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CORE: GI > Esophagus > Flashcards

Esophagus Flashcards

(56 cards)

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1
Q

boundaries: nasopharynx, oropharynx, hypopharynx

A

Nasopharynx: Extends from the base of the skull to the soft palate.
Oropharynx: Located behind the mouth and extends from the uvula to the hyoid bone.
Hypopharynx: Extends from the hyoid bone to the cricopharyngeus muscle, which is located at the lower end of the cricoid cartilage.

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2
Q

cricopharyngeus muscle location

A

C5-C6

upper esophageal sphincter; pharynx vs cervical esophagus

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3
Q

diaphgragmatic hiatus for esophagus

A

T10

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4
Q

anatomic rings of distal esophagus

A

A: muscular
B: mucosal
C: diaphgragmatic impression

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5
Q

esophageal web

A

anterior infolding/indentation of upper esophagus; cause of dysphagia

association with anemia (Plummer Vinson syndrome) and upper esophageal carcinoma

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6
Q

Schatzi ring

A

focal narrowing of mucosal ring (B) of distal esophagus (intermittent dysphagia)

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7
Q

most sensitive study for schatzi ring

A

upper GI > endoscopy

focal circumferential constriction near GEJ, usually associated with hiatal hernia

do not allow passage of 12 mm tablet

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8
Q

ddx for circumferential esophageal constriction

A

focal striction, muscular esophageal ring (A ring); esophageal cancer, esophageal web (usually in cervical esophagus; rarely circumferential)

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9
Q

types of esophagitis

A

reflux, barret, infectious, medication, Crohn

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10
Q

peptic esophagitis

A

exposure of esophageal mucosa to acidic gastric secretions > ulcerations > strictures

seen with GERD, scleroderma, zollinger ellisen

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11
Q

reflux esophagitis on imaging

A

thickened distal esophageal folds

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12
Q

chronic esophagitis on imaging

A

scarring; smoothly tapered stricture above GEJ

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13
Q

barrett esophagus

A

metaplasia of squamous epithelium to gastric type adenomatous mucosa&raquo_space; esophageal carcinoma

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14
Q

imaging of barrett esophagus

A

featureless distal esophagus

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15
Q

infectious esophagitis types

A

candidiasis, herpes, CMV/HIV

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16
Q

esophageal vs herpes vs CMV/HIV esophagitis imaging

A

esophageal: shaggy, scattered plaque like lesions
herpes: discrete small ulcerations; scattered throughout esophagus
CMV/HIV: large flat ovoid ulcer

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17
Q

medication esophagitis

A

ulcer at aortic arch/distal esophagus (areas of relative narrowing)

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18
Q

crohn esophagitis

A

small bowel/colon, typically

apthous ulcers–discrete ulcers with mounds of edema may become confluent

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19
Q

stricture types

A

peptic, barret esophagus, malignant, caustic/NG, radiation, external compression

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20
Q

location of barrett esophagus

A

mid esophagus above metaplastic adenomatous transition; higher than peptic strictures since adenomatous tissue is acid resistant

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21
Q

shouldered margins with stricture

A

circumferential luminal narrwing by mass

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22
Q

caustic stricture

A

long, smooth, narow

1-3 months after caustic ingestion/NG tube placement&raquo_space; increased risk of cancer wiith long lag time (20 years)

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23
Q

radiations tricture

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A

long, smooth, narrow; spares GE junction

24
Q

amount of radiation to cause radiation stricture/time course of radiation stricture

