GI: Esophagus

Question 1

What is tracheoesophageal fistula

Answer 1

congenital defect resulting in a connection between the esophagus and trachea

Question 2

what is the most common variant of tracheoesophageal fistula

Answer 2

proximal esophageal atresia with distal esophagus arising from trachea

Question 3

what are clinical symptoms of tracheoesophageal fistula

Answer 3

vomiting
polyhydramnios
abdominal distension
aspiration

Question 4

what is esophageal web

Answer 4

thin protrusion of esophageal mucosa, most often in upper esophagus

Question 5

clinical presentation for esophageal web

Answer 5

dysphagia for poorly chewed food

Question 6

dysphagia

Answer 6

difficulty or discomfort in swallowing

Question 7

esophageal web increases the risk for what

Answer 7

esophageal squamous cell carcinoma

Question 8

What is Plummer-Vinson syndrome

Answer 8

severe iron-deficiency anemia
esophageal web
beefy-red tongue due to atrophic glossitis

Question 9

what is Zenker diverticulum

Answer 9

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

Question 10

clinical presentation of zenker diverticulum

Answer 10

dysphagia
obstruction
halitosis

Question 11

what is halitosis

Answer 11

bad breath

Question 12

zenker diverticulum arises from what

Answer 12

above esophageal sphincter at junction of esophagus and pharynx

Question 13

What is Mallory-Weiss syndrome

Answer 13

longitudinal laceration of mucosa at the gastroesophageal (GE) junction

Question 14

what causes mallory-weiss syndrome

Answer 14

severe vomiting, usually due to alcoholism or bulimia

Question 15

clinically how does mallory-weiss syndrome present

Answer 15

painful hematemesis

Question 16

what is Risk of Boerhaave syndrome

Answer 16

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

Question 17

What is esophageal varices

Answer 17

dilated submucosal veins in lower esophagus

Question 18

esophageal varices arise secondary to what

Answer 18

portal hypertension

Question 19

how can portal hypertension cause esophageal varices

Answer 19

• distal esophagus vein normally drains into portal vein via left gastric vein
• left gastric vein backs up into esophageal vein

Question 20

symptoms for esophageal varices

Answer 20

asymptomatic ( painless hematemesis), but risk of ruptures exists

Question 21

what is the most common cause of death for esophageal varices

Answer 21

cirrhosis

Question 22

What is achalasia

Answer 22

disordered esophageal motility with inability to relax the lower esophageal sphincter (LES)

Question 23

what causes achalasia

Answer 23

damaged ganglion cells in the myenteric plexus

Question 24

where are ganglion cells of myenteric plexus located and what is their role

Answer 24

• b/w inner circular and outer longitudinal layers of the muscularis propria
• regulating bowel motility and relaxing the LES

Question 25

what can cause damage to ganglion cells

Answer 25

idiopathic or secondary to tyrpanosoma cruzi infection in Chagas disease

Question 26

what are 4clinical features of achalasia

Answer 26

1. dysphagia for solids and liquids 2. putrid breath 3. high LES pressure on esophageal manometry 4. 'brid-break' sign on barium swallow study

Question 27

Achalasia has an increased risk for what

Answer 27

esophageal squamous cell carcinoma

Question 28

what is gastroesophageal reflux disease (GERD)

Answer 28

reflux of acid from stomach due to reduced LES tone

Question 29

what are risk factors for GERD

Answer 29

``` alcohol tobacco obesity fat-rich diet caffeine hiatal hernia ```

Question 30

What are 3 clinical features of GERD

Answer 30

1. heartburn (mimics cardiac chest pain) 2. asthma ( adult-onset) and cough 3. damage to enamel of teeth

Question 31

what are late complications of GERD

Answer 31

1. ulceration with stucture | 2. Barret esophagus

Question 32

What is Barrett esophagus

Answer 32

metaplasia of lower esophageal mucosa from stratified squamous epithelium to nonciliated columnar epithelium with goblet cells

Question 33

why does Barrett esophagus occur

Answer 33

response to lower esophageal stem cells to acidic stress

Question 34

what can Barret esophagus progress to

Answer 34

dysplasia and adenocarcinoma

Question 35

what is esophageal carcinoma subclassified as

Answer 35

adenocarcinoma or squamous cell carcinoma

Question 36

what is the most common type of esophageal cancer in the west

Answer 36

esophageal carcinoma

Question 37

what is adenocarcinoma

Answer 37

malignant proliferation of glands

Question 38

esophageal carcinoma arises from what

Answer 38

preexisting Barrett esophagus | - usually involves the lower 1/3 of esophagus

Question 39

What is the most common esophageal cancer worldwide

Answer 39

esophageal squamous cell carcinoma

Question 40

what is esophageal squamous cell carcinoma

Answer 40

malignant proliferation of squamous cells | - usually arises from upper or middle of esophagus

Question 41

name 5 major risk factors for esophageal squamous cell carcinoma

Answer 41

1. alcohol and tobacco (most common cause) 2. very hot tea 3. achalasia 4. esophageal web (e.g., Plummer-Vinson syndrome) 5. Esophageal injury (e.g., lye ingestion)

Question 42

when can esophageal carcinoma present and what are some symtpoms

Answer 42

- late (poor prognosis) - progressive dysphagia (solids to liquids) - weight loss - pain - hematemesis

Question 43

hematemesis

Answer 43

vomiting of blood

Question 44

what are some more symptoms for esophageal squamous cell carcinoma

Answer 44

``` hoarse voice ( recurrent laryngeal nerve involvement) cough ( tracheal involvement) ```

Question 45

what is the lymph node for the esophagus

Answer 45

upper 1/3: cervical node middle 1/3: mediastinal or tracheobronchial nodes lower 1/3: celiac and gastric nodes