Esophagus

Question 1

Zenker’s Diverticulum - true or false diverticulum? Why?

Answer 1

False
- mucosa and submucosa herniate through the muscularis externa!

Question 2

What muscles pull the Zenker’s Diverticulum down and are beneath where it rests?

Answer 2

Cricopharyngeal muscles

Question 3

What are 4 symptoms of Zenker’s Diverticulum?

Answer 3

• Choking
• Trouble swallowing
• Regurgitation of UNdigested food
• Halitosis

Question 4

What are 4 symptoms of Zenker’s Diverticulum?

Answer 4

• Choking
• Trouble swallowing
• Regurgitation of UNdigested food
• Halitosis

Question 5

What is the diagnostic measure for Zenker’s Diverticulum?

Answer 5

Barium Swallow

Question 6

Treatment for Zenker’s Diverticulum?

Answer 6

Surgery to remove the diverticulum

Question 7

What causes Achalasia?

Answer 7

Loss of the myenteric plexus

Question 8

What occurs with Achalasia?

Answer 8

Loss of myenteric plexus
–> LES unable to relax
–> Absent peristalsis

Question 9

If the LES is tight and unable to relax with absent peristalsis, what is the likely diagnosis?

Answer 9

Achalasia

Question 10

What is a main symptom of Achalasia and where anatomically?

Answer 10

Retrosternal Dysphagia at the LES

Question 11

Achalasia presents with retrosternal dysphagia that is progressive how?

Answer 11

Liquids FIRST!! –> Then solids

Question 12

What is the diagnostic measure for Achalasia and what will be seen?

Answer 12

Barium swallow
= Bird’s beak (narrow LES, dilated esophagus)

Question 13

What is the treatment for Achalasia?

Answer 13

Heller Myotomy

Question 14

What is a possible complication when treating Achalasia with a Heller Myotomy?

Answer 14

Loosening the LES too much = GERD

Question 15

A superficial laceration in the esophagus is commonly called?

Answer 15

Mallory Weis tear

Question 16

What usually causes a superficial laceration?

Answer 16

Forceful vomiting

Question 17

What is the sign of a superficial laceration?

Answer 17

Self-limiting hematemesis

Question 18

If a person is still vomiting blood following a mallory weis tear, what do you do? If it has resolved?

Answer 18

Still vomiting blood –> EGD
If not –> supportive measures

Question 19

A transmural laceration/perforation of the esophagus is commonly called?

Answer 19

Boerhaave’s Esophagus

Question 20

What 2 things commonly cause a transmural laceration?

Answer 20

• Iatrogenic injury
• Prolonged wretching

Question 21

What are 4 possible signs of a transmural laceration?

Answer 21

• Chest pain
• Pneumomediastinum
• SubQ air
• Crunchy heart sounds (Hamman’s Sign)

Question 22

What are 4 possible signs of a Boerhaave’s transmural tear?

Answer 22

• Chest pain
• Pneumomediastinum
• SubQ air
• Hamman’s Sign (crunchy heart sounds)

Question 23

What are 2 ways to diagnose a transmural laceration?

Answer 23

1. Gastrograffin water soluble swallow study
2. CT with ORAL contrast

Question 24

What are 2 ways to diagnose a transmural laceration?

Answer 24

1. Gastrograffin water soluble swallow study
2. CT with ORAL contrast

Question 25

If a transmural laceration is contained, what is the treatment? If not?

Answer 25

Contained = Endoluminal stent If not = Surgery

Question 26

What is GERD?

Answer 26

Reflux of acid into the esophagus due to a hiatal hernia or a weakened LES

Question 27

List some symptoms of GERD?

Answer 27

- Burning chest pain - Metallic taste in the mouth - Regurgitation of partially digested food - Symptoms worse with spicy foods/lying down - Cough/nocturnal asthma

Question 28

Initial treatment for GERD?

Answer 28

Lifestyle/meal changes + PPI

Question 29

What is a possible surgical fix for GERD?

Answer 29

Fundoplication = wrapping stomach around LES to tighten it

Question 30

What study is needed before a Fundopolication can be done?

Answer 30

24 hour esophageal pH monitoring

Question 31

If GERD goes untreated what can develop?

Answer 31

Barrett's Esophagus

Question 32

What is Barrett's Esophagus?

Answer 32

Stratified squamous --> Simple Columnar

Question 33

If Barrett's esophagus occurs, what can then develop?

Answer 33

Esophageal Adenocarcinoma

Question 34

Where does Esophageal Adenocarcinoma occur?

Answer 34

LOWER 1/3

Question 35

If a cancer is in the lower 1/3 of the esophagus, what type is it?

Answer 35

Adenocarcinoma

Question 36

What are a few risk factors for Esophageal Squamous Cell Carcinoma?

Answer 36

- HPV - Smoking - Poverty - Hot liquids

Question 37

Where does Esophageal Squamous Cell Carcinoma occur?

Answer 37

UPPER 1/3

Question 38

If a cancer is in the upper 1/3 of the esophagus, what type is it?

Answer 38

Squamous Cell Carcinoma

Question 39

What is the shared presentation with Esophageal cancers?

Answer 39

Progressive dysphagia (solids --> liquids)

Question 40

How are Esophageal cancers diagnosed?

Answer 40

Barium swallow --> EGD with biopsy