Diseases Of The Oesophagus

Question 1

What are some diseases of the esophagus

Answer 1

GERD/Barrett’s esophagus
Achalasia
Hiatal hernia
Diverticula
Webs/rings
Varices
Mallory Weiss syndrome

Question 2

What are the triad in achalasia

Answer 2

Incomplete relaxation of the LES
Increases LES tore/pressure
Aperistalsis of the esophagus

Question 3

What is the cause of achalasia

Answer 3

Damage to the inhibitory ganglion cells of the esophageal myenteric plexus

Question 4

The primary cause of achalasia is ………..

Answer 4

Idiopathic

Question 5

What is the disease cause of the secondary cause of achalasia

Answer 5

Chagas’ disease (caused by T. cruzi)

Question 6

What is the etiology of Chagas’ disease

Answer 6

Destruction of the myenteric ganglion plexus cells of the GIT by T. cruzi

Question 7

Which disease could cause injury to the vagal nerve

Answer 7

Diabetes mellitus

Question 8

What is the presentation of achalasia

Answer 8

Dysphagia to both solids and liquids
Regurgitation
Retrosternal pain
Halitosis

Question 9

How is achalasia diagnosed

Answer 9

Barium swallow
Manometry
CXR

Question 10

What are the ways through which achalasia could be treated

Answer 10

Endoscopic pneumatic dilation
Heller myotomy
Pharmacological (nitrates, CCB, or botulinum)

Question 11

What is hiatal hernia

Answer 11

The abnormal protrusion of a portion of the stomach into the thoracic cavity through a lac diaphragmatic hiatus

Question 12

What are the risk factors of hiatal hernia

Answer 12

Advanced age
Smoking
Obesity
Pregnancy

Question 13

What are the treatments for hiatal hernia

Answer 13

Lifestyle modifications
PPI
Surgery (hiatoplasty)

Question 14

What are the two types of hiatal hernia

Answer 14

Sliding and rolling types

Question 15

Describe sliding hiatal hernia

Answer 15

GE junction and the gastric cardia slide up into the post mediastinum (hourglass stomach). It associates with GERD and ulcerations

Question 16

Describe the paraesophageal or rolling part of the gastric fundus

Answer 16

Part of the gastric fundus herniates into the thorax. GE junction stays in the anatomical position. It presents with early satiety and pain

Question 17

What is the most common type of esophageal diverticula

Answer 17

Zenker diverticulum

Question 18

Describe zenker diverticulum

Answer 18

A false diverticulum (outpouching) as it only contains the mucosa and submucosa

Question 19

Where does Zenker diverticulum occur

Answer 19

In the weak spot proximal to the upper esophageal sphincter (just above the cricopharyngeal muscle) in the Killian triangle (ie. pulsion type)

Question 20

What are some symptoms of an esophageal diverticulum

Answer 20

Dysphagia
Halitosis
Regurgitation
Retrosternal pain and pulmonary symptoms secondary to aspiration

Question 21

What are some other types of diverticula besides Zenker’s diverticula

Answer 21

Middle diverticulum (diverticulum at the trachea bifurcation. Traction type)
Lower diverticulum (epiphrenic diverticulum)

They are rare

Question 22

How are esophageal diverticula diagnosed

Answer 22

Barium swallowing or endoscopy

Question 23

What is the treatment for esophageal diverticula

Answer 23

Surgery

Question 24

What are esophageal webs

Answer 24

Thin protrusions of the esophageal mucosa into the lumen most often in the upper esophagus

Question 25

Which condition is associated with esophageal squamous cell carcinoma

Answer 25

Esophageal webs

Question 26

In what condition does esophageal webs occur in

Answer 26

Plummer- Vinson syndrome (severe iron deficiency anaemia, esophageal webs, atrophic glossitis)

Question 27

What are esophageal (Schatzki) rings

Answer 27

Circumferential narrowing of the lower esophagus. It can be congenital or acquired (Eg. congenital GERD) Causes dysphagia or rarely complete obstruction of the esophagus

Question 28

Mention some pathogens or other causes that could cause esophagitis

Answer 28

Candida (white or yellow adherent plaques - pseudomembranes) HSV-1 CMV Chemical esophagitis (caused by ingestion of a string acid or base, alcohol, hot drinks or heavy smoking) Medications (antibiotics or NSAIDs) Eosinophilic esophagitis Associated with atopy and allergic disorders (Eg. Food allergies)

Question 29

What are some presentations of esophagitis

Answer 29

Dysphagia Heartburn Food impaction

Question 30

What are esophageal varices

Answer 30

They are extremely dilated submucosal veins in the lower third of the esophagus (drained by the left gastric vein). Most commonly occurs as a consequence of portal hypertension (cirrhosis or portal vein thrombosis) and can lead to sudden onset of severe upper GI bleeding (hematemesis or melene) which could be fatal Mallory Weiss syndrome (longitudinal linear laceration or tear in the mucosa at the GE at the lower oesophagus) could also cause it

Question 31

What is Mallory Weiss syndrome associated with

Answer 31

Forceful repeated vomiting (Eg. Alcohol and bulimia) can lead to painful acute upper GI bleeding and in extreme case to Boerhave syndrome (spontaneous rupture of the esophagus results in mediastinitis and subcutaneous emphysema)

Question 32

Esophagitis could manifest in immunocompromised patients True or false

Answer 32

True

Question 33

Hourglass stomach is associated with what kind of condition

Answer 33

A sliding hiatal hernia

Question 34

What is Plummer-Vinson’s syndrome

Answer 34

Plummer-Vinson syndrome is defined by the classic triad of dysphagia, iron-deficiency anemia and esophageal webs

Question 35

What is Mallory-Weiss syndrome

Answer 35

A tear in the esophagus mostly found in the esophageal junction