Surgical Esophageal Diseases

Question 1

is a false diverticulum; only the mucosa and submucosa herniate through the muscularis externa. This happens over the cricopharyngeus muscle, which acts as a shelf over which the sac hangs. When the patient swallows in an upright position, some food is trapped in the diverticulum.

Answer 1

Zenker

Question 2

is the failure of the lower esophageal sphincter (LES) to relax adequately AND weakened or absent peristalsis in the body of the esophagus during swallowing.

Answer 2

Achalasia

Question 3

ll achalasia types are caused by the loss of neurons in the _______________.

Answer 3

myenteric plexus, Generally, these neurons relax sphincters and coordinate peristalsis (contraction of smooth muscle, not sphincters).

Question 4

What will the barrium swallow test in achalasia show?

Answer 4

A barium swallow will reveal a “bird’s beak” appearance—aperistaltic distal esophagus causes dilation (the bird) and a hypercontractile LES causes a fixed and narrow lumen (the beak).

Question 5

are invaginations of the mucosa and submucosa of the esophagus into its lumen.

Answer 5

Webs (eccentric) and rings (concentric) are invaginations of the mucosa and submucosa of the esophagus into its lumen.

Question 6

How do we dx webs or rings in the esophagus?

Answer 6

Barrium swallow, confirm with endoscopy and biopsy

Question 7

How do we tx esophageal webs and rings?

Answer 7

They are treated with pneumatic dilation, the biopsy is done to rule out underlying malignancy, and surgery is almost never indicated.

Question 8

Schatzki’s ring

Answer 8

is a lower esophageal ring present at the GE junction. The ring is concentric (equal all around) and contains the squamocolumnar transition zone—where the epithelium changes from that of the esophagus (stratified squamous) to that of the stomach (simple columnar that invaginates into its lamina propria to form gastric glands).

Question 9

is a lower esophageal ring present at the GE junction. The ring is concentric (equal all around) and contains the squamocolumnar transition zone—where the epithelium changes from that of the esophagus (stratified squamous) to that of the stomach (simple columnar that invaginates into its lamina propria to form gastric glands).

Answer 9

Schatzki’s ring

Question 10

A condition characterized by the triad of dysphagia, upper esophageal webs, and iron deficiency anemia. Associated with glossitis and increased risk of esophageal squamous cell carcinoma. Most commonly presents in white women 40-70 years of age.

Answer 10

Plummer Vinson syndrome

Question 11

A superficial (mucosal and/or submucosal) esophageal tear, usually at the GE junction, that occurs after forceful vomiting. This causes bleeding from the small arteries in the submucosa. It will present as bright red emesis that resolves spontaneously

Answer 11

Mallory Weiss Tear

Question 12

is a full-thickness tear through all layers of the esophagus. It is most often iatrogenic (due to EGD or dilation) but can be caused by foreign objects (fish bone), retching repeatedly (Boerhaave’s syndrome), or cancer.

Answer 12

Esophageal perforation

Question 13

A transmural rupture of the distal esophagus as a result of a sudden increase in intraesophageal pressure. Usually caused by severe retching or vomiting (e.g., due to excessive alcohol consumption). Manifestations include severe, retrosternal chest pain and mediastinal and/or subcutaneous emphysema.

Answer 13

Boerhaave syndrome (spontaneous esophageal rupture)

Question 14

How do patients w/esophageal rupture tend to present?

Answer 14

Air, food, and oropharyngeal bacteria enter the mediastinum. The patient will be acutely ill, presenting with fever, leukocytosis, and air in the mediastinum—visualized on X-ray, auscultated as a crunching sound with each heartbeat (Hamman’s crunch), or felt as subcutaneous emphysema (“Rice Krispies” under the skin).

Question 15

What is the difference in dysphagia from achalasia vs cancer?

Answer 15

Cancer= solids first
Other= liquids first

Question 16

refers to how the cancerous esophagus behaves most similarly to the simple columnar epithelium that invaginates upon its lamina propria to form gastric glands in the stomach. The esophageal epithelium must undergo gastric metaplasia from stratified squamous epithelium (normal esophagus) to simple columnar epithelium that invaginates upon its lamina propria to form gastric glands.

Answer 16

Adenocarcinoma of the esophagus

Question 17

Iatrogenic injury can lead to what esophageal problem?

Answer 17

Transmural laceration/perforation,
present sick as shit

Question 18

Cancer in upper third of the esophagus

Answer 18

SSC

Question 19

Cancer in lower 2/3 of esophagus

Answer 19

adenocarcinoma

Question 20

Nonkareatinized squamous cell epithelium turning into simple columnar epitheliu that invaginates to form glands

Answer 20

metaplasia that forms barrett’s esophagus

Question 21

patient had a history of long-standing GERD that improved on its own then progressed to dysphagia, this would more likely be what esophageal cancer?

Answer 21

adenocarcinoma

Question 22

When you see retching or alcohol in a stem regarding the esophagus or an upper GI bleed, there are three diagnoses that you should entertain:

Answer 22

Boerhaave’s, Mallory-Weiss tear, and varices.

Boerhaave’s is the eponym for a transmural esophageal laceration, an esophageal perforation that presents not with bleeding but with air in the mediastinum and severe toxicity. Mallory-Weiss is the eponym for a superficial esophageal laceration, a nontoxic, self-limiting upper GI bleed. Any person with cirrhosis can develop esophageal varices, but in the context of binge drinking and vomiting, alcoholic cirrhosis with esophageal varices that have ruptured is a life-threatening emergency. These three conditions are often tested against one another.

Question 23

eponym for a superficial—mucosa and submucosa only—laceration of the esophagus, which presents as a self-limiting upper GI bleed, often preceded by lots of vomiting, usually from an alcohol binge (aka a weekend warrior) when written for licensing exams.

Answer 23

Mallory-Weiss tear

Mallory Weiss Weekend Warrior

Question 24

How do we work up Boerhaave’s syndrome?

Answer 24

“Been Heaving” Syndrome—Boerhaave’s, transmural esophageal laceration, esophageal perforation—the diagnostic pathway is to do a gastrografin swallow → chest CT with oral barium contrast if the swallow is negative →EGD if both are negative → surgery. If any test is positive, the correct answer will be surgery. If negative with a high index of suspicion, you can continue down the diagnostic pathway.

Question 25

Newborn with copious oral secretions and choking/coughing/vomitting with feeding. Dx can be confirmed by inserting NG tube which would encounter resistance at the proximal esophageal pouch.

Answer 25

Tracheoesophageal fistula with esophageal atresia

Question 26

Often seen in younger men (age 20-30), often associated with atopic conditions and classically presents with intermittent solid food dysphagia (meat, bread) that can be described as food sticking in the chest

Answer 26

Eosinophilic Esophagitis

Question 27

CHild with recurrent pneumonia, barium esophography revealing esophageal indentation at T3-T4, and food impaction intermittently is concerning for…

Answer 27

Vascular ring