Esophageal Disorders & Neoplasms

Question 1

the loss of peristalsis in the distal 2/3 of the esophagus and impaired relaxation of the LES

Answer 1

achalasia

Question 2

a patient presents with steady worsening of dysphagia over months to years that started with solid foods and has progressed to liquids. they have substernal fullness/pain after eating and regurg while eating and for several hours after a meal. Dx?

Answer 2

achalasia

Question 3

what symptom warrants an upper endoscopy in a patient with achalasia?

Answer 3

dysphagia

Question 4

what would definitively diagnose a patient with achalasia?

Answer 4

esophageal manometry

Question 5

what would an esophageal manometry show if a patient has achalasia? (2)

Answer 5

absence of normal peristalsis
incomplete LES relaxation with swallowing

Question 6

what diagnostic may show food or fluid in the esophagus of a patient with achalsia?

Answer 6

chest xray

Question 7

what is the finding in a patient with achalasia if we do a barium swallow?

Answer 7

bird’s beak tapering of the distal esophagus

Question 8

what is the treatment of achalasia in low risk surgical patients? (2)

Answer 8

pneumatic balloon dilation
surgical myotomy

Question 9

what is the treatment of achalasia in high risk surgical patients?

Answer 9

botox injections

Question 10

narrowing of the esophagus with scar tissue, most commonly as a result of esophageal injury

Answer 10

esophageal stricture

Question 11

what is the most common risk factor for esophageal stricture?

Answer 11

chronic gastric reflux

Question 12

a patient presents with chronic heartburn with sudden improvement and worsening dysphagia of solid foods only. Dx? Tx (2)?

Answer 12

esophageal stricture

dilation
PPI post-dilation

Question 13

what is the diagnostic of choice of an esophageal stricture?

Answer 13

upper endoscopy

Question 14

what can be used before an endoscopy to limit the risk of perforation?

Answer 14

barium swallow

Question 15

what treatment can be used for refractory esophageal strictures during a 2nd dilation to reduce reoccurrence?

Answer 15

local steroid injections

Question 16

what treatment can be used if patients to continue to experience refractory strictures post steroid injection?

Answer 16

temporary plastic stent placement

Question 17

a non-full thickness esophageal laceration or tear

Answer 17

mallory-weiss esophageal tear

Question 18

what is the most common cause of mallory-weiss esophageal tear?

Answer 18

retching/vomiting

Question 19

a patient presents with vomiting (hematemesis, coffee-ground, blood), abdominal/chest/back discomfort. Dx?

Answer 19

mallory-weiss esophageal tear

Question 20

what symptom will be present in a patient with mallory-weiss esophageal tear if bleeding has been present for 12-72 hours?

Answer 20

black, tarry stools

Question 21

what is the gold standard diagnostic for mallory-weiss esophageal tear?

Answer 21

endoscopy

Question 22

what is the treatment for mallory-weiss esophageal tear?

Answer 22

resolves spontaneously

Question 23

what is the treatment for mallory-weiss esophageal tear if bleeding does not spontaneously resolve of if clinically significant?

Answer 23

endoscopic intervention

Question 24

what is the management for a patient with mallory-weiss esophageal tear that is actively bleeding and hemodynamically unstable? (2)

Answer 24

hospitalize
observe for 48 hours

Question 25

when do mallory-weiss esophageal tears usually heal?

Answer 25

within 48-72 hours

Question 26

when is rebleeding of a mallory-weiss esophageal tear most likely to reoccur?

Answer 26

within first 48 hours

Question 27

mucosa of the pharynx protrudes posteriorly through an inherently weak area at the pharyngoesophageal junction.

Answer 27

zenker diverticulum

Question 28

what is the natural area of weakness called in zenker diverticulum?

Answer 28

killian triangle

Question 29

what is the etiology of zenker diverticulum?

Answer 29

chronic increased pressure on an already weak area

Question 30

a patient presents with worsening dysphagia with coughing/choking sensation, halitosis, and regurgitation of food. Dx?

Answer 30

zenker diverticulum

Question 31

what is the 1st line of study for zenker diverticulum?

Answer 31

barium swallow

Question 32

what allows for a definitive diagnosis and treatment of zenker diverticulum?

Answer 32

upper endoscopy

Question 33

what is the treatment of choice for zenker diverticulum?

Answer 33

flexible endoscopic myotomy + diverticulectomy

Question 34

what are the 2 histological types of esophageal neoplasms?

Answer 34

squamous cell carcinoma adenocarcinoma

Question 35

what are the 2 most common risk factors for squamous cell carcinoma of the esophagus?

Answer 35

chronic alcohol tobacco

Question 36

what are the 2 most common risk factors for adenocarcinoma of the esophagus?

Answer 36

chronic gastric reflux barrett esophagus

Question 37

what is the most common esophageal neoplasm?

Answer 37

adenocarcinoma

Question 38

a patient presents with solid food dysphagia that has been progressively worsening over weeks to months, has odynophagia, weight loss, neck mass, and hoarse voice. Dx?

Answer 38

esophageal neoplasm

Question 39

what will be present in a patient's test if they have esophageal neoplasm?

Answer 39

+ fecal occult blood

Question 40

what gives the definitive diagnosis for esophageal neoplasm?

Answer 40

upper endoscopy + biopsy

Question 41

what is recommended to evaluate complex lesions suspected in esophageal neoplasms?

Answer 41

barium swallow

Question 42

what is the treatment for non-metastatic, localized tumors in the esophagus?

Answer 42

radiation + chemotherapy +/- surgery

Question 43

what is the treatment for distant metastasis from the esophagus?

Answer 43

palliative therapy