Esophagus

Question 1

Types of hiatal hernia

Answer 1

TYPE I
Upward dislocatiom of cardia

TYPEII
Fundus

TYPEIII
Cardia+ fundus

TYPEIV
Additional organ usually colon herniates as well

Endstage of TYPE I/II when intrathoracic stomach

Paraesophageal hernia(PEH): type I/II/III

Question 2

Sliding hernia

Answer 2

Upward dislocation of cardia

So more of reflux symptoms

Question 3

Rolling hernia

Answer 3

Upward dislocation of cardia

More Symptoms of
dysphagia ,postprandial fullness: distension of cardia and pressure on esophagus.
dysnoea: pressure on left atrium

Question 4

Sx for GERD

Answer 4

NISSEN FUNDOPLICATION
Complete
S/E:dysphagia, inability to belch, flatulance

ant partial fundoplication
Posterior partial

COLLIS GASTROPLASTY:for a shortened esophagus

Question 5

Esophageal motility disorder

Answer 5

PRIMARY ESOPHAGEAL MOTILITY DISORDER
Achalasia, “vigorous” achalasia

Diffuse and segmental esophageal spasm

Nutcracker esophagus

Hypertensive lower esophageal sphincter

Nonspecific esophageal motility disorders

SECONDRY ESOPHAGEAL MOTILITY DISORDER
Collagen vascular diseases: progressive systemic sclerosis, polymyositis and dermatomyositis, mixed connective tissue disease, systemic lupus erythematosus, etc.

Chronic idiopathic intestinal pseudoobstruction

Neuromuscular diseases

Endocrine and metastatic disorders

Question 6

Manometric characteristics of the primary esophageal motility disorders

Answer 6

ACHLASIA

Incomplete lower esophageal sphincter (LES) relaxation (<75% relaxation)

Aperistalsis in the esophageal body

Elevated LES pressure ≤26 mmHg

Increased intraesophageal baseline pressures relative to gastric baseline

DIFFUSE ESOPHAGEAL SPASM (DES)

Simultaneous (nonperistaltic contractions) (>20% of wet swallows)

Repetitive and multipeaked contractions

Spontaneous contractions

Intermittent normal peristalsis

Contractions may be of increased amplitude and duration

NUTCRACKER ESOPHAGUS

Mean peristaltic amplitude (10 wet swallows) in distal esophagus ≥180 mmHg

Increased mean duration of contractions (>7.0 s)

Normal peristaltic sequence

Hypertensive lower esophageal sphincter

Elevated LES pressure (≥26 mmHg)

Normal LES relaxation

Normal peristalsis in the esophageal body

INEFFECTIVE ESOPHAGEAL MOTILITY DISORDER

Decreased or absent amplitude of esophageal peristalsis (<30 mmHg)

Increased number of nontransmitted contractions

Question 7

Myotomy of the lower esophageal sphincter is called

Answer 7

Hellers myotomy

Question 8

Characteristic view of eosinophillic esophagitis on Barium swallow or endoscopic view

Answer 8

Ringed esophagus /stacks of rings

Question 9

Endoscopic finding of hiatal hernias

Answer 9

SLIDING HIATAL HERNIA
can be identified by noting a gastric pouch lined with rugal folds extending above the impression caused by the crura of the diaphragm, or measuring at least 2 cm between the crura, identified by having the patient sniff, and the squamocolumnar junction on withdrawal of the scope

PARAESOPJAGEAL HIATAL HERNIA
is identified on retroversion of the scope by noting a separate orifice adjacent to the GEJ into which gastric rugal folds ascend.

MIXED HERNIA
can be identified by noting a gastric pouch lined with rugal folds above the diaphragm, with the GEJ entering about midway up the side of the pouch.