Esophagus

Question 1

What is a fistula?

Answer 1

Abnormal connection between two tubes.

Question 2

What is a Tracheoesophageal Fistula?

Answer 2

Congenital defect resulting in a connection between the esophagus and trachea.

Question 3

What is the most common variant of Tracheoesophageal Fistula?

Answer 3

Proximal esophageal atresia and distal esophagus arising from the trachea.

Question 4

What does the most common variant of Tracheoesophageal Fistual present with?

Answer 4

Vomiting, Polyhydramnios (excess amniotic fluid), Abdominal distension (air in stomach), and Aspiration (stomach contents)

Question 5

What is an Esophageal Web?

Answer 5

Thin protrusion of esophageal mucosa

Question 6

Where does Esophageal Web most often occur?

Answer 6

In the upper esophagus

Question 7

What does Esophageal Web present with?

Answer 7

Dysphagia for poorly chewed food

Question 8

What are people with Esophageal Web at an increased risk for?

Answer 8

Esophageal squamous cell carcinoma

Question 9

What is Plummer-Vinson syndrome characterized by?

Answer 9

• Severe iron deficiency anemia
• Esophageal web
• Beefy-red tongue due to atrophic glossitis

Question 10

What is Zenker Diverticulum?

Answer 10

Outputting of pharyngeal mucosa through an acquired defect in the muscular wall (false diverticulum)

Question 11

What causes the protrusion in Zenker Diverticulum?

Answer 11

Abnormal pressure in back of pharynx –> protrusion of mucosa in muscular wall

Question 12

What is a False Diverticulum?

Answer 12

Only protruded one part of wall through the entire wall

Question 13

Where does Zenker Diverticulum arise?

Answer 13

Above the upper esophageal sphincter at the junction of the esophagus and pharynx

Question 14

What does Zenker Diverticulum present with?

Answer 14

1. Feels like there’s something in the back of the throat
2. Dysphagia
3. Obstruction
4. Halitosis (bad breath)

Question 15

What is Mallory-Weiss Syndrome?

Answer 15

Longitudinal laceration of mucosa at the gastroesophageal (GE) junction.

Question 16

What causes Mallory-Weiss Syndrome?

Answer 16

Severe vomiting, usually due to alcoholism or bulimia.

Question 17

What does Mallory-Weiss Syndrome present with?

Answer 17

Painful hematemesis (vomiting blood)

Question 18

What does Mallory-Weiss create a risk for?

Answer 18

Boerhaave Syndrome

Question 19

What is Boerhaave Syndrome?

Answer 19

Rupture of esophagus leading to air in the mediastinum and subcutaneous emphysema

Question 20

What do you see in the patient with subcutaneous emphysema?

Answer 20

Air bubbles beneath the skin, when pressed on, they make a crackling noise

Question 21

What are Esophageal Varices?

Answer 21

Dilated submucosal veins in the lower esophagus

Question 22

What doe Esophageal Varices arise secondary to?

Answer 22

Portal hypertension

Question 23

What are two ways esophageal blood drains?

Answer 23

1. Most drains via azygous vein to the vena cava

2. Some drains via left gastric vein into portal vein

Question 24

How does the distal esophageal vein normally drain?

Answer 24

Into the portal vein via the left gastric vein

Question 25

What happens to the left gastric vein in portal hypertension?

Answer 25

The left gastric vein back up into the esophageal vein, resulting in dilation (varices).

Question 26

What might Esophageal Varices present like in a patient?

Answer 26

Asymptomatic

Question 27

What risk exists with Esophageal Varices?

Answer 27

Risk of rupture

Question 28

What does esophageal rupture present with?

Answer 28

Painless hematemesis

Question 29

What is the most common cause of death in cirrhosis?

Answer 29

Esophageal rupture

Question 30

What is not produced in cirrhosis/portal hypertension?

Answer 30

The liver does not produce coagulation factors and this causes coagulopathy

Question 31

What is Achalasia?

Answer 31

1. Disordered esophageal motility with | 2. Inability to relax lower esophageal sphincter (LES)

Question 32

What causes Achalasia?

Answer 32

Due to damaged ganglion cells in the myenteric plexus.

Question 33

Where are ganglion cells of the myenteric plexus located?

Answer 33

Between the inner circular and outer longitudinal layers of the muscular propria

Question 34

What are the ganglion cells of the myenteric plexus important for?

Answer 34

Regulating bowel motility and relaxing the LES.

Question 35

What can cause damage to the ganglion cells of the myenteric plexus?

Answer 35

1. Idiopathic | 2. Secondary to known insult (Trypanosome cruzi infection in Chagas disease)

Question 36

What are the clinical features of Achalasia?

Answer 36

1. Dysphagia for solids and liquids | 2. Putrid breath

Question 37

What is seen in Achalasia on Esophageal Manometry?

Answer 37

High LES pressure

Question 38

What is seen in Achalasia on Barium Swallow Study?

Answer 38

'Bird-beak' sign

Question 39

What does Achalasia increase the risk for?

Answer 39

Esophageal squamous cell carcinoma

Question 40

What is GERD (Gastroesophageal Reflux Disease)?

Answer 40

Reflux of acid from the stomach due to reduced LES tone

Question 41

What are risk factors for GERD?

Answer 41

- Alcohol - Tobacco - Obesity - Fat-rich diet - Caffeine - Hiatal Hernia

Question 42

What does acid cause in a general sense in GERD?

Answer 42

Acid leads to stressed cells of the lower esophagus. These cells then undergo metaplasia.

Question 43

What are the clinical features of GERD?

Answer 43

1. Heartburn (mimics cardiac chest pain) 2. Asthma (adult onset) and cough 3. Damage to enamel of teeth 4. Ulceration with stricture and Barrett esophagus are late complications.

Question 44

What causes the Ulceration and Barrett esophagus with GERD?

Answer 44

Acid damage

Question 45

What does the stress from acid in GERD cause in the lower esophagus (detailed)?

Answer 45

1. Non-keratinizing Squamous Epithelium (NKSE) 2. Stress 3. Changes in cell type 4. Non-ciliated columnar cells with goblet cells [Metaplasia]

Question 46

What is a Sliding Hiatal Hernia?

Answer 46

- Very common - Stomach herniates up above diaphragm in a half circle - Allows for reflux (no sphincter) --> increases risk for GERD - Hourglass appearance of the stomach

Question 47

What is a Paraesophageal Hiatal Hernia?

Answer 47

- Much less common than sliding - Bowel sounds are heard in the lower lung fields - Stomach herniates up on one side of the esophagus - If it develops congenitally --> may cause lung hypoplasia - NO GERD