GI Section 1: Luminal (Esophageal Diverticulum)

Question 1

Answer 1

Killian-Jamieson Pulsion Diverticulum

It protrudes through an area of
weakness below the attachment of the cricopharyngeus muscle and lateral to the ligaments that help suspend the esophagus on the cricoid cartilage

Question 2

Answer 2

Zenker Diverticulum:

Pulsion Diverticulum in the back (Z is in the back ofthe alphabet).

Question 3

Answer 3

Traction Diverticulum

Mid esophageal, and often triangular in shape.

Question 4

site of weakness in Zenker

Answer 4

Killian Dehiscence or triangle

Question 5

Zenker Diverticulum arise from?

Answer 5

arise from the hypopharynx (not the cervical esophagus).

Question 6

This one is in the cervical esophagus.

Answer 6

Killian-Jamieson Pulsion Diverticulum

Question 7

These occur from scarring (think granulomatous disease or TB)

Answer 7

Traction Diverticulum

Question 8

Triangular + Will empty =

Answer 8

Traction Diverticulum

Question 9

Round + Will NOT empty (contains no muslce in the wall)

Answer 9

Pulsion

Question 10

Located just above the diaphragm
(usually on the RIGHT).

Answer 10

Epiphrenic Diverticula

Question 11

Answer 11

Epiphrenic Diverticula

Located just above the diaphragm
(usually on the RIGHT).
** The para-esophageal hernia is usually on the LEFT.

They are considered pulsion types (associated with motor abnormality).

Question 12

Answer 12

Esophageal Pseudodiverticulosis

dilated submucosal glands that cause multiple small out pouchings.

Question 13

Usually due to chronic reflux esophagitis.

Answer 13

Esophageal Pseudodiverticulosi

Question 14

The most common benign mucosal lesion of the esophagus. It’sbasically just hyperplastic squamous epithelium.

Answer 14

Papilloma

Question 15

Young man + hx of dysphagia (atopia and periphearl eosinophilia)

+ Concentric rings in barium

+ fail tx with PPI, Improve on Steroids

Answer 15

Eosinophilic Esophagitis

Question 16

Answer 16

Eosinophilic Esophagitis - “Ringed Esophagus”

Question 17

Answer 17

Esophageal web

This thing is basically a ring (you never see posterior only web) caused by a thin mucosal membrane.

Question 18

risk factor for esophageal and hypopharyngeal carcinoma

Answer 18

Esophageal web

Question 19

Iron def anemia + Dysphagea + thyroid issues + “Spoon shaped nales”

Answer 19

Plummer - Vinson Syndrome

Question 20

Esophageal Pseudodiverticulosis is associated with these:

Answer 20

esophageal strictures (90%),
reflux, and
candidiasis.

Question 21

Answer 21

Tons of little tiny out- pouchings which aren’t really diverticula but instead dilated excretory mucosal ducts.

Question 22

“corkscrew” tertiary contractions favoring the distal esophagus.

Answer 22

Esophageal spasm

Question 23

Answer 23

“corkscrew” tertiary contractions favoring the distal esophagus.

Question 24

Answer 24

“nutcracker esophagus” requires manometric findings (>180mmHg).

Question 25

Syndrome refers to problems swallowing secondary to compression from:
an aberrant right subclavian artery (most patients with aberrant rights don’t have symptoms).

Answer 25

Dysphagia Lusoria

Question 26

If you get shown a big dilated esophagus, think about these 3 things

Answer 26

1. Achalasia
2. Pseudoachalasia
3. Scleroderma

Question 27

Motor disorder where
2/3 of the esophagus (smooth muscle part) doesn’t have normal peristalsis ( “absent primary peristalsis ”)

+ Lower esophageal won’t relax

=

Answer 27

Achalasia

Question 28

Answer 28

The esophagus will be dilated above a smooth stricture at the GE junction (Bird’s Beak).

Question 29

repetitive simultaneous non-propulsive contractions. It’s more common in women, but the secondary cancer occurs more in men.

Answer 29

Vigorous Achalasia

Question 30

Failure of the lower esophageal sphincter to relax + Increased risk of Candida

Answer 30

Achalasia

Question 31

The esophagus get paralyzed by some parasite transmitted by a fly.

Answer 31

Chagas disease

Question 32

has the appearance of achalasia, but is secondary to a cancer at the GE junction.

Answer 32

Pesudoachalaisa (Secondary Achalasia)

real Achalasia will eventually relax, the pseudo won’t

Question 33

The LES is incompetent and you end up with chronic reflux, which can cause scarring, Barretts, and even cancer (Adeno).

Answer 33

Scleroderma

Question 34

lower 2/3 of the esophagus stops working normally
+ lung changes (NSIP)
+ Small bowel with closely spaced valvulae conniventes

Answer 34

Scleroderma

Question 35

Answer 35

Varices

Linear often serpentine, filling defects causing a scalloped contour.

DDx:
Varicoid Carcinoma

Question 36

Varices Caused by portal hypertension

Answer 36

Uphill varicess

Question 37

Varices confined to bottom half of esophagus

Answer 37

Uphill varicess

Question 38

Varices caused by SVC obstruction (catheter related, or tumor related)

Answer 38

Downhill varices

Question 39

Varices Confined to Top Half of Esophagus

Answer 39

Downhill varicess