Esophagus 2

Question 1

Elevated IRP – differential?

Answer 1

Acalasia or esophageal obstruction

Question 2

Type 1 vs type 2 versus type 3 achalasia?

Answer 2

Classic (no panesophageal pressurization) vs with esophageal compression (>20% pressurization) vs spastic (>20% premature contractions, DL<4.5 and DCI>450)

Question 3

Major disorders of peristalsis?

IRP?

Answer 3

Absent contractility (100% failed peristalsis)

Distal esophageal spasm (>20% premature contractions, DL<4.5 and DCI>450)

Hypercontractile (jackhammer) esophagus (DCI>8000)

All have normal IRP

Question 4

Minor disorders of peristalsis?

IRP?

Answer 4

Ineffective esophageal motility (> 50% ineffective swallows)

Fragmented peristalsis (break over 5 seconds)

All have normal IRP

Question 5

Achalasia molecular pathophysiology?

Answer 5

Selective loss of post ganglionic inhibitory neurons containing nitric oxide and substance P

Leads to continuous cholinergic stimulation and high LES pressure

Question 6

Infection that can lead to achalasia?

Answer 6

trypanosoma cruzi (chagas disease)

Question 7

Causes of pseudo achalasia?

Answer 7

1. Infiltrating tumor at the GE junction

2. Paraneoplastic (anti-hu anitibodies)

Question 8

CMV versus HSV ulcers - where to biopsy?

Answer 8

Center versus edge

Question 9

Biopsy of this would show enlarged hyperchromatic nucleus, increased volume of cytoplasm, and eosinophilic inclusions

Answer 9

CMV ulcer

Question 10

Multinucleated giant cells, Margination of the nuclear chromatin and Nuclear moulding

biopsy of?

Answer 10

HSV ulcers

Question 11

Treatment for idiopathic HIV esophageal ulcers?

Answer 11

Steroids, thalidomide

Question 12

Posterior indentation at the level of the cricoid cartilage on barium swallow - called?

Manometric finding?
Treatment?

Answer 12

Cricopharyngeal bar

Increased Intrapharyngeal bolus pressure and failure of UES relaxation

Endoscopic dilation if symptomatic

Question 13

Formation of Zenker’s diverticulum occurs with the herniation through?
Eponym?

Answer 13

Posterior hypopharyngeal wall

Killian’s triangle

Question 14

Disease associated with hyper keratosis of the palms and feet AND Esophageal squamous cell carcinoma?

When do you start screening these patients?

Answer 14

Tylosis - autosomal dominant disease

Age 30, then every 1-3 years

Question 15

General timeline for avoiding EGD after caustic ingestion?

Answer 15

Avoid 5-15 days after; increased perforation risk

Question 16

Grading system for caustic ingestions?

Answer 16

Zargar’s grading

Question 17

Integrated relaxation pressure – mainly a measure of? Normal Value?

Answer 17

LES pressure; <15 mmHg

Question 18

Distal latency - measured from? Normal value? Low value suggests?

Answer 18

Onset of Swallow to contractile deceleration point

Greater than 4.5 cm

Premature contraction

Question 19

Distal contractile Integral - measures?

Values that indicate failed peristalsis?

Values that indicate weak peristalsis?

Values that Indicate hypercontractile pattern?

Answer 19

Power of distal esophageal contraction

<100
100-450
>8000

Question 20

Peristaltic break? Abnormal if? (interpretation?)

Answer 20

Length of time at the esophageal contraction breaks (at the level of the transitional zone)

> 5 seconds; Signifies fragmented contraction