Study These Flashcards
A

> 50 Gy

1-3 weeks after radiation therapy; strictures develop 4-8 months after

25
benign mesenchymal tumors
GIST, leomyoma, lipoma, hemangioma smooth round submucosal filling defect
26
size of esopageal adenomas
<1.5, resected endoscopically benign lesion with malignant potential
27
inflammatory polyp
enlarged gastric fold protruding into lower esophagus; usually associated with reflux
28
fibrovascular polyp
pedunculated mass of mesenchymal elements; no malignant potential (unlike adenomas) typically occur in cervical esophagus (regurgitation of fleshy mass)
29
esophageal varices
commonly due to portal hypertnesion uphill varices: portal HTN; distal esophagus (left gastric, periesophageal venous plexus) downhill varices: SVC obstruction, proximal esophagus (supreme intercostal veins, bronchial, inferior thyroid)
30
foregut duplication cysts
esophagus: squamous epithelium; posterior mediastinum (appears similar to leiomyoma on esophagram) bronchogenic: respiratory epithelium neurenteric cyst: associated with vertebral body anomalies
31
common location for bony vs meat foreign objects to get stuck
bony: cervical esophagus meat: GE junction
32
how long does food impaction raise concern for transmural ischemia
>24 hrs; transmural ischemia > esophageal perforation
33
esophageal carcinoma
SCC or adenocarcinoma SCC: upper/mid esophagus; smoking/alcohol, celiac, plummer-vinson, achalasia, HPV adenocarcinoma: distal esophagus/stomach; chronic reflux/Barrett esophagus
34
appearance of esophageal carcinoma
esophagram: plaque like lesion, polypoid lesion, focal wall irregularity ; stricture with shouldered edge/irregular contour varicoid appearance that does not change shape with peristaltic waves (unlike real varices)
35
common mets to esophagus
gastric, lung, breast; mediastinal mets from mid esophagus common
36
contraction wave types
primary: normal, physiologic wave initated by swallow secondary: norma, physiologic wave initiated by bolus tertiary: nonpropulsive contraction; no esophageal clearing
37
vigorous achalasia
less severe form; repetitive nonpropulsive contractions
38
achalasia; treatment
motility disorder; unable to relax due to abnormality of myenteric ganglia in Auerbach plexus treat: heller myomectomy
39
secondary achalasia
Chagas disease
40
complications of achalasia
esophageal cancer; candida infection from stasis
41
imaging appearance of achalasia
dilated esophagus with birds beak stricture at GE junction
42
pseudoachalasia
obstructing GE junction cancer
43
diffuse esophageal spasm
nonpropulsive esophageal contractions which cause corkscrew or shish kebab appearance
44
nutcracker esophagus
high amplitude contractions on manometry with chest pain; related to esophageal spasm
45
types of esophageal dierticula
pulsion diverticula, traction diverticula, zenker, KJ, pseudodiverticulosis
46
pulsion vs traction diverticula
pulsion: increased pressure; common in US traction: traction of adjacent structures; TB mediastinal adenopathy (RARE)
47
Zenker diverticula
failure of cricopharyngeus to relax > elevated hypopharyngeal pressure >> posterior protrusion hypertrophy of cricopharyngeus muscle treatment: myotomy cripharyngeus, diverticulopexy/diverticulectomy presentation: halitosis, aspiration, regurgitation of undigested food
48
KJ diverticulum
weakness below attachment of cricopharyngeus muscle; more often bilateral protrude anteriorly; seen on lateral view
49
pseudo Zenker
barium trapped in pharyngeal contraction wave
50
pseudodiverticulosis
multiple tiny outpouchings caused by dilated submucosal glands analogous to Rokitansky Aschoof sinuses of gallbladder smooth stricture
51
feline esophagus
normal variant; multiple transverse folds
52
aberrant right subclavian artery (normal left arch) on esophagus
travels posterior to esophagus; rarely produces dysphagia smooth indentation on posterior esophagus
53
scleroderma sophagus
excess collagen deposition >> lack of peristalsis in distal esophagus due to smooth muscle atrophy and fibrosis >> esophageal dilation secondary candidiasis/aspiration pneumonia can be seen before skin changes
54
types of esophageal hernias
hiatal vs paraesophageal hernia
55
hiatal hernia
gastric fold seen above diaphragm; sliding (common) or short (secondary to reflux)
56
paraesophageal hernia
GE junction below diphragm; stomach herniates through to chest more prone to strangulation

CORE: GI (9 decks)

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