma symptoms

Answer 34

SCC: dysphagia (solids > liquids), weight loss
adenocarcinoma: dysphagia, reflux