GIT: Esophagus

Question 1

describe esophgeal atresia

Answer 1

• non-canalization of portion of esophagus (atresia/stenosis)

Question 2

esophageal atresia is commonly associated with ____

Answer 2

esophageal atresia is commonly associated with tracheo-esophageal fistula (TEF)

Question 3

list the clinical symptoms of esophageal atresia

Answer 3

• clinical symptoms:
  
  • excessive drooling of saliva
  • aspiration pneumonia
  • choking and cyanosis

Question 4

describe esophageal webs and rings

Answer 4

protrusions of mucosa into the lumen

• upper esophagus = webs
  
  • covered by squamous mucosa with vascularized core
• lower esophagus = Schatzi ring
  
  • undersurface have columnar epi.

Question 5

describe the triad seen in Plummer-Vinson syndrome (aka Kelly Patterson syndrome)

Answer 5

• triad:
  
  • iron deficiency anemia
  • esophageal webs
  • atrophic glossitis

Question 6

Plummer-Vinson syndrome has a high risk for ____

Answer 6

Plummer-Vinson syndrome has a high risk for squamous cell carcinoma of esophagus

Question 7

patients with Plummer-Vinson sydrome present with ____ and ____

Answer 7

patients with Plummer-Vinson syndrome present with koilonychia (spoon nails) and splenomegaly (compensation for iron def.)

Question 8

describe the treatment for Kelly Patterson syndrome

Answer 8

• treatment:
  
  • iron
  • endoscopic dilatation

Question 9

list the 3 main features of achalasia/cardiospasm

Answer 9

• 3 main features:
  
  • partial or incomplete relaxation of LES with swallowing
  • aperistalsis
  • increased resting tone of LES

Question 10

one of the 2 primary causes of achalasia is the loss of _____ of the LES

Answer 10

one of the primary causes of achalasia is the loss of intrinsic inhibitory innervation of the LES

Question 11

one of the primary causes of achalasia is the loss/absence of _____

Answer 11

one of the primary causes of achalasia is the loss/absence of ganglion cells in myenteric plexus

Question 12

list the causes of secondary achalasia (pseduoachalasia)

Answer 12

• Chagas disease (Trypanosoma cruzi)
• diabetic autonomic neuropathy
• infiltrative disorders: malignancy, amyloidosis, sarcoidosis
• spinal motor neurons: polio, surgical ablation
• Down syndrome
• autoimmune disease

Question 13

describe Mallory Weiss syndrome

Answer 13

• longitudinal mucosal tears at esophagogastric junction
• frequently in alcoholics after bout of severe retching
• inadequate relaxation of LES during vomiting
• hematemesis
• usually heals but sometimes fatal

Question 14

in Mallory Weiss syndrome, there are ____ at the esophagogastric junction

Answer 14

in Mallory Weiss syndrome, there are longitudinal mucosal tears at the esophagogastric junction

Question 15

Mallory Weiss syndrome is commonly seen in ___ after bouts of ____

Answer 15

Mallory Weiss syndrome is commonly seen in alcoholics after bouts of severe retching

Question 16

in Mallory Weiss syndrome, there is inadequate ____ of the ____ during vomiting

Answer 16

in Mallory Weiss syndrome, there is inadequate relaxation of the LES during vomiting

Question 17

list irritants that can cause esophagitis

Answer 17

• irritants:
  
  • alcohol
  • acids
  • alkalis

Question 18

list complications of reflux esophagitis

Answer 18

• complications:
  
  • bleeding
  • stricture
  • aspiration pneumonitis
  • Barrett esophagus & adenocarcinoma

Question 19

describe the image

Answer 19

reflux esophagitis with scattered intraepithelial eosinophils and mild basal zone expansion

Question 20

list 1 fungal and 2 viral causes of esophagitis

Answer 20

• fungal:
  
  • Candida
• viral:
  
  • Herpes simplex
  • CMV

Question 21

Barrett esophagus is replacement of esophageal ____ mucosa with metaplastic _____ with ____

Answer 21

Barrett esophagus is replacement of esophageal squamous mucosa with metaplastic columnar epithelium with goblet cells

Question 22

Barrett’s esophagus leads to an increased risk for ____; the risk is related to ____

Answer 22

Barrett’s esophagus leads to an increased risk for adenocarcinoma; the risk is related to the length of Barrett’s mucusa

Question 23

in Barrett’s esophagus screening with biopsy:

if there is no dysplasia, ____

if there is low grade dysplasia, ____

if there is high grade dysplasia, ____

if there is adenocarcinoma, _____

Answer 23

if there is no dysplasia, continue screening

if there is low-grade dysplasia, more frequent screening

if there is high-grade dysplasia, definitive therapy, resection or ablation

if there is adenocarcinoma, resection

Question 24

esophageal varices are caused by dilated tortuous veins in the ___ and ___ of the lower esophagus (and prox. stomach) and is associated with ____

Answer 24

esophageal varices are caused by dilated tortuous veins in the mucosa and submucosa of the lower esophagus (and prox. stomach) and is associated with portal HTN

Question 25

describe what is seen in the image

Answer 25

**esophageal** **varices**

Question 26

describe what is seen in the image

Answer 26

esophageal varices

Question 27

name diets that lead to higher risk of SCC

Answer 27

* diet * vit. deficiency * A, C, riboflavin, thiamine, pyridoxine * fungal contamination * high nitrite content

Question 28

list lifestyles that lead to a higher risk of SCC

Answer 28

* lifestyle: * alcohol * tobacco use * HPV

Question 29

list esophageal disorders that lead to a higher risk of SCC

Answer 29

* esophageal disorders: * long-standing esophagitis * achalasia * Plummer-Vinson syndrome

Question 30

list genetic changes that lead to higher risk for SCC

Answer 30

* genetics: * Celiac disease * ectodermal dysplasia (Tylosis)

Question 31

\_\_\_\_ is the precursor lesion for adenocarcinoma of the esophagus

Answer 31

**Barrett's esophagus** is the precursor lesion for adenocarcinoma of the esophagus