Esophagus

Question 1

Dysphagia is usually painless and intermittent or progressive over years, limited to solid.

Is this associated with weight loss?

Answer 1

Plummer Vinson Syndrome

Yes, sometimes

Question 2

Plummer Vinson Syndrome risk of what cancers?

Answer 2

esophageal or pharyngeal squamous cell carcinoma

Question 3

Plummer Vinson Syndrome Treatment

Answer 3

iron supplementation

mechanical dilation.

Iron supplementation alone can resolve dysphagia in many patients

Question 4

Triad for Plummer Vinson Syndrome

Answer 4

of dysphagia, iron deficiency anemia,, and a cervical esophageal web

Question 5

Part of esophagus affected by espophageal webs

Answer 5

upper

Question 6

dysphagia and foul breath

Answer 6

Zenker Diverticulum

Question 7

Pathophyophysiology of Zenker Diverticulum

Answer 7

Impaired relaxation of cricopharyngeus(recurrent laryngeal) muscle during swallowing can lead to increased to increased pressure in distal pharynx This increased pressure can cause an outpouching of pharyngeal mucosa and submucosa through the muscle of the pharyngeal wall (false diverticulum) Develops above the upper esophageal sphincter

Question 8

Location of Zenker D.

Answer 8

Develops above the upper esophageal sphincter

Question 9

Esophageal Stenosis/Stricture presents with dysphagia for what substances? Is this ass. with weight loss?

Answer 9

Solids, benign causes are not. malignant causes are

Question 10

Compare etiology of Esophageal Stenosis/Stricture in Western vs. developing countries

Answer 10

Alkaline material accounts for most caustic ingestions in Western countries whereas injuries from acid are more common in some developing countries

Question 11

Describe benign esophageal strictures

Answer 11

Benign strictures involve narrowing of esophageal lumen due to fibrosis/scarring of esophageal mucosa, often with atrophy of muscularis propria

Question 12

Location of smooth muscle atrophy and fibrosis in progressive systemic sclerosis (PSS)/Scleroderma

Answer 12

distal two-thirds of the esophagus

Question 13

Infectious related to Esophagitis

Answer 13

HSV-1: punched out lesions vs CMV: linear lesions Human papilloma

Question 14

What do you see on this image?

What cancer is this pt at risk for?

What is the pathophysiology?

Answer 14

Bird beak sign for achlasia

Scc and adenocarcinoma

Failure of LES to relax due to loss of myenteric (Auerbach) plexus due to loss of postganglionic inhibitory neurons (which contain NO and VIP).

Manometry findings include uncoordinated
or absent peristalsis with high LES resting pressure􏰁progressive dysphagia to solids and liquids (vs obstruction—solids only)

Question 15

What do you see?

Answer 15

Zenker Diverticula

Question 16

esophagitis type?

Answer 16

CMV esophagitis

Question 17

What type of esphagitis?

Answer 17

rinnged esophagus

eosinophilic

Question 18

What is this?

Answer 18

Acute esophagitis

neutrophils in the submucosa as well as neutrophils infiltrating into the squamous mucosa

May sometimes see small numbers of eosinophils as well

Question 19

What is this?

Answer 19

barr esophThis is “typical” Barrett mucosa, because there is intestinal metaplasia (note the goblet cells in the columnar mucosa

Question 20

Answer 20

Malignant glands in adenocarcinoma arising from Barrett esophagus are shown

Esophageal Adenocarcinoma

Question 21

Same as E. Web but thicker and LOWER esophagus:

What is this associated with?

Answer 21

Schatski Ring:

Hiatal hernia