Esophagus

Question 1

Numerate the anatomic and motor disorders of oesophagus?

Answer 1

1)Hiatal hernia include:
A-Axial or sliding hernia
B-paraesophageal or rolling  hernia
2)Achalasia include
Primary and secondary achalasia 
3)Lacerations (Mallory-Weiss Syndrome)
4)Varices

Question 2

Which type of hiatal hernia cause barrett oesophagus ?

Answer 2

Axial or sliding hernia

Question 3

Rolling hernia is constitutes 95% of hiatal hernia cases True/False?

Answer 3

False .The correct is

Axial hernia

Question 4

In which type of hiatal hernia a bell-shaped dilation forms?

Answer 4

Sliding hernia

Question 5

The cause of paraesophageal hernia is congenital True /False?

Answer 5

False .The correct is

The cause of this deranged anatomy is obscure

Question 6

What is meaning of achalasia ?

Answer 6

It means incomplete relaxation of lower oesophageal sphincter in response to swallowing

Question 7

Primary Achalasia occurs in Chagas Disease True/False?

Answer 7

False .The correct is

Secondary achalasia occurs in Chagas disease which is caused by Trypanosoma cruzi

Question 8

Explain how Trypanosoma cruzi cause secondary achalasia ?

Answer 8

By destruction of myenteric nerve plexus in oesophageal wall

Question 9

Laceration are longitudinal tears in pharyngoesophageal junction ?And why?

Answer 9

False .The correct is
In gastroesophageal junction
The presumed pathogenesis is inadequate relaxation in lower oesophageal sphincter during vomiting with stretching and tearing the esophagogastric junction at the moment of propulsive expulsion of gastric content

Question 10

Lacerations ,The tears always involve the Musclusa of gastroesophageal wall ?

Answer 10

False

Tears may involve the mucosa or may penetrate the wall

Question 11

NSAIDs therapy is given to stop bleeding in case of lacerations ?

Answer 11

False .The correct is

Supportive therapy and vasoconstrictive medications are given

Question 12

When varices does occur?

Answer 12

When portal venous blood flow in liver is impeded by cirrhosis

Question 13

Why Collateral bypass channels are formations ?

Answer 13

To provide a communication between portal and systemic systems

Question 14

In case of varices the portal venous blood is drain into IVC True/False?

Answer 14

False .The correct is

SVC

Question 15

Explain the collateral bypass mechanism

Answer 15

The portal blood flow is drain into coronary veins of stomach then into oesophageal plexus of sub-epithelial and sub-mucosal veins then to azygos vein and finally in SVC

Question 16

Varices appear as straight thin vessel True/False ?

Answer 16

False

are appeared as tortuous dilated veins

Question 17

Numerate the causes of Oesophagi-tis?

Answer 17

1) Prolonged gastric intubation
2) Ingestion of corrosive and irritant substances
3) Radiation and chemotherap
4) In some cases attributable to gastric reflux

Question 18

Oesophagi-tis include …..&…..

Answer 18

Simple hyperaemia &

Sever oesophagi-tis

Question 19

Barrett oesophagus is defined as replacement of oesophageal mucosa by gastric mucosa ?

Answer 19

False .The correct is
Intestinal mucosa (metaplastic columnar epithelium with goblet cell)

Question 20

How does healing of Barrett oesophagus does occur?

Answer 20

Healing is occur by re-epithelialisation of stem cell that present in wall.In the microenvironment of an abnormally low ph in distal part of oesophagus caused by acid reflux ,the cell differentiated in to columnar epithelium

Question 21

Why re-epithelialisation does occur ?

Answer 21

Due to the newly formed tissue is more resistant to injury caused by gastric contents reflux

Question 22

The parietal cell clinical significances of Barrett oesophagus is related to the development of adenocarcinoma True/False?

Answer 22

False .The correct is

Chief cell

Question 23

Describe the morphology of Barrett oesophagus ?

Answer 23

It may exists as an irregular dark pink colour tongues that extending up from gastro oesophageal junction

Question 24

Oesophageal carcinoma include …..&…..

Answer 24

1) squamous cell carcinoma (mostly in middle and upper two thirds)
2) Adenocarcinoma (distal third )

Question 25

What are the causes of Oesophageal carcinoma ?

Answer 25

Smoking,Alcohol abuse,hot and spicy food and drinks

Also there is strong association with human papilloma virus is noted in high-incidence areas

Question 26

Numerate the forms of oesophageal carcinoma tumour

Answer 26

1) Polypoid exudate masses that protrude into the lumen
2) Necrotising Cancerous Ulcerations that may extend deeply and sometimes erode into the respiratory tree or aorta
3) Diffusible infiltrative neoplasms that impart thickening and rigidity to the wall and narrowing the lumen

Question 27

Where Adenocarcinoma appear?

Answer 27

In the distal part(lower third)of oesophagus and may invade the gastric cardia

Question 28

Describe the form of Adenocarcinoma

Answer 28

Initially it appear as flat and raised patch on an otherwise intact mucosa ,they may latter develop into large nodular masses or exhibit deeply ulcerative or diffusely infiltrative features

Question 29

Who can we diagnose the cancer of oesophagus ?

Answer 29

By using imaging techniques and endoscopic biopsy

Question 30

Oesophageal cancer when is detected ?

Answer 30

When confined the mucosa or submucosa is amenable to surgical treatment