esophagus

Question 1

histology of esophagus

Answer 1

upper 1/3: skeletal
middle 1/3: skeletal + smooth
lower 1/3: smooth

Question 2

failure of LES relaxation due to loss of Auerbach plexus (in muscularis externa layer between inner + outer muscular layers) → uncoordinated persistalsis → food stuck in esophagus

Answer 2

achalasia

Question 3

dysphagia to solids AND liquids

Answer 3

achalasia

Question 4

dysphagia to SOLIDS ONLY

Answer 4

esophageal scarring - obstruction

cancer

Question 5

dilated proximal esophagus + constricted lower esophagus on barium swallow
“birds beak”

Answer 5

achalasia

Question 6

disease due to infection with trypanosoma cruzi infection (makes everything bigger):
cardiomegaly
mega-esophagus →2° achalasia

Answer 6

chagas disease

Question 7

Calcinosis
Raynaud's phenomenon
Esophageal dysmotility
Sclerodactyly
Telangiectasia

Answer 7

CREST syndrome

Question 8

outpouching immediately above the upper esophageal sphincter

Answer 8

Zenker diverticulum

Question 9

outpouching near midpoint of esophagus

Answer 9

traction diverticulum

Question 10

outpouching immediately above LES

Answer 10

epiphrenic diverticulum (above diverticulum)

Question 11

hematemesis → esophageal variceal bleeding
caput medusa
ascites
associated with alcoholic cirrhosis

Answer 11

signs of portal HTN

Question 12

treatment of esophageal variceal bleeding

Answer 12

vasoconstrictors: vasopressin

Question 13

diagnosis of esophageal variceal bleeding

Answer 13

endoscopy (r/o acute PUD bleed)

Question 14

complete rupture of esophagus due to severe retching
complication: L pneumothorax
risk factor: GERD

Answer 14

Boerhaave syndrome

Question 15

laceration of GE junction due to severe retching or cough
less serious than Boerhaave
seen in alcoholics and bulimics

Answer 15

Mallory-Weiss tear

Question 16

symptoms after lying down

associated with obesity, overeat, some trigger foods

Answer 16

GERD

Question 17

treatment of GERD

Answer 17

H2 blockers

PPI

Question 18

complication of chronic GERD

Answer 18

barrett esophagus

Question 19

repeated stomach acid exposure of lower esophagus →
metaplasia in cells of lower esophagus from squamous → columnar + Goblet cells
associated with ↑ risk with esophageal adenocarcinoma

Answer 19

barrett esophagus

Question 20

most common type
GE junction displaced upward into thorax
“hourglass” stomach constriction at diaphragm

Answer 20

sliding hiatal hernia (weakness in diaphragm)

Question 21

no change in GE location

stomach lies next to esophagus

Answer 21

paraesophageal hiatal (weakness in diaphragm)

Question 22

causes of esophagitis

Answer 22

GERD
candida: white pseudomembrane (immunosuppresed)
CMV: large cells, intranuclear + cytoplasmic inclusions with clear, perinuclear halo
HSV: large, pink intranuclear inclusions and host cell chromatin pushed to edges of nucleus

Question 23

causes of esophageal stricture

Answer 23

GERD
swallow lye (NaOH)
dx: barium swallow

Question 24

dysphagia (esophageal webs: protrusion of mucosa in upper esophagus)
glossitis
iron deficiency anemia

Answer 24

plummer-vinson syndrome

Question 25

distal 1/3 of esophagus: where metaplastic change from squamous to columnar has occurred
whites
risk factors:
GERD, BE, smoking, obesity, nitrosamines
most common EC in US

Answer 25

esophageal adenocarcinoma

Question 26

alcohol, tobacco, nitrosamines, achalasia, esophageal webs, strictures
blacks
most common EC worldwide

Answer 26

esophageal squamous cell carcinoma

Question 27

dysphagia
anorexia
pain
weight loss

Answer 27

esophageal adenocarcinoma
or
esophageal squamous cell carcinoma

Question 28

what substance is important for relaxing the LES

Answer 28

NO