10.3 Esophagus

Question 1

Tracheoesophageal Fistula

Answer 1

Congenital defect that connects the esophagus and the trachea

Question 2

What is found with the proximal esophagus in TE fistula?

Answer 2

Esophageal atresia - blind pouch

Question 3

What are the 4 clinical features of TE fistula?

Answer 3

• Vomiting
• Polyhydramnios
• Abdominal Distension
• Aspiration

Question 4

Esophageal Web

Answer 4

Thin protrusion of esophageal mucosa in the upper esophagus that presents with dysphagia for poorly chewed food

Question 5

What is esophageal web associated with?

Answer 5

SCC of the esophagus

Question 6

Plummer-Vinson Syndrome

Answer 6

Manifestation of esophageal web with iron deficiency anemia, and beefy red tongue due to atrophic glossitis

Question 7

Zenker Diverticulum

Answer 7

Outpouching of the pharyngeal mucosa through an acquired defect in the muscular wall

Question 8

Where does Zenker diverticulum generally occur at?

Answer 8

Above the UES

Question 9

How can Zenker diverticulum present?

Answer 9

Dysphagia, obstruction and halitosis

Question 10

Mallory-Weiss Syndrome

Answer 10

Longitudinal laceration of the mucosa at the gastroesophageal junction due to severe vomiting (alcohol, bulimia)

Question 11

Boerhaave Syndrome

Answer 11

Rupture of esophagus leading to air in mediastinum and is a transmural tear - EMERGENCY

Question 12

How does Mallory-Weiss syndrome present?

Answer 12

Painful hematemesis

Question 13

What is the main cause of esophageal varices?

Answer 13

Portal HTN

Question 14

Esophageal Varices

Answer 14

Dilated submucosal veins in lower esophagus

Question 15

What are the clinical signs of esophageal varices?

Answer 15

Asymptomatic with risk of rupture with painless hematemesis

Question 16

What is the most common cause of death in cirrhosis?

Answer 16

Esophageal Varices

Question 17

Achalasia

Answer 17

Disordered esophageal motility due to inability to relax LES

Question 18

What is there dysphagia for in achalasia?

Answer 18

Solids AND liquids

Question 19

What is the cause of achalasia?

Answer 19

Damaged ganglion cells in the myenteric plexus - can be idiopathic or secondary to something like Chagas Disease

Question 20

What are the clinical features of achalasia?

Answer 20

• Dysphagia
• Putrid breath
• High LES pressure
• Bird beak sign with barium swallow

Question 21

What are patients with achalasia at increased risk of?

Answer 21

Esophageal SCC

Question 22

Gastroesophageal Disease (GERD)

Answer 22

Reflux of acid from the stomach due to reduced LES tone

Question 23

What are risk factors of GERD?

Answer 23

• Alcohol
• Smoking
• Obesity
• Caffeine

Question 24

What happens to the esophageal cells in GERD?

Answer 24

Metaplasia from non-keratinized stratified squamous cells to non-ciliated columnar cells with goblet cells

Question 25

Sliding Hiatal Hernia

Answer 25

Cardia of the stomach slides up into the area of the esophagus - associated with GERD

Question 26

Paraesophageal Hernia

Answer 26

Stomach rolls up next to the esophagus - bowel sounds in the lung

Question 27

What are the clinical features of GERD?

Answer 27

- Heartburn - Adult onset asthma - Damage to enamel of teeth - Ulceration of mucosa and submucosa

Question 28

What are the main complications of GERD?

Answer 28

- Strictures | - Barrett's Esophagus

Question 29

What is the most common esophageal carcinoma in the West?

Answer 29

Adenocarcinoma

Question 30

Barrett Esophagus

Answer 30

Metaplasia of the lower esophageal mucosa from stratified squamous to non-ciliated columnar with goblet cells

Question 31

What is the main complication of Barrett Esophagus?

Answer 31

Adenocarcinoma

Question 32

Esophageal Squamous Cell Carcinoma

Answer 32

Malignant proliferation of squamous cells and is the most common esophageal cancer worldwide

Question 33

What are the risk factors for esophageal SCC?

Answer 33

IRRITATION - Alcohol and tobacco - Hot tea - Achalasia - Esophageal web

Question 34

What is the prognosis of esophageal SCC?

Answer 34

Poor prognosis as they tend to present late

Question 35

Why would esophageal SCC present with hoarse voice?

Answer 35

Affects the recurrent laryngeal nerve