GI Section 1: Luminal (Esophagus)

Question 1

The muscular ring above the vestibule. Dynamic on swallow.

Answer 1

A ring

Question 2

The mucosal ring Below the vestibule. Not Dynamic.

Answer 2

B Ring

Question 3

This is a thin constriction at the GE junction

Answer 3

B ring

Question 4

What happens if narrowing of the B ring occurs? how narrow?

Answer 4

Symptomatic dysphagia (<13 mm)

Call in Schatzki ring

Question 5

Represents the squamocolumnar
junction (boundary between esophageal and gastric epithelium).

Answer 5

Z Line

Question 6

This is an endoscopy finding, and is only rarely seen as a thin serrated line.

Answer 6

Z Line

Question 7

The “true upper esophageal sphincter.”

Answer 7

Cricopharyngeus

Question 8

Loication of Zenker Diverticulum

Answer 8

Hypopharynx

Question 9

Location of Killian-Jamieson Diverticulum

Answer 9

Cervical Esophagus

Question 10

This muscle represents the border
between the pharynx and cervical
esophagus.

What is the typical level?

Answer 10

Cricopharyngeus

C5-C6

Question 11

When you swallow the larynx does two things:

Answer 11

1. It elevates
2. Moves anteriorly

Question 12

Reflux Esophagitis:

A common cause of fold thickening, which if left unchecked can cause some serious problems.

Behold the potential spectrum o f unchecked aggression ->

Answer 12

Question 13

This is a precursor to adenocarcinoma - that develops secondary to chronic reflux.

Answer 13

Barretts Esophagus

Question 14

Answer 14

Barrett’s - High Stricture + Hiatal Hernia

Question 15

“Reticular Mucosal Pattern

Answer 15

Barretts Esophagus

Question 16

Answer 16

Feline esophagus

fine transverse folds which course mid and lower esophagus.

*Folds are Transient (they go away with swallowing)
*Folds are ONLY in lower 2/5

Question 17

Consider esophageal cancer when you see this

Answer 17

“irregular contour”, and “abrupt (shouldered) edges. ”

Question 18

(+)drinker
(+)smoker
(+)alkaloid ingestion

Answer 18

Squamous cell CA

Question 19

+ stress = chronic reflux
+ history of PPI use
+ Hx of Barretts

Answer 19

AdenoCA

Question 20

+ Stricture/ulcer/mass in the MID esophagus

Answer 20

Squamous cell CA

Question 21

+ Stricture/ulcer/mass in the LOW esophagus

Answer 21

AdeoCA

Question 22

Critical Stage of Esophageal CA

Invasion

T3 =
T4 =

Answer 22

T3 = Adventitia
T4 = Adjacent Structures

T3 vs T4 is in the radiologists world - and therefore the most likely to be tested.

Question 23

Herniation o f the stomach comes in several flavors with the most common being?

Answer 23

The sliding type I (95%)
Rolling para-esophageal Type 2

Question 24

Gastric herniation Type 1 and Type 2 difference

Answer 24

The distinction between the two is based on the position of the GE junction.

Small type Is are often asymptomatic but do
have an association with reflux if the function of the GE sphincter is impaired.

the Para-E Type 2 - higher rate of incarcertion

Question 25

What is this Fundoplication ?

Answer 25

The gastric fundus is wrapped around the lower end of the esophagus and stitched in place, reinforcing the lower esophageal sphincter.

“Nissen” = 360 degree wrap
Loose = <360 wrap

Question 26

COmplication of fundoplication:

Answer 26

Esophageal obstruction or narrowing (post op edema or wrap made too tight)

Question 27

two main indications for Fundoplication

Answer 27

1. Hiatal Hernia
2. Reflux

Question 28

Failure of fundoplication =

Answer 28

Recurrence of Hiatal hernia and reflux (telescoping of GE junction through the wrap or “Slipped Nissen)

Question 29

Most common reason for recurrent reflux after fundoplication?

Answer 29

Slipped Nissen

Question 30

Mosct common reason for slipped Nissen?

Answer 30

Short esophagus

Question 31

WTF is a “short esophagus ” ?

Answer 31

“Hiatal Hernia that isfixed/non- reducible, and greater than 5cm ”

Question 32

How can you tell i f the wrap (Fundoplication) has slipped ?

Answer 32

Fundoplication wrap should have length of narrowed esophagus < 2cm (anything greater suggests a slipped wrap)

Question 33

What is the treatmentfor a “short esophagus” ?

Answer 33

Collis gastroplasty (lengthening + fundoplication).

Question 34

HIV/Transplant patient (immunocompromised + achalasia/scleroderma

Answer 34

Esophageal Candidiasis

Question 35

Answer 35

Esophageal Candidiasis

discrete plaque-like lesions

nodularity, granularity, and fold thickening as a resuU of mucosal inflammation and
edema.

When it is most severe, it looks more shaggy with an irregular luminal surface.

Question 36

epithelial collection of glycogen - but is known best as a mimic of candidiasis.

Answer 36

Glycogenic Acanthosis

Question 37

Multiple elevated benign nodules in the esophagus in an asymptomatic elderly patient

Answer 37

Glycogenic Acanthosis

Question 38

Answer 38

Esophgeal Herpes

Small and multiple with a halo of edema
{Herpes has a Halo)

Question 39

“Aphthous Ulcers” - (discrete ulcers surrounded by mounds of edema)

Answer 39

CROHN’s

Question 40

Answer 40

Esophageal (enteric) Duplication Cysts

Water density cyst in the posterior mediastinum

Most common location ? - The ileum

Either as an incidental in an adult, or if they are big enough - as an infant with dysphagia / breathing problems.